The NICE guideline for heavy menstrual bleeding: Assessment and management (NG88) makes recommendations in five areas. 1. Impact of heavy menstrual bleeding on women The guideline recommends ensuring that any intervention aims to improve the major impact of HMB on a woman's quality of life rather than focusing solely on blood loss. 2. History, physical examination and laboratory tests Healthcare professionals (HCPs) should take a history from the woman, which covers: The nature of the bleeding, related symptoms such as persistent intermenstrual bleeding or pelvic pain, pressure symptoms that might suggest uterine cavity abnormality, histological abnormality or fibroids. The history should include the impact on the person's quality of life. The guideline reminds practitioners that the history should account for other factors that may affect treatment options, such as comorbidities. The guideline recommends taking into account the range and natural variability in menstrual cycles and blood loss when diagnosing HMB and suggests discussing this variation with the woman. If during this discussion the person feels that she does not fall within the normal ranges, then care options should be explored.
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