02:38am Saturday 19 October 2019

Many women suffering from heavy menstrual bleeding wait over a year before being referred to secondary care

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. It looks at the care received by women with HMB who are referred to NHS outpatient clinics in England and Health Boards in Wales.

HMB affects around 80,000 women in England and Wales each year, and for many, causes a serious deterioration in general health and quality of life. The first annual report published in 2011 reported variations in surgical management across all acute trusts in both countries. The second annual report now looks at the severity of menstrual problems and whether there is variation in the treatment women receive at primary care level. Over 16,000 questionnaires were completed and the average age of participants was 44 years.

Current NICE guidelines recommend that medical treatment is offered in primary care. This report found that most of the women (74%) who participated in the study had been under primary care for over a year before they were referred to secondary care. Almost a third of women had received no previous treatment in primary care before referral to secondary care, despite 50% being in severe pain. Moreover, among women aged over 50, 37% received no initial treatment before referral to secondary care. There was no difference in the proportion of women receiving treatment in primary care across different trusts or Health Boards in England and Wales. 

Medical treatment includes oral contraceptives, tranexamic acid, mefenamic acid (non-steroidal anti-inflammatory drugs) and insertion of Mirena-IUS in the uterus (a hormone loaded device). If these treatment options prove ineffective, then surgical alternatives including endometrial ablation and hysterectomy will be considered. 

Dr Tahir Mahmood, Consultant Obstetrician and Gynaecologist, NHS Fife and Chair of the National HMB Audit, said:

“The first annual report found that there was a wide variation in surgical treatments which were offered within hospitals. This second report finds that national guidelines and care pathways are not always being followed in relation to treatment at primary care level.

“There have been substantial changes in the management of HMB over the last 10 years, with women increasingly having access to a wider range of medical therapies as well as minimal access surgical procedures such as endometrial ablation.  These innovations have been incorporated into national clinical guidelines but more needs to be done to ensure they are being followed.

“The next steps are to look at women’s experiences in secondary care and all participants in this national audit will be sent a follow-up questionnaire. The overall aim is to assess the experience of women living with HMB and make recommendations for improvement in patient care. We would urge upon the commissioners of women’s health services to take note of these findings and ensure that implementation of NICE guidelines for the management of HMB are considered in their contracting process.”


For more information please contact Naomi Weston on 020 7772 6357 or nweston@rcog.org.uk


To view the full second annual report please click here.

To view the NICE guidelines on HMB please click here.  

About The Healthcare Quality Improvement Partnership (HQIP)

The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Their purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care. The programme comprises more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions.

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