NICE published an update to its guideline on heavy menstrual bleeding (menorrhagia) in March 2018. There are a couple of changes:
- Hysteroscopy is now the first line investigation for most women who need investigating for heavy menstrual bleeding, rather than ultrasound.
- There is no mention of age ’45’ now. In the old menorrhagia guideline, being over 45 was seen as being at higher risk and hence an indication for hysteroscopy. As that is now the first line investigation for most women, I guess being over 45 was less relevant.
- Hysterectomy is a bit higher up the treatment pathway, but they don’t expect there to be a sudden jump in numbers done.
As I’ve not summarised this heavy menstrual bleeding guideline before and it is such a common condition, I’ll do a bit of a summary. This isn’t an exhaustive summary, just the most useful bits.