Key content The incidence and prevalence of uterine arteriovenous malformations (AVMs) is difficult to determine because bleeding caused by uterine AVMs does respond to medical management and several of these may go undiagnosed. Fewer than 100 cases have been reported in the literature, but the increasing use of imaging modalities, particularly ultrasound, in acute gynaecology is likely to lead to identification of these lesions more frequently. Uterine AVMs are largely acquired lesions, with pregnancy playing an important role in their pathogenesis. The most frequent clinical manifestation is abnormal uterine bleeding, which can often be episodic, torrential and can result in significant anaemia or even shock. Hysterectomy remains the most definitive treatment, however, modern management of uterine AVMs varies from medical management (hormonal therapy), through minimally invasive uterine artery embolisation to more definitive surgical hysterectomy. Learning objectives To be aware of the existence of these lesions and to understand the risk factors and clinical presentation of women who should be suspected of having these lesions. To learn the various conservative treatment options for the management of uterine AVMs. To understand the implications for women's future fertility. Ethical issues Should ultrasound Doppler be routinely performed in women who have persistent vaginal bleeding after management of miscarriage? Since experience with interpreting angiography to diagnose uterine AVM is limited, should those women with suspected uterine AVM requiring surgical management be referred to a tertiary centre?