Reproductive Health
Prescribing Guidelines by Clinical Area
Patient Resources
- Useful Links | Musculoskeletal Physiotherapy Service | Somerset NHS
- Booklets | POGP Pelvic, Obstetric and Gynaecological booklets from Pelvic, Obstetric and Gynaecological Physiotherapy, a UK-based Professional Network of the Chartered Society of Physiotherapy.
Menstruation
NICE CKS: Dysmennorrhoea: Management - Primary Dysmennorhoea
First line: self-care
Offer an NSAID unless contraindicated. Ibuprofen first line if suitable, naproxen may be considered
Paracetamol can be used if NSAIDs are contraindicated or not tolerated, or in addition to an NSAID if the response is insufficient
If the woman does not wish to conceive, consider prescribing a 3–6 month trial of a hormonal contraceptive as an alternative treatment if appropriate - see NICE CKS for more information.
Consider recommending the following non-drug measures (in addition to drug treatments) to help reduce pain:
- Local application of heat (for example, a hot water bottle or heat patch)
- Transcutaneous electrical nerve stimulation (TENS) — set to a high frequency
Provide patient information on dysmenorrhoea. For example:
- The NHS website (www.nhs.uk) has patient information on Period pain.
- The Women’s Health Concern (WHC) website (www.womens-health-concern.org) has a leaflet on Period pain.
If symptoms are severe and do not respond to initial treatment within 3–6 months, or if there is doubt about the diagnosis, refer to a gynaecologist.
Red flags can be found in the NICE CKS: Dysmenorrhoea: Management - Secondary Dysmenorrhoea
From age 12 years onwards
From NICE CKS- Management of premenstrual syndrome.
Management of PMS should be tailored to the severity and type of symptoms, the person's treatment preferences, and any desire to become pregnant. There are no formal criteria available for defining mild, moderate, or severe PMS; severity is usually based on clinical judgement after considering the woman's perception of symptom severity, the impact of symptoms on the woman's quality of life, and the presence or absence of distress or impairment of socioeconomic function.
See NICE CKS: Management | Premenstrual syndrome for management information
Premenstrual Syndrome, Management (Green-top Guideline No. 48) | RCOG
A very small number of women get a severe form of Premenstrual Syndrome, known as Premenstrual Dysphoric Disorder (PMDD). PMDD is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Symptoms should be present at most menstrual cycles and improve at the onset of menses. Symptoms can range from emotional to physical and behavioural, significantly affecting life during the luteal phase of the cycle.
While many people women may experience symptoms of PMS, in women with PMDD these symptoms are much worse and can have a serious impact on their life. Experiencing PMDD can make it difficult to work, socialise and have healthy relationships and can lead to depression and suicidal feelings.
People with PMDD could benefit from a tailored contraception regimen including a continuous regimen, more information can be read in the FSRH Clinical Guideline: Combined Hormonal Contraception (January 2019, Amended October 2023) - Faculty of Sexual and Reproductive Healthcare
For more information on treatment options for Severe PMS see the NICE Scenario: Management of premenstrual syndrome
Premenstrual Syndrome, Management (Green-top Guideline No. 48) | RCOG
Mind: Self-care for PMDD may be helpful, particularly whilst keeping a symptom diary & awaiting a diagnosis
Information can be found:
Polycystic ovary syndrome | Health topics A to Z | CKS | NICE
Long-term Consequences of Polycystic Ovary Syndrome (Green-top Guideline No. 33) | RCOG
Patient information from the Royal College of Obstetricians and Gynaecologists Polycystic ovary syndrome (PCOS): what it means for your long-term health | RCOG
Endometriosis
Please see the Somerset Pain Management - NHS Somerset ICB page for information on chronic pain relief in endometriosis- please note, there are some differences to management of chronic pain, and long term endometrial pain.
Recommendations | Endometriosis: diagnosis and management | Guidance | NICE
Note if using NSAIDs for pain relief, stomach protection in the form of proton pump inhibitors (PPIs) should be offered.
Sexual Health and Sexually Transmitted Infections (STIs)
See the joint NHS Somerset Formulary for our formulary position on treatments for erectile dysfunction.
From 1st October 2025, tadalafil and vardenafil no longer require prescriber endorsement with "SLS" this is already the case for sildenafil.
See the current Drug Tariff | NHSBSA Part XVIIIB for prescribing guidance and patient eligibility for generic treatments on formulary. (Information can also be found on endorsement requirements for brands- please note Cialis®, Viagra® and Levitra® require prescriber SLS endorsement and are non-formulary, where clinically indicated, these medications should be prescribed generically follow formulary guidance ).
Urinary Incontinence, Vaginal Atrophy, Prolapse and Pelvic Health
See the Somerset Infection Management Guidance for information on recurrent urinary tract infections and urogenital atrophy treatment options.
See the Local Estrogen - NHS Somerset ICB page for information on local estrogen use for vaginal atrophy symptoms in peri- or post- menopause.
See formulary page for pharmacological treatments.
Ensure that the anticholinergic burden (ACB) of medication is taken into account and deprescribe in unsuitable patients. See the Deprescribing - NHS Somerset ICB page for more information on ACB, and other prescribing resources.
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