Context

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 one of the most common reasons for gynaecological consultations in both primary and secondary care. About 1 in 20 women aged between 30 and 49 years consult their GP each year because of heavy periods or menstrual problems, and menstrual disorders comprise 12% of all referrals to gynaecology services.

The focus of this guideline is on women of reproductive age (after puberty and before the menopause) with HMB, including women with suspected or confirmed fibroids, and women with suspected or confirmed adenomyosis. The guideline does not primarily cover women with gynaecological bleeding other than HMB (for example, intermenstrual bleeding or postcoital bleeding) or with gynaecological conditions in which HMB is not the main symptom (such as endometriosis).

Since the publication of the original guideline in 2007, equipment and software for transvaginal ultrasound have improved. Outpatient hysteroscopy has become more widely available, and is more acceptable to women with the advent of modern equipment such as miniature hysteroscopes. Therefore the relative clinical and cost effectiveness of diagnostic strategies have changed. Improvements in diagnostic imaging in recent years have resulted in an increase in the reported prevalence of adenomyosis. Adenomyosis, which is associated with abnormal uterine bleeding, pelvic pain and infertility, was not included in the previous version of the guideline.

This guideline makes recommendations on a range of pharmacological and surgical treatment options for HMB. Outpatient management comprising insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) has increased in popularity in recent years, and there has been a reduction in surgical procedures. However, some endometrial ablation techniques (such as microwave endometrial ablation) are no longer available in the UK.

The guideline aims to help healthcare professionals advise each woman with HMB about the treatments that are right for her, with a clear focus on the woman's choice. It should be borne in mind that it is the woman herself who decides whether a treatment has been successful.

More information

You can also see this guideline in the NICE Pathway on heavy menstrual bleeding.

To find out what NICE has said on topics related to this guideline, see our web pages on endometriosis and fibroids and gynaecological conditions.

For full details of the evidence and the committee's discussions on the 2018 recommendations, see the evidence reviews. Evidence for the 2007 recommendations is in the full version of the 2007 guideline. You can also find information about how the guideline was developed, including details of the committee.

  • National Institute for Health and Care Excellence (NICE)