Heavy menstrual bleeding (CG44)
Fast, easy summary view of NICE guidance on 'heavy menstrual bleeding'
Specific, concise statements that act as markers of high-quality, cost-effective patient care
Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss which interferes with a woman's physical, social, emotional and/or material quality of life. It can occur alone or in combination with other symptoms.
HMB is not associated with significant mortality and may be considered unimportant by some healthcare professionals. Many women with HMB consult healthcare professionals in primary care and HMB is a common reason for referral to a specialist.
In the early 1990s, it was estimated that at least 60% of women presenting with HMB went on to have a hysterectomy. This was often the only treatment offered. Hysterectomy is a major operation and is associated with significant complications in a minority of cases. Since the 1990s the number of hysterectomies has been decreasing rapidly. This guideline makes recommendations on a range of treatment options for HMB. It aims to help healthcare professionals provide the right treatments for individual women. Healthcare professionals should be aware that it is the woman herself who determines whether a treatment is successful for her.
Corrections made in 'Understanding NICE guidance' and 'Quick reference guide' concerningoral progestogen (norethisterone): January 2008
Understanding NICE guidance
On the 'Drug treatments compared' table, row 5 'Oral progestogen (norethisterone)', column 4: note that the recommended dosing regimen for norethisterone is not licensed for use as a contraceptive, but may affect a woman's ability to become pregnant while it is being taken.
Quick reference guide (N1180)
On page 7, row 5 'Oral progestogen (norethisterone)', column 4: note that the recommended dosing regimen for norethisterone is not licensed for use as a contraceptive, but may affect a woman's ability to become pregnant while it is being taken.
- CG44 Heavy menstrual bleeding: evidence tables
- CG44 Heavy menstrual bleeding: search strategies
- CG44 Heavy menstrual bleeding: NICE guideline (web format)
This guidance has been incorporated into the following NICE Pathways, along with other related guidance and products.
Visit the NICE Pathway: heavy menstrual bleeding
This page was last updated: 10 March 2014
- Web format
- Quick reference guide (PDF)
- NICE Guideline (PDF)
- Full Guideline (PDF)
- CG44 Triniaeth a gofal i ferched sy'n cael misglwyfi trwm: deall canllawiau NICE (fformat MS Word)
Information for the public
Implementation tools and resources
- Audit support
- Costing report
- Costing template
- Slide set
- Heavy menstrual bleeding commissioning guide
- Heavy menstrual bleeding: implementation advice
- IUD and the IUS commissioning guide
- Endometrial ablation service commissioning guide
- Hysterectomy service commissioning guide
- Heavy menstrual bleeding: online educational tool: management in primary care
- Heavy menstrual bleeding: online educational tool: management in secondary care
See this guidance in practice
The summary of the key recommendations in the guidance written for patients, carers and those with little medical knowledge and may be used in local patient information leaflets.
Quick Reference Guide
The quick reference guide presents recommendations for health professionals
The published NICE clinical guideline, contains the recommendations for health professionals and NHS bodies.
The published full clinical guideline for specialists with background, evidence, recommendations and methods used.