[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.