Heavy Menstrual Bleeding Clinical Care Standard

Heavy menstrual bleeding is a common problem affecting 25% of women of reproductive age.1 


Heavy menstrual bleeding has been defined as ‘excessive menstrual blood loss which interferes with the woman’s physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms’.2

Around 50% of women referred to secondary care for heavy menstrual bleeding experience severe or very severe pain, even when they do not have any uterine pathology3, and many women who seek medical help do so because of disabling pain.4

The range of management options for heavy menstrual bleeding has expanded and improved since the 1970s and 1980s, when rates of hysterectomy for menstrual disorders were first observed to be relatively high and to vary considerably between regions.5,6  Although hysterectomy remains an option, it is not generally recommended for first-line management unless less invasive options are unsatisfactory or are inappropriate.2

The development of a Clinical Care Standard on heavy menstrual bleeding was a recommendation of the first Australian Atlas of Healthcare Variation.

The goal of the Heavy Menstrual Bleeding Clinical Care Standard is to ensure that women with heavy menstrual bleeding are offered the least invasive and most effective treatment appropriate to their clinical needs, and have the opportunity to make an informed choice from the range of treatments suitable to their individual situation.

The Heavy Menstrual Bleeding Clinical Care Standard was launched on 20 October 2017 at the Rural Medicine Australia Conference 2017 (RMA17) in Melbourne. Watch a video of the launch and panel discussion online.

You can also listen to the following interviews on best practice care for women with heavy menstrual bleeding:

On 7 May 2018, the Commission partnered with Safer Care Victoria to conduct a forum to promote best practice care for heavy menstrual bleeding across primary health and acute care sectors. Videos and a presentation from this forum are available to view online and include detailed expert presentations and panel discussions on the condition, treatment options and the Commission’s work on both the Atlas and the Heavy Menstrual Bleeding Clinical Care Standard.

Heavy Menstrual Bleeding Care Clinical Care Standard

This resource provides guidance to consumers, clinicians and health services on delivering appropriate care to people with Heavy Menstrual Bleeding

Heavy Menstrual Bleeding CCS
Publication, report or update

Indicator specification

This resource provides a set of suggested indicators to assist with local implementation of the Heavy Menstrual Bleeding Clinical Care Standard. Clinicians and health services can use the indicators to monitor implementation of the quality statements, and support improvements as needed.

The indicator specification is available from METeOR

Implementation resources

These resources can be used to promote and explain what the Heavy Menstrual Bleeding Clinical Care Standard means to health services, clinicians, patients and their carers.


Why we need this clinical care standard

The Case for Improvement document is a resource for clinicians and health services that explains what each quality statement means, why it matters, and how use of the clinical care standard could improve patient outcomes:

Thumbnail for Heavy Menstrual Bleeding: The case for improvement
Publication, report or update

You can also watch an interview with an expert clinician and a consumer on the Heavy Menstrual Bleeding Clinical Care Standard.


  1. Royal College of Obstetricians and Gynaecologists. National heavy menstrual bleeding audit.  London: RCOG, 2014.
  2. National Institute for Health and Care Excellence. Heavy menstrual bleeding. NICE Quality Standard 47. London: NICE; 2018. 
  3. Royal College of Obstetricians and Gynaecologists. National heavy menstrual bleeding audit. Second annual report. London: RCOG, 2012.
  4. Weisberg E, McGeehan K, Fraser IS. Effect of perceptions of menstrual blood loss and menstrual pain on women's quality of life. Eur J Contracept Reprod Health Care 2016:1
  5. Yusuf F, Siedlecky S. Hysterectomy and endometrial ablation in New South Wales, 1981 to 1994-1995. Aust N Z J Obstet Gynaecol 1997;37:210-6.
  6. Hill EL, Graham ML, Shelley JM. Hysterectomy trends in Australia between 2000/01