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Supply scenarios and case studies

Understanding  pharmacy  practice

The following case studies are designed to help your pharmacy team identify and support patients with HMB.

Case Study 1

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  • The patient has HMB and a regular menstrual cycle with two days of variability
  • Advise the patient to try Evana for three cycles to see if it is effective in reducing their HMB6
  • NICE guidance recommends NSAIDs, such as naproxen or ibuprofen, as the first-line treatment choice for period pain,19 therefore recommend a switch from paracetamol.

Case Study 2

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  • The patient has symptoms consistent with iron deficiency anaemia, likely due to their HMB. 
  • As they have a regular menstrual cycle with one day of variability, Evana can be recommended.6 
  • Advise the patient to take Evana for three cycles to see if it is effective in reducing their HMB.6 
  • NICE guidance recommends iron deficiency anaemia is treated with a daily tablet of oral ferrous sulfate, ferrous fumarate or ferrous gluconate that is continued for 3 months after the iron deficiency is corrected.3 Advise the patient that iron supplements can be purchased from pharmacy and that if their iron deficiency symptoms do not improve then they should see the doctor for further advice.9
  •  Also advise the patient to monitor their analgesic intake as taking analgesics for 15 days or more per month can cause medication overuse headache.20
  • In addition, advise the patient that codeine-containing analgesics should be taken for a maximum of 3 days, due to the risk of addiction.21 

Case Study 3

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  • The patient has HMB symptoms but the change in frequency and severity warrant further investigation from their doctor.
  • Evana is not a suitable treatment option as they are under 18 years of age and have an irregular menstrual cycle with a less than a 21-35- day cycle and more than 3 days of individual variability.6
  •  Naproxen can be recommended as an alternative NSAID to ibuprofen19 for long-lasting period pain relief.

Case Study 4

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  • The patient has diagnosed HMB and is being treated with a combined oral contraceptive.
  • Evana is not a suitable treatment option as its use is contraindicated in those taking oral contraceptives because of the increased risk of thrombosis.6 
  • Refer patient to their GP or if the NHS pharmacy contraceptive service is in place, the pharmacist may be able to resolve this and liaise with the GP.   

Case Study 5

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  • The patient has been taking Evana for the past three cycles and has not noticed any reduction in her menstrual bleeding.
  • On this basis, a further sale is inappropriate, and the woman should be referred to her doctor for further management advice.6 

Case Study 6

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  • The patient has been taking Evana for the past two cycles and is now experiencing visual disturbances.
  • This is likely to be related to their Evana use,6 rather than a migraine and the patient should be advised to stop taking the product and consult their doctor for further guidance on HMB management. 
Reporting of suspected adverse reactions

Healthcare professionals should report any suspected adverse reactions via the Yellow Card Scheme at https://yellowcard.mhra.gov.uk/  or search for MHRA Yellow Card in the Google Play or Apple App store.