Quality statement 1: Menstrual history
Heavy menstrual bleeding can be distressing and have a major impact on the person's wellbeing and many aspects of their life, including work and education. Documenting a focused menstrual history is important to identify the severity and range of the person's symptoms, and the impact on their quality of life. A focused history can ensure that people have appropriate diagnostic tests, further investigations for any underlying pathologies, and prompt and effective treatment. It can also help to avoid unnecessary referrals to secondary care.
a) Evidence that healthcare professionals are aware of and recognise symptoms related to heavy menstrual bleeding that might suggest uterine cavity abnormality, histological abnormality, adenomyosis or fibroids.
Data source: Local data collection, for example training records.
b) Evidence of local clinical protocols for a focused history that includes the impact on quality of life based on symptoms related to heavy menstrual bleeding.
Data source: Local data collection, for example local clinical protocols.
Numerator – the number in the denominator who have a focused history taken that includes the impact on their quality of life.
Denominator – the number of people who present with symptoms of heavy menstrual bleeding.
Data source: Local data collection, for example NHS England's heavy periods self-assessment tool.
Service providers (such as general practices and sexual health clinics) ensure that staff are aware of symptoms related to heavy menstrual bleeding so that they can document a focused history. The history should include severity of bleeding, related symptoms, comorbidities and the impact of heavy menstrual bleeding on quality of life.
Healthcare professionals (such as GPs and nurses) document a focused history in line with the Royal College of General Practitioners' menstrual wellbeing toolkit and NHS England's heavy periods self-assessment tool when a person presents with symptoms related to heavy menstrual bleeding. The history should include severity of bleeding, related symptoms (for example irregular periods), comorbidities and the impact of heavy menstrual bleeding on quality of life.
Commissioners (such as clinical commissioning groups and NHS England) ensure that they have service specifications in place that include clinical protocols for focused histories to be taken that address severity of bleeding, related symptoms, comorbidities and the impact on quality of life when a person presents with symptoms related to heavy menstrual bleeding.
People with heavy periods are asked about the severity of bleeding, any other symptoms or conditions that they have and how their periods affect their life, in line with NHS England's heavy periods self-assessment tool. This includes the impact on work, education and daily life. The information is recorded in their notes by their healthcare professional.
Heavy menstrual bleeding: assessment and management. NICE guideline NG88 (2018, updated 2020), recommendation 1.2.1
A focused history should include questions about the following:
the nature of the bleeding
impact on quality of life, for example bleeding through to clothing or bedding, needing to use 2 types of sanitary product together (such as tampons and pads) or disruption to daily life (such as being unable to go out)
other factors that may affect treatment options such as comorbidities or previous treatment for heavy menstrual bleeding.