TREATMENT PLAN, REFERRAL CRITERIA, KEY INFORMATION & EXTRAS
TREATMENT PLAN
Conservative:
- LNG-IUD (Mirena 52mg) – first line Medical:
- Tranexamic acid
- NSAIDs
- Combined hormonal contraceptives
- Cyclical progesterone
Surgical (if conservative/medical treatments fail):
- Refer to gynaecology for:
- Embolisation
- Ablation o Myomectomy
o Hysterectomy
Interim treatment for large fibroids (>3cm):
- Tranexamic acid
- NSAIDs
REFERRAL CRITERIA
- Routine:
- IDA + failing treatment & other causes excluded o Complications/compression symptoms from large fibroids o Dyspareunia, pelvic pain o Uterine, bowel &urinary symptoms
- Urgent:
- IDA with ascites
- Pelvic/abdominal mass (not fibroid)
- 2-week cancer referral:
- Pelvic mass with cancer symptoms/features
- Postmenopausal bleeding (>55 years, no obvious cause)
KEY INFORMATION
- LNG-IUD first-line treatment
- Investigate the underlying causes
- Refer if symptoms persist or suspicious features are present
EXTRAS
- Pelvic examination is not required for asymptomatic menorrhagia with fibroids <3cm or adenomyosis.