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 and/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 uterine cavity abnormality, histological abnormality, adenomyosis or fibroids. These women will undergo further investigations 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 affects women's quality of life. Tranexamic acid and/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 and/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 and/or NSAIDs at the initial assessment.

Numerator – the number of women in the denominator who are offered tranexamic acid and/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 and/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 and/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 and/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) and/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

Heavy menstrual bleeding: assessment and management (2018) NICE guideline NG88, recommendation 1.5.8

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's guideline on heavy menstrual bleeding, recommendation 1.3.3, states that the woman's history and examination should be taken into account when deciding whether to offer hysteroscopy or ultrasound as the first-line investigation.

Equality and diversity considerations

The drug treatment option chosen should take account of individual circumstances, including age and the relevant licensing considerations.