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Medical management options for heavy menstrual bleeding, as recommended by NICE, include: Levonorgestrel intrauterine system (LNG-IUS) : Often first-line treatment, reducing menstrual blood loss by up to 95% within 12 months Tranexamic acid : An antifibrinolytic agent taken during menstruation to reduce blood loss by 40-50% (caution if you have a history of blood clots) Non-steroidal anti-inflammatory drugs (NSAIDs) : Such as mefenamic acid, which can reduce flow by 20-30% and help with associated pain (use with caution if you have gastrointestinal, renal or cardiovascular conditions) Combined hormonal contraception : Can regulate cycles and reduce bleeding in suitable candidates Oral progestogens : Taken cyclically or continuously, depending on individual circumstances If you currently use a copper intrauterine device (IUD), this can contribute to heavier periods, and switching to a levonorgestrel IUS might be beneficial

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Blood samples were collected from the medial canthus using micro-hematocrit tubes