history of heavy menstrual bleeding

Last edited 06/2018

  • aspects to be covered in the history include:
    • nature of the bleeding
    • related symptoms that might suggest structural or histological abnormality e.g.such as intermenstrual or postcoital bleeding, pelvic pain and/or pressure symptoms
    • impact on quality of life and other factors that may determine treatment options (such as presence of comorbidity)

  • when diagnosing heavy menstrual bleeding (HMB), clinicians should take into account the range and natural variability in menstrual cycles and blood loss - the clinician should also discuss this variation with the woman

  • if the woman has a history of HMB without other related symptoms (such as persistent intermenstrual bleeding, pelvic pain and/or pressure symptoms, that might suggest uterine cavity abnormality, histological abnormality, adenomyosis or fibroid), consider pharmacological treatment without carrying out a physical examination (unless the treatment chosen is levonorgestrel-releasing intrauterine system [LNG IUS])

  • if the history suggests HMB with structural or histological abnormality, with symptoms such as intermenstrual or postcoital bleeding, pelvic pain and/or pressure symptoms, a physical examination and/or other investigations (such as ultrasound) should be performed

  • measuring menstrual blood loss is not routinely recommended for HMB

  • NICE emphasise that whether menstrual blood loss is a problem should be determined not by measuring blood loss but by the woman herself


  1. NICE (March 2018). Heavy menstrual bleeding