Menorrhagia is a significant health problem for many women. It increases with age and peaks during the perimenopause. Although historically, hysterectomy as been the mainstay for treatment there are many effective medical and surgical alternatives to hysterectomy that may be eminently suitable for perimenopausal women as menopause will intervene in due course. The incidence, aetiology, initial management and effective treatment options are discussed in this review article.