Quality standard
Quality statement 4: Interim drug treatment
- Quality statement
- Rationale
- Quality measures
- What the quality statement means for service providers, healthcare professionals and commissioners
- What the quality statement means for patients and carers
- Source guidance
- Definitions of terms used in this quality statement
- Equality and diversity considerations
Quality statement 4: Interim drug treatment
Quality statement
Women with heavy menstrual bleeding who are undergoing further investigations or awaiting definitive treatment are offered tranexamic acid or non-steroidal anti-inflammatory drugs at the initial assessment.
Rationale
Definitive treatment can take months to organise for women who have a suspected or confirmed structural abnormality (such as uterine fibroids) or histological abnormality (cancer or atypical hyperplasia). These women will undergo further investigations (such as ultrasound) and, depending on the outcome of the further investigations, may need a referral to specialist services. Heavy menstrual bleeding can be a painful condition to live with and heavy menstrual blood loss lowers women's quality of life. Tranexamic acid or non-steroidal anti-inflammatory drugs (NSAIDs) can provide some symptom relief for women who are undergoing investigations or awaiting definitive treatment.
Quality measures
Structure
Evidence of local arrangements that women with heavy menstrual bleeding who are undergoing further investigations or awaiting definitive treatment are offered tranexamic acid or NSAIDs at the initial assessment.
Data source: Local data collection. The National heavy menstrual bleeding audit collected data about patterns of primary care treatment among women before referral (see section 7 in the second annual report of the National heavy menstrual bleeding audit). These data may inform a baseline assessment.
Process
Proportion of women with heavy menstrual bleeding who are undergoing further investigations or awaiting definitive treatment who are offered tranexamic acid or NSAIDs at the initial assessment.
Numerator – the number of women in the denominator who are offered tranexamic acid or NSAIDs at the initial assessment.
Denominator – the number of women with heavy menstrual bleeding who are undergoing further investigations and awaiting definitive treatment.
Data source: Local data collection. The National heavy menstrual bleeding audit collected data about patterns of primary care treatment among women before referral (see section 7 in the second annual report of the National heavy menstrual bleeding audit). These data may inform a baseline assessment.
Outcome
Women's satisfaction with symptom control and quality of life.
Data source: Local data collection. The National heavy menstrual bleeding audit collected related data about clinical symptoms among women referred for heavy menstrual bleeding to outpatient clinics and quality of life of women at the first outpatient visit and at the 1-year follow-up appointment (see sections 5 and 6 in the second annual report of the National heavy menstrual bleeding audit and section 6 in the third annual report of the National heavy menstrual bleeding audit). These data may inform a baseline assessment.
What the quality statement means for service providers, healthcare professionals and commissioners
Service providers ensure that women with heavy menstrual bleeding who are undergoing further investigations or awaiting definitive treatment are offered tranexamic acid or NSAIDs at the initial assessment.
Healthcare professionals ensure that women with heavy menstrual bleeding who are undergoing further investigations or awaiting definitive treatment are offered tranexamic acid or NSAIDs at the initial assessment.
Commissioners ensure that women with heavy menstrual bleeding who are undergoing further investigations or awaiting definitive treatment are offered tranexamic acid or NSAIDs at the initial assessment.
What the quality statement means for patients and carers
Women with heavy menstrual bleeding who are having further tests or waiting for treatment are offered temporary treatment with tranexamic acid (to help reduce bleeding) or a non-steroidal anti-inflammatory drug (or NSAID for short – a drug that helps reduce bleeding and pain) to ease their symptoms.
Source guidance
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NICE clinical guideline 44 recommendation 1.5.6.
Definitions of terms used in this quality statement
Drug treatment
The drug treatment option chosen should take account of individual circumstances, including age and the relevant licensing considerations. Informed consent is needed when using medicines outside the licensed indications.
Initial assessment
The initial assessment starts when the woman presents with symptoms of heavy menstrual bleeding. It is usually undertaken in primary care and involves 1 or more appointments, in which the woman receives a diagnosis and her treatment options are discussed.
The term 'initial assessment' has been included in the quality statement based on expert consensus.
Further investigations
NICE clinical guideline 44 recommendation 1.2.15 states that ultrasound is the first-line diagnostic tool for identifying structural abnormalities. Recommendation 1.2.13 states that if appropriate a biopsy should be undertaken to exclude endometrial cancer or atypical hyperplasia.