What changed recently

The July 2026 update withdrew the recommendation on serum ferritin testing from the laboratory investigations section for women presenting with heavy menstrual bleeding. NG88 originally replaced the 2007 heavy menstrual bleeding guideline CG44.

The April 2026 amendment reworked the advice on unscheduled vaginal bleeding while on systemic HRT, changing one recommendation and adding a new one so the guidance lines up with NICE's suspected cancer referral guidance. The preceding November 2024 update had added evidence-based recommendations on cognitive behavioural therapy for menopausal symptoms, on genitourinary symptoms, and on the health outcomes associated with HRT.

NG201 updated and replaced the 2008 antenatal care guideline CG62 when it was published in August 2021, and also superseded evidence summary ES20. Revisions since then have been maintenance changes rather than new clinical recommendations, the December 2024 one adding a cross-reference to NICE's guideline on end of life care for adults.

The 2024 edition explicitly replaces the 2016 U.S. MEC. It adds chronic kidney disease (including nephrotic syndrome and patients on haemodialysis or peritoneal dialysis) as a new condition and revises guidance for several others, among them postpartum and breastfeeding use, postabortion contraception distinguishing medication from procedural abortion, thrombophilia and venous thromboembolism on anticoagulation, sickle cell disease, lupus, and interactions with HIV antiretroviral therapy.

The 2023 edition extends the 2018 international guideline, most visibly by allowing serum anti-Mullerian hormone as an alternative to ultrasound for defining polycystic ovarian morphology in adults (using one test, not both, to limit overdiagnosis) and by raising the ultrasound follicle threshold. It also gives more weight to cardiovascular risk, sleep apnoea and psychological screening, and addresses newer weight-management drugs.

The April 2023 update revised the recommendations on when clinicians should offer placental growth factor (PlGF)-based blood testing to help rule out pre-eclampsia, bringing the guideline into line with NICE's separate diagnostics guidance on PlGF testing. NG133 itself had earlier replaced the 2010 hypertension in pregnancy guideline CG107.

The 2022 ESHRE guideline replaced the 2014 version and demoted diagnostic laparoscopy from a gold standard to an option reserved mainly for symptomatic patients with negative imaging. It also revised medical therapy, positioning GnRH antagonists as a second-line option for endometriosis-associated pain while dropping danazol and antiprogestins, and added new sections on adolescents, menopause and fertility preservation.

Bulletin 228 replaced the 2008 leiomyoma bulletin No. 96 and brought in treatment options that did not exist in the earlier edition, notably oral GnRH antagonists such as elagolix with hormonal add-back for bleeding associated with fibroids, capped at about two years because of bone-loss risk, and laparoscopic radiofrequency ablation as a uterine-preserving option with counselling about limited reproductive-outcome data.

The December 2020 update added new recommendations on continuous glucose monitoring and flash glucose monitoring in pregnancy for women with type 1 diabetes, dropped glibenclamide because the drug had been discontinued, and added referral advice to the NHS Diabetes Prevention Programme after gestational diabetes.

Bulletin 222 formally replaced Practice Bulletin No. 202 from December 2018. Its interim update carried focused corrections to the platelet-count thresholds and to the boxed diagnostic criteria for preeclampsia and for preeclampsia with severe features.

The 2018 statement added five-yearly high-risk HPV testing alone as an alternative to three-yearly cytology for women aged 30 to 65, which the 2012 statement had not endorsed as a stand-alone strategy. Advice against screening under 21, over 65 after adequate prior screening, and after hysterectomy was carried over unchanged.

Bulletin 190 replaced the 2013 gestational diabetes bulletin No. 137 and hardened ACOG's stance on drug therapy: insulin is named the preferred first-line agent when nutrition therapy fails, and glyburide is no longer endorsed as a first-choice alternative, a reversal of the earlier position that glyburide and insulin were broadly equivalent.

The fifth edition kept most fourth-edition criteria but changed several postpartum and HIV-related recommendations: progestogen-only pills and implants in the first six weeks after birth moved from category 3 to category 2, the levonorgestrel IUD was cleared for insertion within 48 hours of delivery or from four weeks, and new guidance was added for women at high risk of HIV and for those on antiretroviral therapy using hormonal contraception.