Treatment options for women with heavy menstrual bleeding: a comprehensive systematic review and network meta-analysis

A quarter of women experience heavy periods in their lifetime, which can significantly impair their wellbeing, productivity, and quality of life. Every year about 50000 women in England and Wales are referred to NHS hospitals due to heavy periods. Almost half of them eventually require surgery such as removing their womb.

Currently, there are twenty different treatment options offered in the NHS for managing heavy periods. These are largely divided into medical options such as non-hormonal tablets, hormone-releasing coils, and contraceptive pills; or surgical options such as removing the womb via keyhole or open surgery. However, access to these treatments varies across the UK depending on local resources and care settings. This often exposes affected women to inequitable care, reduces treatment satisfaction, and prolongs their suffering from this condition.

A large number of published studies (>150) evaluated individual treatments for heavy periods. While helpful, this approach yields limited information on the benefits, safety, and cost of each treatment compared to the others. This knowledge gap makes it difficult for women to consider and prioritise their preferred treatment option for managing their periods and reduces their ability to make informed treatment decisions jointly with their caring health professionals.

To remedy this, we plan to use published and unpublished data where possible to compare all available treatment options in one analysis, while considering the views and treatment preferences of affected women.

We will first review the literature to identify all relevant randomised studies that evaluated any treatment options for women with heavy periods. We will then employ a statistical methodology called “network meta-analysis” (NMA) to combine the data from all included studies and evaluate the benefits and safety of all available treatment options compared to each other whilst maintaining the structure and independence of each included study. We will then rank those treatments for their ability to reduce menstrual bleeding, safety and impact on women’s quality of life. We will also assess the treatments’ success across particular subgroups of women who may have specific health needs, such as adolescents or those seeking to become pregnant.

We aim to produce an evidence-based decision aid toolkit that will help women and their caring health professionals to choose the most suitable treatment for their heavy periods. This will help to raise awareness and empower women to seek the treatments they desire to manage their periods and resume their routine activities in the community.

We will share the study findings with relevant health bodies and policymakers directly to promote rapid adoption into women’s healthcare services in the NHS. We will co-produce lay outputs to share the findings with the lay community and maximise the impact of our research on the health and wellbeing of women worldwide. We will also communicate results at international conferences (e.g. RCOG World Congress 2025) and publish the findings in relevant peer reviewed journals, making sure they are made widely available through open access routes.