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Evidence to Improve Care

Heavy Menstrual Bleeding

Care for Adults and Adolescents of Reproductive Age

Click below to see a list of brief quality statements and scroll down for more information.​​


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence. ​

See below for the quality statements and click for more detail.​


Quality Statement 1: Comprehensive Initial Assessment
Patients with symptoms of heavy menstrual bleeding have a detailed history taken, gynecological exam, complete blood count test, and pregnancy test (if pregnancy is possible) during their initial assessment.


Quality Statement 2: Shared Decision-Making
Patients with heavy menstrual bleeding are provided with information on all potential treatment options and are supported in making an informed decision on the most appropriate treatments for them, based on their values, preferences, and goals, including their desire for future fertility.


Quality Statement 3: Pharmacological Treatments
Patients with heavy menstrual bleeding are offered a choice of non-hormonal and hormonal pharmacological treatment options.


Quality Statement 4: Endometrial Biopsy
Patients with heavy menstrual bleeding who exhibit risk factors for endometrial cancer or endometrial hyperplasia are offered an endometrial biopsy.


Quality Statement 5: Ultrasound Imaging
Patients with heavy menstrual bleeding who have suspected structural abnormalities based on a pelvic exam, or who have tried pharmacological treatment but have not had significant improvement in their symptoms, are offered an ultrasound of their uterus.


Quality Statement 6: Referral to a Gynecologist
Patients with heavy menstrual bleeding have a comprehensive initial assessment and pharmacological treatments offered prior to referral to a gynecologist. Once the referral has been made, patients are seen by the gynecologist within 3 months.


Quality Statement 7: Endometrial Ablation
Patients with heavy menstrual bleeding who do not wish to preserve their fertility are offered endometrial ablation. In the absence of structural abnormalities, patients have access to non-resectoscopic endometrial ablation techniques.


Quality Statement 8: Acute Heavy Menstrual Bleeding
Patients presenting acutely with uncontrolled heavy menstrual bleeding receive interventions to stop the bleeding, therapies to rapidly correct severe anemia, and an outpatient follow-up appointment with a health care professional at or immediately following their next period (roughly 4 weeks).


Quality Statement 9: Dilation and Curettage
Patients with heavy menstrual bleeding do not receive dilation and curettage unless they present acutely with uncontrolled bleeding and medical therapy is ineffective or contraindicated.


Quality Statement 10: Offering Hysterectomy
Patients with heavy menstrual bleeding are offered hysterectomy only after a documented discussion about other treatment options, or after other treatments have failed.


Quality Statement 11: Least Invasive Hysterectomy
Patients with heavy menstrual bleeding who have chosen to have a hysterectomy have it performed by the least invasive method possible.


Quality Statement 12: Treatment for Fibroids Causing Heavy Menstrual Bleeding
Patients with heavy menstrual bleeding related to fibroids are offered uterine artery embolization, myomectomy, and hysterectomy as treatment options.


Quality Statement 13: Bleeding Disorders in Adolescents
Adolescents with heavy menstrual bleeding are screened for risk of inherited bleeding disorder, using a structured assessment tool.


Quality Statement 14: Treatment of Anemia and Iron Deficiency
Patients with heavy menstrual bleeding who have been diagnosed with anemia or iron deficiency are treated with oral and/or intravenous iron.

2

Shared Decision-Making

Patients with heavy menstrual bleeding are provided with information on all potential treatment options and are supported in making an informed decision on the most appropriate treatments for them, based on their values, preferences, and goals, including their desire for future fertility.


Shared decision-making involves a partnership between the clinician and the patient. The health care professional brings clinical expertise to the discussion while the patient brings knowledge about the impact the heavy menstrual bleeding is having on their life and about their goals for treatment. To facilitate informed shared decision- making about treatment, clinicians should provide patients with accurate information about the range of normal menstrual bleeding and all potential treatment options for the patient’s specific case. Patients should receive information on the treatment objectives, side effects, risks, impact on fertility, and anticipated out-of-pocket costs of all potential treatment options.

For Patients

You should decide what treatment you prefer after discussing all the options with your health care professional. You should be told about any side effects, risks, effects on your ability to get pregnant, and out-of-pocket costs.


For Clinicians

Provide patients with information on all potential treatment options and help them make a decision consistent with their values and preferences.


For Health Services

Ensure systems, processes, policies, and resources are in place such that patients have access to their treatment of choice.

Process Indicator

Percentage of patients with heavy menstrual bleeding who reported that they received information from their health care professional about treatment options, including information on treatment objectives, side effects, risks, impact on fertility, and potential out-of-pocket costs of each option

  • Denominator: number of patients with heavy menstrual bleeding

  • Numerator: number of patients with heavy menstrual bleeding who reported that they received information from their health care professional about their treatment options, including information on:

    • Treatment objectives

    • Side effects

    • Risks

    • Impact on fertility

    • Potential out-of-pocket costs

  • Data source: local data collection

Note: The indicator can be calculated as an overall percentage and by each listed component.


Percentage of patients with heavy menstrual bleeding who reported that they received their preferred treatment option

  • Denominator: number of patients with heavy menstrual bleeding

  • Numerator: number of patients with heavy menstrual bleeding who reported that they received their preferred treatment option

  • Data source: local data collection

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