[Summary of the practice guideline 'Heavy menstrual bleeding']

A new multidisciplinary practice guideline on heavy menstrual bleeding (HMB) has recently been published. HMB may occur with or without structural abnormalities. The pictorial blood loss assessment chart (PBAC) is the best method for estimating the amount of blood loss and for distinguishing between heavy and normal blood loss. Haemoglobin levels should be determined at least once. Transvaginal ultrasound is the preferred imaging technique. Saline or gel infusion sonography should be used in cases where ultrasound results are suspect for intracavitary abnormalities. A hysteroscopy should only be performed if sonography results are inconclusive. The very first treatment of choice should be placement of a hormone-impregnated intrauterine system. For HMB without structural abnormalities, endometrial ablation is an alternative to hysterectomy, whereby second-generation ablation techniques are preferred to first-generation techniques. For HMB with uterine fibroids, uterine artery embolisation is a good alternative to hysterectomy. For HMB with submucosal fibroids, hysteroscopic resection of the fibroids is recommended.