ABSTRACT
As this woman is sexually active and has a raised BMI and has not explored medical management, initially medical management would be advised before embarking on surgery such as a hysterectomy or endometrial resection or ablation. The combined oral contraceptive pill is a recognized medical management for menorrhagia but would be contraindicated in this woman as she has a raised BMI and is a smoker. As she has a normal-size cavity within the uterus, a Mirena would be the best choice. NICE guidelines would recommend Mirena in the initial management of menorrhagia and as the woman is under the age of forty five and has regular periods, she would not need endometrial sampling before trying the Mirena. See Chapter 5, Gynaecology by Ten Teachers, 19th edition.
