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Heavy menstrual bleeding — DRCOG MCQ

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HardGynaecologyHeavy menstrual bleedingDRCOG

A 42-year-old woman has heavy regular periods affecting work. Pelvic examination is normal, pregnancy test is negative and full blood count shows mild iron deficiency anaemia. She wants treatment and contraception. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Offer a 52 mg levonorgestrel intrauterine device

NICE recommends a levonorgestrel intrauterine system as first-line treatment for heavy menstrual bleeding when there is no significant pathology or fibroids distorting the cavity, and it also provides contraception. Ablation and hysterectomy are later options after assessment and discussion. Tranexamic acid can help bleeding but does not provide contraception. The pearl is that treatment should improve quality of life and align with contraceptive needs.

Reference: NICE NG88; FSRH intrauterine contraception guideline