Managing HMB

Evana contains tranexamic acid, recommended by NICE as a first-line non-hormonal treatment option for HMB² 

Patients can be reassured that they don’t need to suffer in silence when there is a range of effective HMB treatments available. 

Non-hormonal treatment options for HMB²:

• The anti-fibrinolytic tranexamic acid, which is available OTC
• An NSAID – these have been shown to cut menstrual bleeding by up to 50%.¹² However, pharmacists should be aware that NSAIDs are not indicated for the treatment of HMB. ⁹ 

Hormonal treatment options for HMB (available on prescription) ²,⁹: 

• A levonorgestrel intrauterine system is the first-line hormonal treatment choice
• Combined hormonal contraception
• Cyclical oral progestogen (norethisterone) – this can suppress menstruation which can be of particular benefit to those with HMB.

Where these treatments are unsuccessful, surgical interventions may be a suitable option.²,⁹

When should you refer to a doctor?

The following patients with HMB should be referred to their doctor for further investigation if they⁹,¹¹:

• have severe pain during their period
• experience bleeding between periods or after sex
• experience pain when having sex, micturition or passing stools
• have a pelvic mass with unexplained bleeding or weight loss
• are over 55 years of age and experiencing post-menopausal bleeding
• have ascites (abnormal fluid collection in the abdomen) and/or pelvic or abdominal mass
• have iron deficiency anaemia that is not responding to iron supplementation
• have HMB that is not improving with OTC treatments.