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.

NICE recommends healthcare professionals recognise that heavy menstrual bleeding (HMB) has a major impact on a woman's quality of life, and ensure that any intervention aims to improve this rather than focusing on blood loss.

When agreeing treatment options for HMB with women, take into account:

• the woman's preferences
• any comorbidities
• the presence or absence of fibroids (including size, number and location), polyps, endometrial pathology or adenomyosis
• other symptoms such as pressure and pain.

Treatments for women with no identified pathology, fibroids less than 3 cm in diameter, or suspected or diagnosed adenomyosis:

• • LNG-IUS (Levonorgestrel-releasing intrauterine system)

• • Tranexamic Acid

• • NSAIDs (non-steroidal anti inflammatory drugs)

• • Combined hormonal contraception

• • Cyclical oral progestogens

• • Second-generation endometrial ablation

• • Hysterectomy

Please consult NICE guidelines for full treatment recommendations.