Heavy Menstrual Bleeding Clinical Care Standard 1. Assessment and diagnosis The initial assessment of a woman with symptoms of heavy menstrual bleeding includes a detailed medical history, assessment of impact on quality of life, a physical examination and exclusion of pregnancy and anaemia. Further investigations are based on the initial assessment. 2. Specialist referral for women with risk factors A woman with heavy menstrual bleeding who has risk factors for, or clinical findings suspicious of malignancy, or who is not responding to medical treatment, is referred to a specialist. Appropriate investigations are performed and initial symptomatic management is provided before the specialist appointment. 3. Quality ultrasound When the presence of a uterine abnormality is being considered, a woman with heavy menstrual bleeding has a pelvic (preferably transvaginal) ultrasound performed in days 5 to 10 of her menstrual cycle. 4. Informed choice and shared decision making A woman with heavy menstrual bleeding is provided with consumer-focused information about her treatment options and their potential benefits and risks. She is asked about her preferences in order to support shared decision making for her clinical situation. 5. Initial treatment is pharmaceutical A woman with heavy menstrual bleeding in whom malignancy and significant pelvic pathology have been ruled out, is offered pharmaceutical treatment initially, taking into account evidence-based guidelines, her individual needs and any associated symptoms. 6. Choice of pharmaceutical treatment When pharmaceutical treatment is being considered, the woman is offered the levonorgestrel intra-uterine system if clinically appropriate, as it is the most effective option for managing heavy menstrual bleeding.
Heavy Menstrual Bleeding Clinical Care Standard 1. Assessment and diagnosis The initial assessment of a woman with symptoms of heavy menstrual bleeding includes a detailed medical history, assessment of impact on quality of life, a physical examination and exclusion of pregnancy and anaemia. Further investigations are based on the initial assessment. 2. Specialist referral for women with risk factors A woman with heavy menstrual bleeding who has risk factors for, or clinical findings suspicious of malignancy, or who is not responding to medical treatment, is referred to a specialist. Appropriate investigations are performed and initial symptomatic management is provided before the specialist appointment. 3. Quality ultrasound When the presence of a uterine abnormality is being considered, a woman with heavy menstrual bleeding has a pelvic (preferably transvaginal) ultrasound performed in days 5 to 10 of her menstrual cycle. 4. Informed choice and shared decision making A woman with heavy menstrual bleeding is provided with consumer-focused information about her treatment options and their potential benefits and risks. She is asked about her preferences in order to support shared decision making for her clinical situation. 5. Initial treatment is pharmaceutical A woman with heavy menstrual bleeding in whom malignancy and significant pelvic pathology have been ruled out, is offered pharmaceutical treatment initially, taking into account evidence-based guidelines, her individual needs and any associated symptoms. 6. Choice of pharmaceutical treatment When pharmaceutical treatment is being considered, the woman is offered the levonorgestrel intra-uterine system if clinically appropriate, as it is the most effective option for managing heavy menstrual bleeding.
Heavy%20Menstrual%20Bleeding%20Clinical%20Care%20Standard_consultation%20version.docx