How does menorrhagia, fibroids, or previous ectopic pregnancy influence choice?
• Women with idiopathic menorrhagia: • Methods that can be used without restriction: combined oral contraceptives (COCs), combined contraceptive patch, combined contraceptive vaginal ring, and the levonorgestrel-releasing intrauterine system (IUS), which all may reduce menstrual blood loss; sterilization. • Methods that can generally be used (advantages generally outweigh the risks): progestogen-only pill (POP), progestogen-only injectables and implants, copper intrauterine devices (IUDs), the levonorgestrel-releasing IUS (continuation of use), barrier methods, and natural family planning methods (if the cycle is regular; if the cycle is irregular, a new user would find it more difficult to learn the method). • Consider: • The levonorgestrel IUS (Mirena®) as the first-line option (licensed indication). • The COC as the second line option. • The POP and progestogen-only injectables as third line options. • For information on non-contraceptive treatments, see the CKS topic on Menorrhagia
