Costeffectiveness of diagnostic strategies for the management of abnormal uterine bleeding heavy menstrual bleeding and postmenopausal bleeding. Abnormal uterine bleeding aub is any variance of the normal menstrual cycle, which is defined on the basis of four parameters frequency, regularity, duration, and volume. Heavy menstrual bleeding there are medical definitions of heavy menstrual bleeding, but the only practical definition is when there is excessive menstrual blood loss that interferes with the physical, emotional, social and material quality of life. Everything nice has said on assessing and managing heavy menstrual bleeding in an interactive flowchart. The classic objective criteria of blood loss 80 mlcycle using laboratory techniques or pictorial blood loss assessment chart pbac. The managing heavy menstrual bleeding path for the heavy menstrual bleeding pathway. The new treatment pathway recommends investigating the symptoms and causes of menorrhagia, which in many cases will now lead to a hysteroscopy, previously only considered after pelvic and transvaginal ultrasounds. It is a type of abnormal uterine bleeding aub abnormal uterine bleeding can be caused by structural abnormalities in the reproductive tract, anovulation, bleeding disorders, hormone issues such as hypothyroidism or cancer of the reproductive tract. This site is intended for uk healthcare professionals subscribe to our free ebulletin.
These recommendations are based on the british medical journal bmj best practice guide uterine fibroids, the national institute for health and clinical excellence nice guideline heavy menstrual bleeding. The updated 2018 nice guideline is built on the 2007 guidance, endorses a methodical and costeffective approach to the assessment and management of heavy menstrual bleeding based on expert opinion, and includes 30 clinical tables on the diagnostic accuracy of ultrasonography and hysteroscopy. Heavy menstrual bleeding hmb is defined as excessive menstrual blood loss which interferes with a. Treatments can broadly be classified into medical, surgical and radiological options.
Combined hormonal contraceptives for heavy menstrual bleeding. It aims to help healthcare professionals investigate. It aims to help healthcare professionals appropriately investigate the causes of the heavy periods that are affecting a womans quality of life. Assessment and management of heavy menstrual bleeding.
Nice guidance on heavy menstrual bleeding highlights. This jama clinical guidelines synopsis summarizes the united kingdom 2018 national institute for health and care excellence nice. New nice guideline on heavy menstrual bleeding published rcog. This guidance has been updated and replaced by heavy menstrual bleeding. This guideline covers assessing and managing heavy menstrual bleeding menorrhagia.
Follow the principles in the nice guideline on patient experience in adult nhs services in relation to communication, information and shared decisionmaking. Nice wants this guideline to make a difference to women with heavy menstrual bleeding by making sure that. Heavy menstrual bleeding hmb in female athletes part 2. The guideline covers the assessment and management of women with heavy menstrual bleeding. The initial assessment of a woman presenting with heavy menstrual bleeding includes a detailed medical history, assessment of impact on quality of life, a physical examination, and exclusion of pregnancy, iron deficiency and anaemia.
Heavy menstrual bleeding clinical care standard consumer fact sheet these resources were referred to during the webinar for further reading and information. It is defined as blood loss greater than 80ml equal to onethird of a cup per cycle, or periods. This article provides a brief summary of the guidance. The variety of therapeutic interventions allows management to be individualised taking into account a womans preference. This cks topic is largely based on the national institute for health and care excellence nice guideline heavy menstrual bleeding. It is said to affect 3% of women, with those aged 4051 years most likely to present to healthcare services. If obstetriciangynecologists suspect that a patient has a bleeding disorder, they should work in coordination with a hematologist for laboratory evaluation and medical management. Bleeding can last up to eight days, but bleeding for five days is average. We are happy to announce the publication of the nice guideline on heavy menstrual bleeding developed by the national guideline alliance nga. For heavy menstrual bleeding, the choice of surgical treatment should be made jointly by the woman and the clinician responsible for treatment.
A common and often debilitating condition, affecting women of reproductive age. Nice guidance on heavy menstrual bleeding highlights importance of patient choice. Everything nice has said on assessing and managing heavy menstrual bleeding in an interactive flowchart az topics latest a. Treatment aims are to improve quality of life and alleviate associated symptoms, not necessarily to cure heavy bleeding. Abnormal uterine bleeding treatment algorithm bmj best. To reflect these developments, nice published nice guideline ng 88 on heavy menstrual bleeding. Evidencebased information on clinical guidelines for heavy menstrual bleeding from hundreds of trustworthy sources for health and social care. The national institute for care and excellence defines heavy menstrual bleeding hmb as excessive menstrual blood loss mbl that interferes with the physical, social, emotional andor material quality of life. Management of heavy menstrual bleeding heavy menstrual. The new nice guideline helps healthcare professionals investigate the cause of heavy periods that are affecting a womans quality of life and to offer the right treatments, taking into account the womans priorities and preferences dr anne connolly, gp, dr diana mansour, consultant and dr asha kasliwal, consultant, discuss the new guideline, what it means for srh clinicians and. These are frequent symptoms that raise concerns about gynaecological cancer. Heavy menstrual bleeding also known as menorrhagia is excessive andor prolonged menstrual bleeding. By dr anne connolly on the 30 october 2018 nice recommends that women should be provided with sufficient information for them to be able to make their own choice about treatment options, explains dr anne connolly.
This guidance has been updated and replaced by nice guideline ng88. This second article outlines clinical investigations to consider and. Provide women with information about hmb and its management. It aims to help healthcare professionals investigate the cause of heavy periods that are affecting a womans quality of life and to offer the right treatments, taking into account the womans priorities and preferences. The amount varies from woman to woman and can change at different stages in your life. Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a womans physical, social, emotional, or material quality of life. Menorrhagia, also known as heavy menstrual bleeding hmb, is widely accepted as the loss of menstrual blood of. Heavy menstrual bleeding assessment and management. Nice heavy menstrual bleeding guideline guidelines. Heavy menstrual bleeding nice a4medicine heavy menstrual bleeding assessment and management evaluate impact heavy menstrual bleeding hmb is one of the commonest reason for gynecological referral and consultations about 1 in 20 women aged 3049 yrs see gp year for hmb or menstrual problems menstrual disorders comprise. Heavy menstrual bleeding is a common problem affecting 25% of women of reproductive age. All patients should be strongly encouraged to keep bmi in health range. A service of the national library of medicine, national institutes of health.
Joint rcog, bsge and bgcs guidance for the management of. Combined oral contraceptives for heavy menstrual bleeding. Nice heavy menstrual bleeding guideline nice guideline. Heavy menstrual bleeding, previously known as menorrhagia, is a menstrual period with excessively heavy flow. Heavy menstrual bleedingnice a4medicine authorstream.
The national institute for health and care excellence nice has updated its guidance on heavy menstrual bleeding. New nice guideline on heavy menstrual bleeding published. The guideline is a partial update of the 2007 nice guideline on heavy menstrual bleeding. March 2018 dr hayley willacy recommends reading the recently released national institute for health and care excellence nice guideline dealing with the assessment and management of heavy menstrual bleeding. Our trial reflects contemporary practice in the uk, where nice defines heavy menstrual bleeding as excessive menstrual bleeding that affects a womans quality of life and recommends the levonorgestrel releasing intrauterine system or an alternative medical treatment as the first step in women with no identified pathology or fibroids less than 3. A systematic approach to chronic abnormal uterine bleeding.
It can occur alone or in combination with other symptoms. Guidelines for the management of heavy menstrual bleeding explanation of grading of evidence the working party accepted a grading of evidence recommended by the department of health, uk and endorsed by the national health service executive, uk mann 1996. Heavy periods menorrhagia causes and treatment patient. Offering hysterectomy as a firstline treatment option may result in an increase in hysterectomies.
Heavy menstrual bleeding hmb is defined as excessive menstrual blood loss which interferes with a womans physical, social, emotional andor material quality of life. In current practice, hysterectomy is a secondline treatment strategy for heavy menstrual bleeding, for which women need to have tried firstline treatment strategies, and for these to be unsuccessful, before being offered a hysterectomy. Heavy menstrual bleeding clinical care standard 1 assessment and diagnosis. Surgical management is likely to be declined if bmi is over 35. This consensus statement provides a framework for the management of women with abnormal uterine bleeding heavy menstrual bleeding hmb, intermenstrual imb, postmenopausal bleeding pmb or post coital bleeding pcb during the current pandemic. Heavy menstrual bleeding has been defined as excessive menstrual blood loss which interferes with the womans physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms. The definition of excessive is set by the woman who presents with the problem. Heavy menstrual bleeding nice clinical guideline 44. On march 14, nice published a substantial update to their 2007 clinical guideline, heavy menstrual bleeding. There are a number of treatments available to alleviate hmb and improve the healthrelated quality of life of women with this condition. Heavy menstrual bleeding nice clinical guideline 44 heavy menstrual bleeding hmb is defined as excessive menstrual blood loss which interferes with a womans physical, social, emotional andor material quality of life. Heavy menstrual bleeding hmb is a description of excessive menstrual loss which interferes with a womans quality of life either on its own or in combination with other symptoms. Heavy menstrual bleeding nice clinical guideline 44 rcog.
1475 1165 1094 1039 557 320 68 863 1333 1553 257 194 1197 559 501 788 879 972 1558 805 879 831 328 456 848 937 650 979 1428 341 1486 1320 1173 822 1356 1596 1149 898 1039 1153 579 1031 1481 668 1286 1424 529 1356 967 1142 542