Heavy menstrual bleeding

List of quality statements

Note that the word 'women' is used in the statements to refer to women of reproductive age, including women younger than 18 years.

Statement 1. Women presenting with symptoms of heavy menstrual bleeding have a detailed history and a full blood count taken.

Statement 2. Women with heavy menstrual bleeding in whom a structural or histological abnormality is suspected have a physical examination before referral for further investigations.

Statement 3. Women with heavy menstrual bleeding without suspected structural or histological abnormalities are offered drug treatment at the initial assessment.

Statement 4. Women with heavy menstrual bleeding who are undergoing further investigations or awaiting definitive treatment are offered tranexamic acid or non-steroidal anti-inflammatory drugs at the initial assessment.

Statement 5. Women with heavy menstrual bleeding and a normal uterus or small uterine fibroids who choose surgical intervention have a documented discussion about endometrial ablation as a preferred treatment to hysterectomy.

Statement 6. Women with heavy menstrual bleeding related to large uterine fibroids who choose surgical or radiological intervention have a documented discussion about uterine artery embolisation, myomectomy and hysterectomy.