Heavy menstrual bleeding affects about one in four women. After excluding malignancy, first-line management in primary care is with pharmaceutical treatments. Other treatment options include endometrial ablation and hysterectomy.
- Heavy menstrual bleeding (HMB) affects about 25% of women of reproductive age.
- Comprehensive assessment is essential to determine the likely cause of the bleeding and its impact on a woman’s life; it includes exclusion of anaemia, iron deficiency and reproductive tract cancer.
- Many women with HMB of benign causes can be managed in general practice with pharmaceutical treatment including the levonorgestrel-releasing intrauterine system.
- Less-invasive surgical options such as endometrial ablation are appropriate for some women.
- Hysterectomy offers definitive treatment of HMB of benign causes when other treatment options have been ineffective or are unsuitable.