This quality standard covers the care of women of reproductive age (including women younger than 18 years) with heavy menstrual bleeding. For more information see the topic overview.

Why this quality standard is needed

Heavy menstrual bleeding is a common condition that affects 20–30% of women of reproductive age[1]. It is defined as excessive menstrual blood loss that interferes with the woman's physical, emotional, social and material quality of life. It can occur alone or in combination with other symptoms.

Many women seek help from their GPs and heavy menstrual bleeding is a common reason for referral to secondary care. The focus of this quality standard is on accurate diagnosis and helping women to make an informed choice about the most appropriate intervention for them.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measureable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2013/14


Overarching indicators and improvement areas

2 Enhancing quality of life for people with long-term conditions

Overarching indicator

2 Health-related quality of life for people with long-term conditions**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition**

Reducing time spent in hospital by people with long-term conditions

2.3i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)*

3 Helping people to recover from episodes of ill health or following injury


3b Emergency readmissions within 30 days of discharge from hospital

4 Ensuring people have a positive experience of care


4a Patient experience of primary care (i) GP services

4b Patient experience of hospital care

4c Friends and Family Test (placeholder)

Improvement areas

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework

** Indicator complementary with Adult Social Care Outcomes Framework

Table 2 Public health outcomes framework for England, 2013 to 2016


Objectives and indicators

2 Health Improvement

2.19 Cancer diagnosed at stage 1 and 2

4 Healthcare public health and preventing premature mortality

4.11 Emergency readmissions within 30 days of discharge from hospital*

Alignment across the health and social care system

* Indicator shared with NHS Outcomes Framework

Coordinated services

The quality standard for heavy menstrual bleeding specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole heavy menstrual bleeding care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to women with heavy menstrual bleeding.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality heavy menstrual bleeding service are listed in related NICE quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating women with heavy menstrual bleeding should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting young women with heavy menstrual bleeding. If appropriate, healthcare professionals and social care and public health practitioners should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.

[1] Royal College of Obstetricians and Gynaecologists (2011) National heavy menstrual bleeding audit. First annual report.