Clinical recommendation	Evidence rating	References	Comments
Adolescents with excessive uterine bleeding should be evaluated for bleeding disorders, such as von Willebrand disease.	C	4, 6, 15	Consensus guidelines
Saline infusion sonohysterography is more sensitive and specific for the detection of endometrial abnormalities than transvaginal ultrasonography.	C	21, 22	Meta-analysis and a small prospective comparison trial
The levonorgestrel-releasing intrauterine system (Mirena) is an effective treatment for menorrhagia, with patient satisfaction scores similar to endometrial ablation and hysterectomy.	A	35, 44	Cochrane review and randomized trial
NSAIDs are effective in reducing heavy menstrual blood flow. There is no evidence that one NSAID is more effective than another.	B	36	Cochrane review of nine small randomized controlled trials