Understanding NICE guidance Information for people who use NHS services Treatment and care for women with heavy periods Are heavy periods disrupting your life? Every woman is different and the amount of blood each woman loses
during her period varies widely from one person to another. If heavyperiods are disrupting your life, your doctor should be able to offer
First stop: your doctor
Your doctor will ask you about your periods, how much bleeding you have(how often you need to change your tampons/sanitary pads, whether you
have clots or experience flooding) and how long your period lasts. If you
bleed after sex or have pelvic pain or bleeding between periods, your
doctor should offer to examine you to try and find out the cause.
Your doctor may offer tests to try and find out what is causing your heavy
periods. A blood test will show the doctor if you have anaemia (not
If your doctor is concerned about the cause of your heavy periods, you
may be offered an ultrasound scan. If the scan doesn’t show anything is
wrong or is unclear, you may be offered other types of tests. Your doctormay offer to refer you to a specialist if there seem to be large fibroids orother problems with your womb. (A fibroid is a non-cancerous growth inthe womb.)
Information about NICE clinical guideline 44 Issue date: January 2007
e your appointment you should be given this
oblems with your womb, your doctor will be able
eatments eatments
ed to another specialist with this training.
our specialist should be competent in the pr
and some may stop the bleeding completely
Second stop: your specialist
leaflet or other similar information. Surgical tr
operations that can help (see the second table below). Y
risks of each option, and given enough time and support to help you
making a decision about these operations your specialist should discuss in
specialist is not trained to undertake a particular tr
Questions you might like to ask your doctor fects (not Possible unwanted ef everyone experiences these) See note 1 at bottom of table egnant in fect my chance Could it af of getting pr the futur contraceptive? How does it work?
one is not licensed for use as a contraceptive, but may af
fects may be experienced by 1 in 100 women. Less common unwanted ef
What is it? eatments in ogestogen ethister ogestogen recommended or of what to try first as long as it’ suitable for you Levonorgestr intrauterine system Tranexamic acid Non-ster anti-inflammatory drugs (NSAIDs) Combined oral contraceptives Injected or implanted Gonadotr releasing hormone analogue Possible unwanted ef (not everyone experiences these) See note at bottom of table egnant in the futur Could it af chance of getting What is it?
our specialist should discuss both the short- and long-term ef
oids (uterine ectomy). der – some types may not
fects may be experienced by 1 in 100 women. Less common unwanted ef
oids (myomectomy) ecommended or move the lining of the womb (endometrial emove fibr emove the womb (hyster
t want to keep your womb or to have a child
ee fluid thermal endometrial ablation’.
ou fully understand the risks and benefits and ask for a
be suitable for you Surgery to r ablation).
• ‘thermal balloon endometrial ablation’ (TBEA)
Treatment to block the blood supply to fibr artery embolisation or UAE) Surgery to r Surgery to r
main ways of doing this depending on your individual cir
removed, all the options should be discussed. If you have a str
Types of surgery in r
Your careYour treatment and care should take into account your personal needs and preferences, and you have the right to be fully informed and to makedecisions in partnership with your healthcare team. To help with this, yourhealthcare team should give you information you can understand and that
is relevant to your circumstances. All healthcare professionals should treat
you with respect, sensitivity and understanding and explain heavy periodsand the treatments simply and clearly.
The information you get from your healthcare team should include details
of the possible benefits and risks of particular treatments. You can ask any questions you want to and can always change your mind as your
treatment progresses or your condition or circumstances change. Your own
preference for a particular treatment is important and your healthcare team
should support your choice of treatment wherever possible. You should be
able to get a second opinion if an agreement between you and your
healthcare professional on your treatment is not reached.
Your treatment and care, and the information you are given about it,
should take account of any religious, ethnic or cultural needs you mayhave. It should also take into account any additional factors, such as
physical or learning disabilities, sight or hearing problems, or difficulties
with reading or speaking English. Your healthcare team should be able toarrange an interpreter or an advocate (someone who supports you inasking for what you want) if needed. You should not be offered: • oral progestogens for use only in the second half of your
• dilatation and curettage (D and C, which involves scraping out the
This leaflet does not cover treatment for women whose heavyperiods are caused by endometriosis or HRT, or whose bleedingis not related to the menstrual cycle.Information about NICE clinical guideline 44
The organisations below can provide more information and support for
women with heavy periods. Please note that NICE is not responsible forthe quality or accuracy of any information or advice provided by these
• Fibroid Network, [email protected], www.fibroidnetworkonline.com
or diseases and thetreatments they
• The Hysterectomy Association, 0871 7811141,
• Women’s Health Concern, 0845 123 2319,
NHS Direct online (www.nhsdirect.nhs.uk) may be a good starting point forfinding out more. Your local Patient Advice and Liaison Service (PALS) mayalso be able to give you further information and support.
About NICENICE produces advice (guidance) for the NHS about preventing, diagnosing and treatingdifferent medical conditions. The guidance is written by independent experts includinghealthcare professionals and people representing patients and carers. They consider the bestavailable evidence on the condition and treatments, the views of patients and carers and theexperiences of doctors, nurses and other healthcare professionals working in the field. Staffworking in the NHS are expected to follow this guidance. To find out more about NICE, its work and how it reaches decisions, seewww.nice.org.uk/aboutguidanceThis booklet and other versions of this guideline aimed at healthcare professionals are available at www.nice.org.uk/CG044You can order printed copies of this booklet from the NHS Response Line (phone 0870 1555 455 and quote reference N1181).National Institute for Health and Clinical Excellence MidCity Place, 71 High Holborn, London, WC1V 6NA, www.nice.org.uk
National Institute for Health and Clinical Excellence, January 2007. All rights reserved. This material may be freely reproduced for educational and not-for-profit purposes. No reproduction by or for commercialorganisations, or for commercial purposes, is allowed without the express written permission of the Institute.
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Understanding NICE guidance