Heavy menstrual bleeding

Summary

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' concerning oral 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.

Documents

For healthcare professionals

• CG44 Heavy menstrual bleeding: Full guideline
• CG44 Heavy menstrual bleeding: Evidence tables
• CG44 Heavy menstrual bleeding: Quick reference guide
• CG44 Heavy menstrual bleeding: NICE guideline
• CG44 Heavy menstrual bleeding: NICE guideline (MS Word format)

For patients, carers and the public

• CG44 Heavy menstrual bleeding: Understanding NICE guidance
• CG44 Heavy menstrual bleeding: Understanding NICE guidance (MS Word format)

Background information

• 2007/004 NICE guidance highlights new treatment options available to women living with heavy menstrual bleeding

Implementing this guidance

Any further information NICE has produced to help the NHS implement this guideline locally is linked to below:

• CG44 Heavy menstrual bleeding: Implementation advice
• Heavy menstrual bleeding: Costing report
• CG44 Heavy menstrual bleeding: Presenter slides
• Heavy menstrual bleeding: Costing template
• CG44 Heavy menstrual bleeding: Audit criteria
• IUD and the IUS commissioning guide
• Endometrial ablation service commissioning guide
• Hysterectomy service commissioning guide

Implementation lead