A 32-year-old woman has heavy menstrual bleeding for 6 months. Examination and ultrasound are normal and she wishes contraception. Which is first-line?
Answer and explanation
Correct answer: B. A levonorgestrel-releasing intrauterine system
- Step 1: NICE NG88 recommends LNG-IUS first when there is no structural cause and contraception is wanted.
- Step 2: It reduces bleeding and provides contraception.
Answer
A levonorgestrel-releasing intrauterine system.
Why not the others: Endometrial ablation: Ablation is for when drugs fail. Combined oral contraceptive pill only: The COC and other options are second line. Tranexamic acid and mefenamic acid taken together continuously: These drugs are used when LNG-IUS is unsuitable and not taken together as first choice.
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