# Uterine Fibroids - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Endocrine System 2024 (norethisterone monograph) · Egyptian National Drug Formulary 2024 — Endocrine System Drugs, Norethisterone (Norethindrone) monograph, Adult dosage regimen (endocrine.pdf, page index 125, printed p112) · Mefenamic Acid 500 mg film-coated Tablets SmPC sections 4.2 and 4.3 (eMC product 12503) · Mikes BA, Vadakekut ES, Sparzak PB. Abnormal Uterine Bleeding. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2025 Feb 21. Bookshelf ID: NBK532913; PMID: 30422508. · NICE Guideline NG88: Heavy menstrual bleeding: assessment and management 2018 · RCOG / SOGC Guideline on Management of Uterine Fibroids 2015 · Tranexamic Acid 500 mg Tablets SmPC section 4.2 (eMC product 14622) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary 2024 — Endocrine System Drugs, Norethisterone (Norethindrone) monograph, Adult dosage regimen (endocrine.pdf, page index 125, printed p112) - SmPC section 4.2, https://www.medicines.org.uk/emc/product/14622/smpc - Mikes BA, Vadakekut ES, Sparzak PB. Abnormal Uterine Bleeding. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2025 Feb 21. Bookshelf ID: NBK532913; PMID: 30422508. ## Treatment metadata - Tranexamic acid — 500 mg — oral.solid - Norethisterone — 5 mg — oral.solid ## Complete treatment card ```text UTERINE FIBROIDS Sources: Egyptian National Drug Formulary - Endocrine System 2024 (norethisterone monograph) · Egyptian National Drug Formulary 2024 — Endocrine System Drugs, Norethisterone (Norethindrone) monograph, Adult dosage regimen (endocrine.pdf, page index 125, printed p112) · Mefenamic Acid 500 mg film-coated Tablets SmPC sections 4.2 and 4.3 (eMC product 12503) · Mikes BA, Vadakekut ES, Sparzak PB. Abnormal Uterine Bleeding. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2025 Feb 21. Bookshelf ID: NBK532913; PMID: 30422508. · NICE Guideline NG88: Heavy menstrual bleeding: assessment and management 2018 · RCOG / SOGC Guideline on Management of Uterine Fibroids 2015 · Tranexamic Acid 500 mg Tablets SmPC section 4.2 (eMC product 14622) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (12) - Presentation varies with the number, size and position of the fibroids, from silent to disabling - Most have no symptoms; roughly 25% to 30% have symptoms bad enough to warrant treatment - Symptoms shift over time as fibroids grow, degenerate, calcify or bleed - The usual picture is abnormal bleeding, pelvic pain or pressure, passing urine often, constipation, infertility and anaemia from blood loss [abdominal pain · anaemia · bleeding · constipation · infertility · pelvic pain] - Pain may be period pain, pain on intercourse, or continuous pelvic pain [abdominal pain · painful intercourse · painful periods · pelvic pain] - Bleeding may be abnormal in amount, in timing, or in both [bleeding] - Fibroids just under the lining cause heavy bleeding even while small [bleeding] - Bulky fibroids on the outer surface press on neighbouring organs instead - Large front-lying fibroids give pelvic pressure and bladder symptoms; back-lying ones give constipation and low back pain [back pain · constipation] - Some present with infertility, depending on where the fibroid distorts the anatomy [infertility] - Half to seven in ten women have them by the menopause, and more than eight in ten Black women - Red flag: they raise the risk of repeated miscarriage, preterm labour, a badly sited placenta, caesarean birth and bleeding after delivery [postpartum haemorrhage] SIGNS - what you find (7) - Do a speculum and bimanual examination to look for vaginal and cervical disease and size the uterus - Bimanual examination may find a big, bulky uterus with an irregular outline - Mostly posterior fibroids give fullness behind the uterus with the cervix pushed forward - Small fibroids within the wall or under the lining may leave the uterus feeling normal - A normal examination settles nothing; a suggestive history still earns further evaluation - Look for anaemia as well, such as pale conjunctivae [anaemia · pallor] - They arise from the muscle of the uterus and are driven to grow by circulating oestrogen TESTS (10) - Transvaginal ultrasound is the best first test when fibroids are suspected - Below a 10-week uterine size it detects them with 95% to 100% sensitivity - On ultrasound they are well-defined, concentric, dark masses that cast a shadow - Calcification or dead tissue inside changes how the fibroid reflects sound - Saline infusion sonohysterography fills the cavity and shows lesions that distort it - MRI shows size and position best, but cost keeps it off the first line - MRI helps plan surgery by mapping anatomy, blood supply, degeneration and depth into the muscle - MRI cannot reliably separate a benign fibroid from a leiomyosarcoma - With heavy or abnormal bleeding in reproductive years, start with beta-hCG, a blood count, TSH and prolactin - Take an endometrial biopsy where cancer risk factors exist: obesity, chronic anovulation, older age IF NOT THIS - what else fits (8) - Structural causes of abnormal bleeding: polyps, adenomyosis, fibroids and malignancy - Non-structural causes: a clotting disorder, ovulatory dysfunction, endometrial dysfunction, iatrogenic and unclassified - Adenomyosis frequently coexists and also gives a large uterus, heavy bleeding and period pain - On imaging a fibroid is well-defined whereas an adenomyoma has indistinct borders - Adenomyosis also shows uneven muscle thickness, patchy myometrium, cysts and linear striations under the lining - Adenomyosis on its own rarely causes mass effect or major bulk symptoms - Leiomyosarcoma looks almost identical: abnormal bleeding with a rapidly enlarging uterus - Nothing but biopsy separates them, so suspect sarcoma after the menopause, or with a solitary outer-surface mass, rapid growth, or patchy T2 signal on MRI Source StatPearls "Uterine Leiomyomata" - disease-level clinical article Status traced to the source above 1. TRANEXAMIC ACID [1st line] Adult Local fibrinolysis: 15-25 mg/kg PO 2-3 times daily (or 1000-1500 mg PO TID). Menorrhagia: 1000 mg (2 tabs) PO TID up to 4 days (max 4 g/day). x 3-4 days per menstrual cycle during heavy flow Peds Calculated according to body weight at 25 mg/kg per dose. Source SmPC section 4.2, https://www.medicines.org.uk/emc/product/14622/smpc Why Antifibrinolytic that reduces menstrual blood loss by inhibiting plasminogen activation and clot breakdown at the endometrial surface; first-line non-hormonal treatment for the heavy bleeding caused by uterine fibroids, without shrinking the fibroids themselves. Caution First-line non-hormonal treatment to reduce heavy menstrual bleeding associated with uterine fibroids. Contraindicated in active thromboembolic disease (DVT, PE) or history of venous/arterial thrombosis. Does not reduce fibroid size; treats symptomatic menorrhagia only. Contraindicated in severe renal impairment because of risk of accumulation. Contraindicated in patients with a history of convulsions. Egypt TREXAM 500 MG 20 TABS. MEMPHIS 24.00 EGP (1.20/unit) TRANEX 500 MG 30 TABS. EGPI > ABBOTT 117.00 EGP (3.90/unit) KAPRON 500 MG 20 F.C.TABS. AMOUN 110.00 EGP (5.50/unit) SAVIBLEED 500 MG 20 F.C.TABS. MARCYRL PHARM... 110.00 EGP (5.50/unit) 2. NORETHISTERONE [2nd line] Adult Acute bleed: 20 mg by mouth three times daily for 7 days (StatPearls, Abnormal Uterine Bleeding NBK532913, acute AUB progestin-only option). The Egyptian National Drug Formulary gives 5 mg by mouth three times daily for 10 days for the same indication, with bleeding usually stopping within 48 hours. Then, to prevent recurrence: 5 mg by mouth twice daily from day 19 to day 26 of each of the next two cycles (Egyptian National Drug Formulary). x 7 days for the acute course (StatPearls) or 10 days (Egyptian formulary), then the day 19 to day 26 course in each of the two following cycles Peds The monograph's dosage regimen is headed "Adult" only; it lists no paediatric dose. Source StatPearls, Abnormal Uterine Bleeding (NBK532913), acute AUB progestin-only option (lead); Egyptian National Drug Formulary - Endocrine System Drugs 2024, norethisterone (norethindrone) monograph (endocrine.pdf page index 125, printed p112) Why Oral progestogen used cyclically to control heavy menstrual bleeding and dysmenorrhoea in fibroids by stabilising the endometrium; an alternative to tranexamic acid, and must not be combined with it. Caution The two sources disagree four-fold on the acute dose: StatPearls gives 20 mg three times daily for 7 days, the Egyptian formulary 5 mg three times daily for 10 days. The international figure leads here per the app's source policy; both are printed. Check blood pressure and liver function, and evaluate bleeding that persists or is severe. Contraindicated in pregnancy, in current or past deep vein thrombosis or pulmonary embolism, in active or recent arterial thromboembolic disease, in hepatic impairment or disease, and in known, suspected or past breast cancer. Undiagnosed abnormal genital bleeding is a contraindication: evaluate the bleeding before treating it. This controls the bleeding, not the fibroid — uterine fibroids are not among the monograph's listed indications. Never with tranexamic acid. The Egyptian formulary's norethisterone monograph lists that combination under Risk X - avoid, not merely monitor - and both drugs are offered in this entry. Side effects include fluid retention, bloating, weight gain, mood changes, and breast tenderness. Refer to gynecology if fibroids exceed 3 cm, cause pressure symptoms, or if heavy bleeding persists despite medical therapy. The formulary's regimen for heavy or dysfunctional bleeding is 5 mg three times daily for 10 days, with bleeding usually stopping inside 48 hours; it also lists 5 mg twice daily on days 19 to 26. Contraindicated in severe pruritus or pemphigoid gestationis during past pregnancy. Egypt CIDOLUT NOR 5 MG 20 TABS. CID 36.00 EGP (1.80/unit) CIDOLUT NOR 5 MG 30 TABS. CID 57.00 EGP (1.90/unit) STERONATE 5 MG 20 TABS. HI-PHARM 56.00 EGP (2.80/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)