Heavy menstrual bleeding

Structure

a) Evidence of local arrangements for women with heavy menstrual bleeding related to large uterine fibroids who choose surgical or radiological intervention to have a documented discussion about uterine artery embolisation, myomectomy and hysterectomy.

Data source: Local data collection.

b) Evidence that service providers have arrangements to refer women for uterine artery embolisation and myomectomy if these interventions are not provided locally.

Data source: Local data collection. The National heavy menstrual bleeding audit includes an organisational audit to establish provision of treatment options (see section 4 in the first annual report of the National heavy menstrual bleeding audit). These data may inform a baseline assessment.

Process

The proportion of women with heavy menstrual bleeding related to large uterine fibroids who choose surgical or radiological intervention who have a documented discussion about uterine artery embolisation, myomectomy and hysterectomy.

Numerator – the number of women in the denominator who have a documented discussion about uterine artery embolisation, myomectomy and hysterectomy.

Denominator – the number of women with large uterine fibroids and heavy menstrual bleeding who choose surgical or radiological intervention.

Data source: Local data collection. The National heavy menstrual bleeding audit includes an analysis of patterns of surgical treatment for women with heavy menstrual bleeding (see section 3 and appendix 3 in the first annual report of the National heavy menstrual bleeding audit). These data may inform a baseline assessment.

Outcome

a) Women's satisfaction with the decision-making process around radiological and surgical treatment options for heavy menstrual bleeding related to large uterine fibroids.

Data source: Local data collection. The National heavy menstrual bleeding audit includes an analysis of women's self-reported experiences of the secondary care they received. The analysis includes the elements 'information received and satisfaction with information received', 'communication with doctors in secondary care' and 'overall rating of care received' (see section 7 in the third annual report of the National heavy menstrual bleeding audit). These data may inform a baseline assessment.

b) Rates of uterine artery embolisation, myomectomy and hysterectomy.

Data source: Local data collection. The National heavy menstrual bleeding audit includes an analysis of patterns of surgical treatment for women with heavy menstrual bleeding (see section 3 and appendix 3 in the first annual report of the National heavy menstrual bleeding audit). These data may inform a baseline assessment.

Documented discussion

The discussion should be between the woman and the relevant clinician. It should reflect the guidance in sections 1.7 and 1.8 of NICE clinical guideline 44 and include the different types of interventions and the potential short-, medium- and long-term effects these can have. This discussion should be documented in the woman's notes. Written information about the different treatment options should be given to the woman.

Uterine fibroids

The full clinical guideline on heavy menstrual bleeding defines uterine fibroids as smooth-muscle tumours of the uterus, generally benign although occasionally (less than 1%) malignant. They vary greatly in size from millimetres to tens of centimetres, and are associated with heavy periods, pressure symptoms and occasionally pain. Small uterine fibroids are 3 cm or less in diameter and large uterine fibroids are more than 3 cm in diameter.

Women who choose further intervention

This includes women for whom other treatments have failed, been declined or are contraindicated.