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Menorrhagia (heavy menstrual bleeding) - Management
Basis for recommendation
These are pragmatic recommendations by the CKS, based on standard clinical practice. They are consistent with the clinical guideline on Heavy menstrual bleeding, published by the National Institute for Health and Clinical Excellence (NICE) [National Collaborating Centre for Women's and Children's Health, 2007].
- NICE recommends on the basis of consensus opinion that 'when a first pharmaceutical treatment has proved ineffective, a second pharmaceutical treatment can be considered rather than immediate referral to surgery'.
- NICE does not make any recommendations on combining treatments, nor is there evidence from controlled trials on the effectiveness of combining treatments. Nevertheless, this is often done in practice and anecdotal evidence suggests that it can be beneficial. For further information on which treatments can be combined, see When to combine treatment.
- Further treatment options, including referral, are available from specialist management in secondary care.
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