Heavy menstrual bleeding

NICE guidelines [CG44] Published date:

Review decision date: January 2012

Review decision: 

March 2012: It has been proposed that the guideline review revert back to its three year cycle with the review commencing January 2013.

Next review date: March 2015

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.

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