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Evidence to Improve Care

Heavy Menstrual Bleeding

Care for Adults and Adolescents of Reproductive Age


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.


Imaging of the uterus by ultrasound is indicated if the clinician suspects that a patient with heavy menstrual bleeding has structural abnormalities within the pelvis that require further investigation.

If imaging is needed, a lower abdominal ultrasound is typically followed by transvaginal ultrasound to visualize the uterine cavity. Transabdominal pelvic evaluation alone may be more appropriate in patients who are not sexually active. If further investigations are needed, the clinician may consider saline-infused hysterography, hysteroscopy, or magnetic resonance imaging.

For Patients

You may need an ultrasound of your uterus to look at its size or shape. An ultrasound uses sound waves to take pictures.


For Clinicians

Ultrasound is the first-line imaging technique for patients with heavy menstrual bleeding. Do a pelvic exam before considering ultrasound. Your patient is a candidate for ultrasound if, based on the pelvic exam, you suspect structural abnormalities that need further investigation. If you’ve done a pelvic exam and do not suspect a structural abnormality, but your patient is not improving with pharmacological treatment, it is acceptable to order an ultrasound.


For Health Services

Ensure systems, processes, and resources are in place such that all patients, have access to ultrasound of the uterus when needed.

Process Indicator

Percentage of patients with heavy menstrual bleeding who have ultrasound imaging of the uterus and did not have a pelvic or gynecological exam in the preceding year

  • Denominator: number of patients with heavy menstrual bleeding who had ultrasound imaging of the uterus

  • Numerator: number of patients in the denominator who did not have a pelvic or gynecological exam in the 12 months before ultrasound imaging

  • Data source: local data collection

Note: This indicator measures the inappropriate use of ultrasound for heavy menstrual bleeding.

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