Synopsis Assessment Ascertain blood loss by a pad and tampon count and determine any social or physical problems that heavy periods are causing. Greater understanding may prevent unnecessary treatment. Dilatation and curettage should not be offered to women under the age of 35 as the risks outweigh the benefits. Endometrial sampling by catheter or hysteroscopy as an outpatient procedure is preferable in younger women. Endometrial sampling by hysteroscopy as an outpatient procedure is likely to be the most cost-effective method of diagnosing uterine conditions in older women.
Vaginal ultrasonography is a useful diagnostic test in all women without an intact hymen.
Tranexamic acid is more effective in the short term, but its long term safety has not been established, making it a second-line treatment. Norethisterone from Days 5 to 26 of the menstrual cycle may be a suitable alternative second-line treatment, although further controlled trials to establish its comparable efficacy are required. There is no obvious best surgical treatment. The advantages of endometrial resection over hysterectomy for menorrhagia in women with a normal uterus may not be sustained in the longer term and the patient's choice of procedure is important. Dilatation and curettage should not be used as treatment for menorrhagia.