Clinical update

Heavy menstrual bleeding

Our essential guide to new National Institute for Health and Care (NICE) guidance on how nurses can help women affected by heavy menstrual bleeding.
menstrual

Our essential guide to new National Institute for Health and Care (NICE) guidance on how nurses can help women affected by heavy menstrual bleeding.

Essential facts

Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with a womans physical, emotional, social or material quality of life. According to charity Womens Health Concern, it is one of the most common reasons for women to visit their GP, with one in 20 seeking help for this problem during a year.

In England and Wales, around 80,000 women a year will be referred for the first time to secondary care, according to the Royal College of Obstetricians and Gynaecologists, with 30,000 requiring surgical treatment.

Whats new?

In August, NICE updated its guidance on HMB originally

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Our essential guide to new National Institute for Health and Care (NICE) guidance on how nurses can help women affected by heavy menstrual bleeding.


One in 20 women are affected by heavy menstrual bleeding. Photo: iStock

Essential facts

Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with a woman’s physical, emotional, social or material quality of life. According to charity Women’s Health Concern, it is one of the most common reasons for women to visit their GP, with one in 20 seeking help for this problem during a year.

In England and Wales, around 80,000 women a year will be referred for the first time to secondary care, according to the Royal College of Obstetricians and Gynaecologists, with 30,000 requiring surgical treatment.

What’s new?

In August, NICE updated its guidance on HMB – originally published in 2007 – adding new recommendations to offer ulipristal acetate to women with HMB and fibroids of more than 3cm in diameter.

The guidance also includes recommendations on examination and investigations, education and information, and choice of treatments, including pharmaceutical and surgical. 

Signs/symptoms

HMB can occur alone or in combination with other symptoms such as menstrual pain, otherwise known as dysmenorrhoea. The amount of blood lost during a period varies considerably between women, with an average of 30-40mL – about half a teacup.

According to NHS Choices, heavy periods are defined as losing 60-80ml or more in each cycle. One in ten women lose more than 80ml. Other signs of HMB include using an unusually high number of tampons or towels, bleeding through clothes or bedding, having to change tampons or towels in the middle of the night, and needing to use towels and tampons together. HMB may also be a sign of perimenopause. 

Causes/risk factors

In a majority of cases, there is no obvious cause of HMB. Some conditions and treatments have been linked to HMB, including uterine fibroids, polycystic ovary syndrome, endometriosis, adenomyosis, pelvic inflammatory disease, endometrial polyps, intrauterine contraceptive devices and anticoagulant medication. Some women may become anaemic through HMB.

How you can help your patient

Although some healthcare professionals consider HMB unimportant, it can be very disruptive for women, affecting their work, social and sexual lives. Nurses can play a key role in encouraging women whose quality of life is being affected to seek treatment, reassuring them that different kinds of help are available to suit their individual needs.

Expert comment

Dianne Crowe, Northumbria Healthcare NHS Foundation Trust gynaecology clinical nurse specialist and RCN’s Women’s Health Forum steering committee member  

Dianne Crowe
Dianne Crowe

‘I welcome the inclusion of ulipristal acetate in these updated guidelines. It’s a great treatment for fibroids that helps women to avoid surgery, offering a real alternative when this option is not suitable or desirable.

It’s especially helpful for those who are coming up towards menopause, when fibroids will naturally shrink afterwards. It’s also useful for women who might want to become pregnant. 

‘Nurses can play a major role in helping women to know that it’s not acceptable for them to just put up with HMB, and there are various treatments available that don’t involve surgery.

Many women are juggling busy lives, so trying to cope with HMB too can leave them feeling debilitated. They may also be experiencing anaemia, which can lead to tiredness and low mood.

Many patients don’t know about the different treatment options and nurses can help to signpost them towards information. The RCN Women’s Health Forum has several pocket guides in the pipeline, including one on HMB.’

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