RCOG release: Women with heavy menstrual bleeding receive varied treatment across Wales, finds new data

The HMB Audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and is led by the Royal College of Obstetricians and Gynaecologists (RCOG), in collaboration with the London School of Hygiene & Tropical Medicine and Ipsos MORI.

This new Addendum looks specifically at Wales between 2003-2010, and looks at patterns of surgical treatment for HMB.

HMB is a common condition that can affect around 20% of women of reproductive age.  Between April 2003 and March 2010, 25, 477 women were admitted to hospital with HMB as their primary diagnosis in Wales. The average age of the women was 40.

The new data found that 38% of women admitted with HMB received surgical treatment.  There were a total of 611 vaginal hysterectomies, 2302 abdominal hysterectomies and 6541 endometrial ablations.

The number of endometrial ablations increased over the last 6 years, accounting for 71% of all procedures for HMB in 2009/10 as compared with 62% in 2003/04.

However there were differences in treatment between areas of Wales. Women living in the most deprived areas of Wales were more likely to have hysterectomies whilst women in the least deprived areas were more likely to have endometrial ablations.

This variation may be down to differences in population demand and clinical uncertainty die to the lack of precise treatment indications.

The National Institute for Health and Clinical Excellence (NICE) guidelines recommend that endometrial ablation be offered as first-line treatment if HMB has a severe impact on quality of life. However there are no clear criteria for what constitutes a ‘severe impact on quality of life’. Hysterectomy is only recommended when other treatment options have failed or are declined by a woman.

Dr Tahir Mahmood, Chair of the National HMB Audit, said:

“This new data for Wales shows that regional variations in surgical rates for HMB persist across the region.

“More women are having endometrial ablations increasing the surgical rate, however, more needs to be done to improve the management of women with heavy menstrual bleeding within Wales.”

Please click here to read the Addendum


For more information please contact Naomi Weston on 020 7772 6357 or [email protected] 


The analysis used data from Patient Episode Database for Wales (PEDW), an administrative database that captures all inpatient admissions and day cases in Welsh NHS acute hospitals. The sample was restricted to women aged between 25 and 59 years at the time of surgery and included the first surgical procedure only.