Heavy menstrual bleeding is one of the most common health problems which could be seen in women. According to the researches, approximately 1 out of 20 women aged between 30 to 49 has experienced heavy menstrual bleeding. Lots of other physical and mental health issues are concerned with this. After seeing these big reports and analytics about these serious issues, medical science has evolved lots of treatments for this serious issue in women. Recently a report stating the guidelines for heavy menstrual bleeding nice has been issued. Lots of guidelines about the assessment and treatment are there in this report. Below is the summary of the whole guidelines given by the nice on this health problem.

Examination/Test and History
According to the nature of bleeding, it is advised that the patient should be taken into the professional consultation. Other related symptoms could also be there. It is necessary to take a note on them too. Persistent PMB, Pelvic pain and uterine cavity pain are some of the other additional symptoms of heavy menstrual bleeding.

Physical examination
To uncover the underlying issues of this issue, NICE advises taking the person under the professional physical examination processes. According to the initial symptoms in the patient, the doctor should take the physical test. If the patient is only experiencing the HMB without any additional symptom then a physical assessment is necessary. The laboratory tests should also be prescribed to the patient. It will confirm the possibilities of other health disorders which can cause these issues.

Investigation of Cause
After observing the initial symptoms and doing basic assessments, the nice guidelines heavy menstrual bleeding states that it is necessary to take the suitable action for further investigation. It could be an ultrasound or Outpatient hysteroscopy. Women with the larger fibroids are generally prescribed with the ultrasounds. NICE has also stated that the hysteroscopy could only be offered by the GPs. Hysteroscopy should be given under the local anesthesia.

Treatment
NICE guidelines show that the treatment should be given after discussing all the previous treatment histories. Also, the condition of the patient should also be considered.
Management of Heavy Menstrual Bleeding
For the fibroids less than 3cm, the LNG-IUS as the first line should be considered. The women with submucosal fibroids, hysteroscopic removal is considered. After the successful diagnosis, it is necessary to observe the effectiveness of treatment.
The women with the fibroids more than 3cm, it is stated that the women should be referred for the further treatment options. Ulipristal acetate can cause certain liver injuries. It is told to consider this after properly observing the health conditions of the patients. In the case, if the treatment is unsuccessful, the doctors should also check the reasons behind it.
According to these heavy menstrual bleeding nice guidelines, there are lots of effective ways are given to diagnose and treat the symptoms of this serious problem. It is advised to go to the doctor as soon as possible when you see the symptoms of HMB.