Update information

July 2026: We have removed a recommendation that stated not to routinely test for serum ferritin in the section on laboratory tests. Based on feedback from stakeholders, we reviewed this recommendation from 2007. After revisiting the evidence behind it, we concluded that a recommendation against serum ferritin testing in women with heavy menstrual bleeding is not justified because of the risk of iron deficiency in this population.

May 2021: We reinstated and amended recommendations in line with updated MHRA safety advice on the risk of serious liver injury with ulipristal acetate (Esmya).

March 2020: In response to updated MHRA advice on the use of ulipristal acetate (Esmya), we amended or withdrew recommendations referring to ulipristal acetate.

March 2018: We added new recommendations on investigations for heavy menstrual bleeding (HMB) and management. These recommendations are marked as [2018].

Some changes were made to recommendation wording without an evidence review. These recommendations are marked as [2007, amended 2018]. These changes were mainly for ease of reading and consistency, or to reflect current practice or drug safety advice.

Minor changes since publication

December 2024: We added links to relevant technology appraisal guidance in the section on management of HMB.

October 2021: We added a link to NICE's shared decision making guideline in recommendation 1.4.1.

ISBN: 978-1-4731-9600-1