New clinical standard to help address variation in care for heavy menstrual bleeding

Amanda Lyons

9/11/2017 12:03:12 PM

The Australian Commission on Safety and Quality in Health Care (ACSQHC) recently launched its Heavy menstrual bleeding clinical care standard (the Standard), with the goals of informing best practice for healthcare providers and empowering the 25% of women of reproductive age who experience the condition.

One in four women of reproductive age experiences heavy menstrual bleeding.
One in four women of reproductive age experiences heavy menstrual bleeding.

‘What we hope is that women are able to make informed decisions about the best treatment or management of their heavy menstrual bleeding for themselves,’ Dr Deborah Bateson, Medical Director at Family Planning New South Wales and member of the Standard’s Topic Working Group, told newsGP.         
The Standard’s development was driven by the ACSQHC’s Second Australian atlas of healthcare variation, which found a high degree of variation around Australia of rates of hysterectomy (up to 6.6-fold) and endometrial ablation (up to 20.5-fold), common treatments for heavy menstrual bleeding.
‘[The variation] may suggest that women are not always aware of, or are possibly not always being offered, other less invasive procedures than hysterectomy for their heavy menstrual bleeding,’ Dr Bateson said.
The Standard contains eight statements that describe high-priority areas for quality improvement and suggest an order in which treatment decisions should proceed:

  1. Assessment and diagnosis
  2. Informed choice and shared decision making
  3. Initial treatment is pharmaceutical
  4. Quality ultrasound
  5. Intra-uterine hormonal devices (IUDs)
  6. Specialist referral
  7. Uterine-preserving alternatives to hysterectomy
  8. Hysterectomy
Dr Bateson said she is particularly keen to increase awareness of IUDs in treating heavy menstrual bleeding, and ensure that women across the country have access to this option.
‘[IUDs] reduce blood loss by around about 90% and are suitable for many women,’ she said. ‘They’re certainly something everyone should consider as a first-line [treatment], and we need to ensure there’s someone in every general practice who is able to insert IUDs or that there’s a fast-track mechanism to refer someone on to have them inserted.’
The ACSQHC’s Heavy menstrual bleeding clinical care standard is available online.

ACSQHC Australian-Commission-on-Safety-and-Quality-in-Health-Care heavy-menstrual-bleeding menstruation women's-health

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