This guideline covers assessing and managing heavy menstrual bleeding (menorrhagia). It aims to help healthcare professionals investigate the cause of heavy periods that are affecting a woman’s quality of life and to offer the right treatments, taking into account the woman’s priorities and preferences.
In November 2018 we reinstated recommendations on ulipristal acetate (Esmya) following the European Medicines Agency review of the use of Esmya for uterine fibroids. We also added information on shared decision making and monitoring for side effects.
This guideline includes recommendations on:
Who is it for?
- Healthcare professionals
- Commissioners and providers of heavy menstrual bleeding services
- Women with heavy menstrual bleeding, their families and carers
Guideline development process
This guideline updates and replaces NICE guideline CG44 (January 2007). We have updated the recommendations on investigations for the cause of heavy menstrual bleeding and management of heavy menstrual bleeding in sections 1.3 and 1.5.
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.