Statement 1 People presenting with symptoms related to heavy menstrual bleeding have a focused history taken that includes the impact on their quality of life. [2013, updated 2020]
Statement 2 People with heavy menstrual bleeding and suspected submucosal fibroids, polyps or endometrial pathology are offered outpatient hysteroscopy. [new 2020]
Statement 3 People with heavy menstrual bleeding have a discussion with their healthcare professional about all their treatment options. [2013, updated 2020]
In 2020 this quality standard was updated, and statements prioritised in 2013 were updated [2013, updated 2020] or replaced [new 2020]. For more information, see update information.
Statements from the 2013 quality standard for heavy menstrual bleeding that are still supported by the evidence may still be useful at a local level:
Women with heavy menstrual bleeding who have a suspected uterine cavity abnormality, histological abnormality, adenomyosis or fibroids have a physical examination before referral for further investigations.
Women with heavy menstrual bleeding who are undergoing further investigations or awaiting definitive treatment are offered tranexamic acid and/or non-steroidal anti-inflammatory drugs at the initial assessment.
Note that the terminology has changed since 2013. The 2020 statements use 'people' rather than 'women' to ensure that nobody with heavy menstrual bleeding is excluded from this quality standard.
The 2013 quality standard for heavy menstrual bleeding is available as a pdf.
NICE has developed guidance and a quality standard on patient experience in adult NHS services (see the NICE Pathway on patient experience in adult NHS services), which should be considered alongside these quality statements.
Other quality standards that should be considered when commissioning or providing heavy menstrual bleeding services include:
A full list of NICE quality standards is available from the quality standards topic library.