Standards aim to reduce invasive procedures for heavy periods

Australia’s rates of hysterectomy remain high compared to other OECD countries, despite women increasingly choosing less invasive options to treat heavy menstrual bleeding.
 
Released this week by the Australian Commission on Safety and Quality in Health Care (ACSQHC), the Women’s Health Hub includes national data revealing a 20% fall in hysterectomy rates over eight years, and a 10% increase in rates of endometrial ablation – the less invasive alternative to managing heavy menstrual bleeding.
 
The ACSQHC also released the updated Heavy Menstrual Bleeding Clinical Care Standard which aims to provide more treatment options and empower women to make informed healthcare choices. First developed in 2017, the 2024 revision builds on this in response to an unexplained variation in rates of hysterectomy across Australia.
 
Associate Professor Liz Marles, GP and ACSQHC Clinical Director, says while these findings are encouraging, Australia has a long way to go to ensure women with heavy menstrual bleeding can access the full range of treatment options.
 
‘Heavy periods are a hidden problem that a lot of women live with,’ she said.
 
‘It can be a sensitive topic that some women do not feel comfortable raising with their doctor. The Commission’s work advocates on behalf of these women, many of whom have had their life substantially affected.
 
‘We want women to know they don’t have to put up with symptoms, to feel comfortable talking about their periods and to be aware that there are a range of treatments, which don’t necessarily involve a major operation.’
 
The new data and revised clinical care standard aim to improve understanding of the risks and benefits of treatments for heavy menstrual bleeding. Options for treating heavy periods include oral medicines, hormonal IUD, and procedures such as endometrial ablation – removal of the uterus lining using heat. The most invasive treatment is having the major procedure of a hysterectomy.
 
As part of the launch, the ACSQHC’s new Women’s Health Focus Report examines the two procedures.
 
Despite the dip in invasive procedures to treat heavy periods, Australia’s rate of hysterectomy remaining significantly higher than comparable OECD countries such as New Zealand and the UK.
 
In 2021–22 an estimated 24,030 Australian women aged 15 years and over with a non-cancer diagnosis had a hysterectomy. Hysterectomy rates in 2019 were 215 per 100,000 women, compared to 132 per 100,000 in the UK and 126 in New Zealand.
 
The report details geographical areas with the highest and lowest rates of both procedures, revealing disparities between where people live.
 
Both hysterectomy and endometrial ablation rates are higher in regional areas than major cities and remote areas, with hysterectomy rates 9% higher among Aboriginal and Torres Strait Islander women.
 
Associate Professor Marles said these findings indicate nationally inconsistent access to treatments for heavy menstrual bleeding and highlight the need for culturally appropriate care.
 
‘Every woman should have access to care that is tailored to her needs,’ she said.
 
‘Yet we know that women’s concerns about heavy menstrual bleeding can be overlooked and it can be hard to access suitable care.
 
‘The fact that treatment differs based on where people live suggests there is more work to do.’
 
One in four women of reproductive age experience heavy menstrual bleeding, but less than one in two seek medical treatment, the Women’s Health Focus Report states. The cause of bleeding, the need for contraception, desire for future pregnancy, and co-existing conditions were all listed as factors impacting treatment choices.
 
Associate Professor Marles said the ACSQHC is working with the health sector across Australia to improve care for women with heavy menstrual bleeding, with the revised clinical care standard providing guidance for more equitable access.
 
‘Let’s upskill the healthcare workforce so women are offered the full suite of treatment options, and practitioners can deliver minimally invasive treatments if appropriate, such as the hormonal IUD,’ she said.
 
‘Health practitioners need to ask women about their menstrual health and tailor care to individual needs, so they receive the most suitable treatment, which differs for each woman.
 
‘While some women may choose hysterectomy, we want to avoid them going straight to the most invasive procedure, without being offered less invasive and effective alternatives and information on the risks and benefits.
 
‘Hysterectomy cannot be reversed and has increased risk of complications.’
 
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ACSQHC endometrial ablation heavy menstrual bleeding heavy periods hysterectomy women’s health