Irregular Menstrual Bleeding

Please refer to:           Menstrual disorders clinic if <45

                                      Hysteroscopy if >45


Between three & five episodes with fewer than 3 bleeding-free intervals of length 14 days or more

Information to include in referral letter:


Effect on quality of life

Contraception, Smear history

Treatment tried


Irregular bleeding in peri-menopausal women (>45y) -            Refer to DIRECT ACCESS HYSTEROSCOPY

Irregular bleeding in women <45y                              -              Refer to MENSTRUAL DISORDERS CLINIC



Offer pelvic ultrasound for women with irregular bleeding if any of the following apply:

·         the uterus is palpable abdominally

·         the history or examination suggests a pelvic mass

·         examination is inconclusive or difficult, for example in women who are obese

·         significant dysmenorrhoea (period pain)

·         a bulky, tender uterus on examination that suggests adenomyosis

·         for women who decline hysteroscopy, consider a pelvic ultrasound, explaining the limitations of this technique for detecting intracavitary causes of HMB (pelvic USS can miss about 50%of treatable pathology)



Chlamydia screening


NICE Guideline Jan 2007 Heavy Menstrual Bleeding

Faculty of Sexual and Reproductive Healthcare (FSRH). Management of Unscheduled Bleeding in Women Using Hormonal Contraception. London: Royal College of Obstetricians and Gynaecologists (RCOG); 2009.

Download Irregular Menstrual Bleeding PDF


Date Reviewed                                 26/08/2019

Date of Next Review                      26/08/2020

Author                                                  Dr. Anna Harrold


Version No.   2.1