Recommendations for research

The guideline committee has made the following recommendations for research. The committee's full set of research recommendations is detailed in the full guideline.

As part of the 2016 update, the standing committee made an additional research recommendation on prolonged ulipristal acetate treatment. Details can be found in the addendum.

1 Prolonged ulipristal acetate treatment for women with heavy menstrual bleeding and fibroids of 3 cm or more

What is the efficacy and safety of ulipristal acetate 5 mg for a duration of more than 4 courses for women with heavy menstrual bleeding and fibroids of 3 cm or more in diameter, compared with other uterus-sparing treatments?

Why this is important

The current evidence suggests that ulipristal acetate 5 mg is an effective treatment for women with heavy menstrual bleeding and fibroids of 3 cm or more in diameter. The evidence covers a period of 4 courses (20 months). Research is needed on the efficacy and safety of ulipristal acetate 5 mg over a period of more than 4 courses, compared with other uterus‑sparing treatments.

2 What is the epidemiology of women presenting with HMB in primary care?

Why this is important

There are only limited data available on the epidemiological profile of women presenting with HMB in primary care. This is important as the majority of women with HMB will be treated solely within primary care. An epidemiological profile of women presenting with HMB would help understanding of the presentation of HMB and the requirements from treatment.

3 Investigate routine use of indirect measurements of menstrual blood loss in primary and secondary care

Why this is important

Evidence shows that direct measurement of menstrual blood loss is accurate but complex to undertake in clinical practice, and that subjective assessment of menstrual blood loss is inaccurate but easy to undertake in clinical practice. An alternative is the use of indirect measures of menstrual blood loss, such as the 'Pictorial blood loss assessment chart'. However, evidence on the use of indirect measures is contradictory and no data are available to show whether they could be used in routine practice. If indirect measures are shown to work then they could be introduced as a simple technique for assessing menstrual blood loss, and from this the management of HMB could be improved.

4 What are the long-term recurrence rates of fibroids after uterine artery embolisation or myomectomy?

Why this is important

Both UAE and myomectomy are undertaken to reduce symptoms associated with uterine fibroids by directly removing the fibroids or reducing their size. Data exist on short- and medium-term recurrence of fibroids, but no data are available on long‑term recurrence.

5 What are the effects of hysterectomy and oophorectomy on the occurrence of cancer?

Why this is important

One of the arguments surrounding the use of hysterectomy and oophorectomy is the effect on cancer risks. Epidemiological studies are required to investigate the impact of hysterectomy and oophorectomy on cancer. The results of this research will have fundamental implications on the use of these treatments.

6 Do volume–outcome relationships exist in gynaecological procedures, taking into account case-mix, hospital and surgeon factors?

Why this is important

No good evidence was identified for any volume–outcome relationships in gynaecological procedures. If volume–outcome relationships do exist then this would suggest the need for concentration of services.

  • National Institute for Health and Care Excellence (NICE)