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Menorrhagia (heavy menstrual bleeding) - Management
Basis for recommendation
These pragmatic recommendations are based on national formularies [BNF 53, 2007], data sheets [ABPI Medicines Compendium, 2006], the available medical literature [Rees, 2003], and expert opinion [Rees, Personal Communication, 2007].
- There is no strict definition on what constitutes very heavy bleeding. It ranges from prolonged, heavy menstruation to acute periods of exceptionally heavy bleeding that is difficult to control using sanitary products. In these cases, the woman may desire acute treatment to rapidly stop the bleeding.
- CKS could not find any controlled trials that investigated the use of drugs to stop acute and exceptionally heavy menstrual bleeding, but oral progestogens are usually used for this purpose.
- The licensed dose of norethisterone to arrest uterine bleeding is 10–15 mg per day [ABPI Medicines Compendium, 2006; BNF 53, 2007]. This should be adequate in most cases; if the higher dose regimen of oral norethisterone (i.e. 30 mg per day) is considered necessary, informed consent should be sought before starting treatment.
- However, a higher (off-license) dose of norethisterone may be required for rapid cessation of bleeding if the bleeding is exceptionally heavy (flooding) [Rees, Personal Communication, 2007].
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