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Patients with heavy menstrual bleeding who exhibit risk factors for endometrial cancer or endometrial hyperplasia are offered an endometrial biopsy.
Endometrial biopsy is a minimally invasive procedure that provides information about abnormalities of the endometrial cells. If a patient with heavy menstrual bleeding exhibits risk factors for endometrial cancer or hyperplasia, they require an endometrial biopsy to confirm or rule out these conditions. Clinicians should assess the contributing risk factors for endometrial cancer when deciding to recommend an endometrial biopsy.
You may need an endometrial biopsy, a procedure to take a tissue sample from your uterus to look for abnormal cells or an overgrowth of the lining.
Ensure your patient has an endometrial biopsy if they have risk factors for endometrial cancer or hyperplasia.
Ensure systems, processes, and resources are in place such that patients are able to receive an endometrial biopsy if they exhibit risk factors for endometrial cancer. This includes access to skilled professionals capable of performing a biopsy, the equipment required to do so, and the laboratories required to test the samples once obtained.
Percentage of patients with heavy menstrual bleeding who had an endometrial biopsy
Denominator: number of patients with heavy menstrual bleeding
Numerator: number of patients in the denominator who had endometrial biopsies (exclude biopsies done within a month of endometrial ablation, to exclude non-diagnostic biopsies)
Data sources: local data collection; for system level, Ontario Health Insurance Plan claims database, Discharge Abstract Database, National Ambulatory Care Reporting System
Note: The purpose of this indicator is to measure the overall rate of endometrial biopsies and variation across the province. It is not intended to show whether endometrial biopsies are being done appropriately.
Proportion of women with heavy menstrual bleeding with risk factors for endometrial cancer or hyperplasia who did not have an endometrial biopsy
Denominator: number of patients with heavy menstrual bleeding who have risk factors for endometrial cancer or hyperplasia
Risk factors: age older than 40 years, bleeding that does not improve with pharmacological treatment, chronic anovulation, persistent intermenstrual bleeding, obesity, prolonged exposure to unopposed estrogens or tamoxifen, diabetes, nulliparity, early menarche, family history of endometrial cancer
Numerator: number of patients in the denominator who did not have an endometrial biopsy
Data source: local data collection
Bleeding that does not improve with pharmacological treatment
Persistent intermenstrual bleeding
Age
Older than 40 years
Nature of the bleeding
Bleeding that does not improve with pharmacological treatment‒Persistent intermenstrual bleeding
Other risk factors for endometrial cancer
Chronic anovulation
Obesity
Prolonged exposure to unopposed estrogens or tamoxifen
Diabetes
Nulliparity
Early menarche
Family history of endometrial cancer
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