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GEM - heavy menstrual bleeding with reference to NICE guidance

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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GPnotebook Educational Module (GEM) - heavy menstrual bleeding

Menorrhagia (heavy menstrual bleeding) is defined as excessive menses in an otherwise normal menstrual cycle. It is largely a subjective definition as what constitutes heavy bleeding to one women may be quite normal for another.

How do NICE define the term heavy menstrual bleeding?

How common is heavy menstrual bleeding?

What causes should be considered if a woman presents with a history of heavy menstrual bleeding?

What are important features of the history when a woman presents with a history of heavy menstrual bleeding?

What laboratory investigations are indicated in cases of heavy menstrual bleeding?

Management in primary care:

With respect to management of heavy menstrual bleeding?

  • when is pharmaceutical management indicated?
  • if history and investigations indicate that pharmaceutical treatment is appropriate and either hormonal or non-hormonal treatments are acceptable, then what order have NICE suggested that treatments should be considered?
  • if menorrhagia/heavy menstrual bleeding (HMB) is managed with non-hormonal treatments, when would treatment with a NSAID be advantageous?
  • is imaging indicated after a failure of a first pharmaceutical agent?
  • what is a pharmaceutical regime to stop flooding/torrential menstrual bleeding?

Referral from primary care:

  • When should an urgent two week referral for suspected gynaecological cancer be initiated?


  1. Royal College of General Practitioners. Curriculum Statement 10.1 Women's Health.

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