NICE has published NICE Guideline (NG) 88 on Heavy menstrual bleeding: assessment and management, updating and replacing Clinical Guideline (CG) 44, first published in 2007.

Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that affects a woman’s quality of life. In primary and secondary care HMB is one of the most common reasons for gynaecological consultations, with 1 in 20 women aged between 30 and 49 years consulting their GP annually due to heavy periods or menstrual problems.

The recommendations provided by NG88 cover the following areas:

  • impact of HMB on women
  • history, physical examination, and laboratory tests
  • investigations for the cause of HMB, now including investigations for suspected adenomyosis
  • management of HMB 
  • information for women about HMB and treatments.

A further update of NG88 on the management of HMB is expected at the conclusion of a European Medicines Agency review of Esmya (ulipristal acetate 5 mg), following concerns about a risk of hepatic adverse effects in patients receiving this treatment. Please see the full guideline for details of temporary safety measures.