ABSTRACT1. Distribution and status of medicinal leeches were re-considered in the light of the new taxonomy recognizing four Western Palaearctic species: Hirudo medicinalis, Hirudo verbana, Hirudo orientalis and Hirudo troctina.2. Recent records and new data obtained on expeditions to Ukraine, Russia, Azerbaijan, Kazakhstan, Uzbekistan and the Western Balkans were mapped to obtain an up-to-date overview of the distribution.3. Three hypotheses explaining the current ranges of all Hirudo species were tested. The ecological hypothesis, suggesting a strong impact of large-scale environmental factors, received the highest support, while anthropogenic influence was minimal, and no historical patterns of refugia and colonization were detected.4. Mapped localities of all Hirudo species show extensive, belt-shaped ranges extending from east to west. H. medicinalis is distributed from Britain and southern Norway to the southern Urals and probably as far as the Altai Mountains, occupying the deciduous arboreal zone. H. verbana has been recorded from Switzerland and Italy to Turkey and Uzbekistan, which largely corresponds to the Mediterranean and sub-boreal steppe zone. H. orientalis is associated with mountainous areas in the sub-boreal eremial zone and occurs in Transcaucasian countries, Iran and Central Asia. H. troctina has been found in north-western Africa and Spain in the Mediterranean zone.5. Based on the data gathered, and considering real and potential threats, global IUCN category Near Threatened is proposed for H. medicinalis, H. verbana, and H. orientalis, while H. troctina can only be assigned to category Data Deficient.