A 42-year-old woman with a known 3 cm submucosal fibroid presents to the GP with worsening menorrhagia despite tranexamic acid and mefenamic acid. She...

Question

A 42-year-old woman with a known 3 cm submucosal fibroid presents to the GP with worsening menorrhagia despite tranexamic acid and mefenamic acid. She does not wish to conceive. A trial of the LNG-IUS was attempted but expelled twice. According to NICE NG88, which is the next most appropriate step?

Accepted Answer

Refer for hysteroscopic myomectomy as the submucous fibroid is likely causing LNG-IUS expulsion and contributing to her bleeding

Answer

Prescribe norethisterone 5 mg TDS cyclically

Answer

Try a third LNG-IUS insertion

Answer

Prescribe a GnRH agonist indefinitely

Answer

Refer for uterine artery embolisation

uk-drcog MCQ (SBA): Submucous Fibroid Causing LNG-IUS Expulsion

A 42-year-old woman with a known 3 cm submucosal fibroid presents to the GP with worsening menorrhagia despite tranexamic acid and mefenamic acid. She does not wish to conceive. A trial of the LNG-IUS was attempted but expelled twice. According to NICE NG88, which is the next most appropriate step?