Abnormal uterine bleeding

​​​​​​​​Emergency

If any of the following are suspected, seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary)

  • Acute or severe pelvic pain
  • Haemodynamic instability
  • Inevitable and/or incomplete termination
  • Persistent heavy menstrual bleeding with haemoglobin < 70 mmol/L​

When public outpatient services are not routinely provided

  • Histopathologically confirmed genital tract malignancy
    Note: referral to gynaecological oncology is indicated, where available
  • Uncomplicated (i.e. normal haemoglobin, normal pelvic ultrasound, negative cervical screening test) heavy menstrual bleeding where there has been no trial of first-line treatment​

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.

  • Abnormal uterine bleeding with haemoglobin between 70 and 85 mmol/L
  • Blood transfusion dependent abnormal uterine bleeding
  • Irregular and thickened endometrium > 12 mm during
    the follicular phase (days 5 to 10 only) confirmed by transvaginal ultrasound with the following features:
    • Aged > 45 years
    • Body mass index (BMI) > 35
  • Suspicion of malignancy or endometrial hyperplasia on pelvic ultrasound
  • Uterine fibroid leading to urinary obstruction or renal impairment (e.g. hydronephrosis, urinary retention requiring indwelling catheter)​
​Category 2
​Recommended to be seen within 90 calendar days.

  • ​Abnormal uterine bleeding with anaemia and haemoglobin > 85 mmol/L
  • Heavy menstrual bleeding where first line treatments are not appropriate or contraindicated
  • Irregular and thickened endometrium > 12 mm during the follicular phase (days 5 to 10 only) confirmed by transvaginal ultrasound with any of the following features:
    • Aged > 45 years
    • Body mass index (BMI) > 35
    • Nulliparity
    • Oligomenorrhoea
  • ​Persistent and/or unexplained intermenstrual bleeding for > 3 months

Category 3
Recommended to be seen within 365 calendar days.

  • ​Abnormal uterine bleeding with the following features:
    • ​​Fibroids < 8 cm or normal pelvic ultrasound
    • Negative cervical screening test
    • Normal haemoglobin

  • No response to medical management Irregular and thickened endometrium > 12 mm during the follicular phase (days 5 to 10 only) confirmed by transvaginal ultrasound without any risk factors listed in Category 1 or 2

Information to include within a referral

Required

  • Reason for referral
  • Details of the presenting condition, including history, symptoms and their duration
  • Provisional diagnosis
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • Menstrual history (cycle – days or months, days of bleeding, blood loss – e.g. change of pads or tampons per day or hours)
    • Previously trialled treatments
    • Quality of life concerns (including missed work, school or extracurricular activities as a result
    • Abnormal examination findings
    • Height, weight and body mass index (BMI)
    • Trans-vaginal or pelvic (trans-abdominal) ultrasound (ideally performed within the early follicular phase (days 5-10) if cycle is regular)
    • Full blood count (FBC)
    • Thyroid stimulating hormone (TSH) result
    • Ferritin levels
    • Human chorionic gonadotropin (ßhCG) or urinary ßhCG
    • Cervical screening test within the last 5 years or recent test if abnormal symptoms

If available

  • Pelvic examination (if sexually active)
  • Blood pressure
  • Other relevant imaging​

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

Current as at: Monday 23 March 2026
Contact page owner: System Purchasing