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Other Information for Doctors


How heavy? How often sanitary pad/tampon needs to be changed? Heavy for how many days?

Any symptoms of anaemia?Any intermenstrual bleeding to suggest endometrial pathology?

Pelvic Examination:
Pelvic mass, tenderness

Speculum exam: cervical lesions, pap smears

FBC, Fe studies, TFT, Coag
TVUS looking for:
Endometrial issues: hyperplasia
Intracavitory lesions: Polyps or fibroids
Wall lesions: fibroids, adenomyosis

Medical Therapy:
Tranexamic Acid (Cyklokapron)
Action: Antifibrinolytic
Dose: 500mg x 2 QID (100)
Indication: HMB (consider alternative if not effective after 3 cycles)
CI: History or risk of arterial or venous thromboembolic disease
Caution: concomitant use with COCP
SE: Nausea, vomiting, dizziness, Visual disturbance, seizure

NSAID (eg Ponstan Mefanamic Acid)
Action: Inhibits Prostaglandin synthesis

Dose: 250mg x2 TDS
Note: Not as effective as TA or Progestogen

Progestogen (Primolut N 5mg 30)
Action: Stablise endometrium, inhibits tPA, enhances vasoconstriction
To arrest acute HMB: 5mg tds x 10 day
Cyclically: 5mg daily day 5-25
Continuously: 5mg BD for 4-6 months
CI: History or risk of arterial or venous thromboembolic disease
SE: breast tenderness, acne, weight gain. bloating, moodiness, migraine

Combined Oral Contraceptive Pills(COCP)
Action: Stabilise lining of uterus, suppress cyclical hormone changes, prevent mid cycle oestrogen surge.
CI: thromboembolic risks: Obesity, Hypertension, smoking
Caution: Monitor fibroid growth
Note: No specific studies that OCP reduces HMB in fibroids or adenomyosis.

Progesterone-releasing IUD (Mirena)
Action: endometrial atrophy
Caution: Submucosal fibroid: bleeding due to friction, difficult to insert or expulsion.
SE: similar to oral progestogen; continuous spotting or bleeding.

1.Medical management of heavy menstrualbleeding, Jacqueline A Maybin,, Hilary OD Critchley, Womens Health (2016) 12(1), 27–34
2. Available management options for heavy menstrual bleeding, Prescriber ,19 September 2014

Additional information for Referring Doctors by Dr Eisen Liang, Fibroid Embolisation Specialist, 

UFE Factsheet for referring doctors

UFE Patient Information Brochure

UFE FAQs from referring doctors

Australian Doctor : How to Treat Fibroids

Liang ANZJOG UFE Audit Paper 2012

Adenomyosis Review 2018

Management of HMB 2019

Links to reference materials


View fact sheet for patients here

View fact sheet for GP here

View fact sheet for medical writers here


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