CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Menorrhagia (heavy menstrual bleeding) - Evidence
Comparative efficacy of drugs in primary care at reducing blood loss
- Table 1 shows the relative effectiveness of pharmacological treatments in reducing menstrual blood loss.
Table 1. Summary of evidence base for pharmacological interventions in menorrhagia.
Treatment | Reduction in blood loss (%) | Source of evidence | Additional comment |
|---|
Levonorgestrel-releasing intrauterine system | 71–90 | Several high-quailty RCTs | Compared favourably with other treatments in head-to-head trials in terms of effectiveness and patient satisfaction |
Tranexamic acid | 29–58 | Several high-quality RCTs | No long-term outcomes have been reported |
Nonsteroidal anti-inflammatory drugs | 20–49 | Several high-quality RCTs | Mefenamic acid most effective, ibuprofen significantly less effective Also effective treatment for menstrual pain |
Combined oral contraceptive | 43 | One small RCT (n = 45) | Other benefits including regulation of cycles and reduction in breast pain |
High-dose oral progestogen* | 83 | One small RCT (n = 44) | Not as effective or preferred as the levonorgestrel-releasing intrauterine system Requires long-term use |
Long-acting progestogen | 22–47† | No direct evidence from RCTs | Data extrapolated from large trials of women requiring long-term contraception |
Danazol | About 50 | Several high-quality RCTs | Use limited by frequent, clinically significant adverse effects |
Etamsylate | About 13 | Several high-quality RCTs | Least effective treatment for menorrhagia |
RCT = randomized controlled trial * Use in both the follicular and luteal phases. Use in the luteal phase only is ineffective. † Figure relates to the proportion of women with amenorrhoea after 1–2 years of use with depot medroxyprogesterone acetate. |
|
© NHS Institute for Innovation and Improvement