Drugs central to NICE guide on heavy menstruation
Obtaining NICE guidance
Guidelines and technology appraisals issued
by NICE this week are available from the institute’s website
(heavy menstrual bleeding) |
Drug treatments form a central part of the National Institute for Health and Clinical Excellence guideline on the management of heavy menstrual bleeding (HMB), which was issued to the NHS in England and Wales this week.
The guideline recommends that when drug treatment is considered appropriate,
after examination and investigations have excluded certain causes of
HMB, the first choice should be a levonorgestrel-releasing intrauterine
system (providing long-term use is expected). The second option is to
use tranexamic acid, non-steroidal anti-inflammatory drugs or combined
oral contraceptives. The third option is norethisterone (15mg daily)
from days 5 to 26 of the menstrual cycle, or injected long-acting progestogens.
If hormonal treatments are not acceptable to the woman, tranexamic acid
or NSAIDs can be used.
The guideline makes it clear that a range of treatments should be discussed
before considering surgical operations such as hysterectomy and that
women should be provided with evidence-based information to help inform
their decisions. The guideline also states that if agreement on the choice
of treatment is not reached, a woman can obtain a second opinion.
NICE estimates that 6.5 per cent of all women aged 12 to 51 years have
heavy menstrual bleeding but that only 50 per cent of these women seek
help from their GP. The estimated overall cost once the guideline is
fully implemented is £8.2m. |
The
Pharmaceutical Journal
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