Is heavy menstrual bleeding investigated and managed appropriately?

Kirkwood-Wilson, R.; Bardapure, J; Sangeeta, Das

doi:10.3109/01443615.2012.750287

Cited by 2 publications

(7 citation statements)

References 12 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…25 A 2013 study also highlighted inconsistencies in the management of women with HMB. 3 Treatment options should be offered in a hierarchical fashion outlined by NICE. This is the first step that would decrease the number of referrals to secondary care and therefore reduce costs and reduce the resource burden in gynaecological services.…”

Section: Discussionmentioning

confidence: 99%

“…This is the first step that would decrease the number of referrals to secondary care and therefore reduce costs and reduce the resource burden in gynaecological services. 3…”

Section: Discussionmentioning

confidence: 99%

“…2 HMB can have a significant impact on a woman's physical and psychological well-being, leading to a reduction in quality of life as well as utilising significant health service resources. 3,4 The structural anomalies responsible for causing HMB are endometrial polyps, submucosal fibroids and malignancy. 5 In the United Kingdom, in primary care, the initial management for HMB should be pharmacological treatment without other investigations.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Should outpatient hysteroscopy be used in preference to transvaginal ultrasound to identify endometrial pathology in premenopausal women with heavy menstrual bleeding? Revisiting NICE Guideline 88

Litherland

Phillips

2023

Ultrasound

View full text Add to dashboard Cite

Introduction: National Institute for Health and Care Excellence Guideline 88 advocates outpatient hysteroscopy in preference to transvaginal ultrasound for premenopausal women with heavy menstrual bleeding, who are suspected of having submucosal fibroids, polyps or endometrial pathology. The guideline, however, analysed outdated studies that provided low-quality evidence. This study aimed to assess the diagnostic accuracy of transvaginal ultrasound in detecting endometrial pathology; and to evaluate the cost-effectiveness of outpatient hysteroscopy if it were to be used in preference to transvaginal ultrasound. Methods: A health service evaluation was conducted at a district general foundation trust between 1 January 2019 and 31 March 2019 of all premenopausal women with heavy menstrual bleeding. A cost-effectiveness analysis was also performed to evaluate the financial implication of outpatient hysteroscopy being used in preference to transvaginal ultrasound. Results: 100 patients were included in the study. For the detection of endometrial pathology, transvaginal ultrasound had a positive predictive value of 65.2%; negative predictive value of 98.5%; sensitivity of 93.75%; specificity of 88.89% and an accuracy of 89.77%. For identifying endometrial polyps, submucosal fibroids and endometrial thickening, transvaginal ultrasound had a positive predictive value of 33.3%, 85.7% and 50%, respectively. It would have cost the Trust 78.7% more if National Institute for Health and Care Excellence’s recommendation was carried out, with a 23.4% increase in workload in the hysteroscopy department, and a decrease of 7.8% transvaginal scans performed. Conclusion: Outpatient hysteroscopy is costly and would increase the workload burden in the hysteroscopy department. Transvaginal ultrasound has a high sensitivity, specificity and accuracy in detecting endometrial pathology therefore it should remain as the initial diagnostic investigation.

show abstract

Section: Discussionmentioning

confidence: 99%

“…This is the first step that would decrease the number of referrals to secondary care and therefore reduce costs and reduce the resource burden in gynaecological services. 3…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Should outpatient hysteroscopy be used in preference to transvaginal ultrasound to identify endometrial pathology in premenopausal women with heavy menstrual bleeding? Revisiting NICE Guideline 88

Litherland

Phillips

2023

Ultrasound

View full text Add to dashboard Cite

show abstract

“…A more contemporary definition is that proposed by the National Institute of Health and Care Excellence (NICE): "excessive menstrual blood loss which interferes with a woman's physical, social, emotional and/or material quality of life" [1]. HMB is common in women of reproductive age [2] accounting for a large proportion of health care resources in primary and secondary care [3]. Internationally, the World Health Organisation estimates that 18 million women suffer from HMB [4].…”

Section: Introductionmentioning

confidence: 99%

“…There are a variety of medical, radiological and surgical treatments for HMB but accurate diagnosis of the underlying cause is needed to optimise outcomes [3]. Several structural and non-structural causes for HMB have been identified within the International Federation for Obstetrics and Gynaecology (FIGO) PALM-COEIN classification system.…”

Section: Introductionmentioning

confidence: 99%

Investigation of the contribution of an underlying platelet defect in women with unexplained heavy menstrual bleeding

et al. 2018

View full text Add to dashboard Cite

Heavy menstrual bleeding (HMB) is often undiagnosed in women and can cause discomfort and distress. A haemostatic cause for excessive bleeding is often not routinely investigated and can lead to hysterectomy at an early age. A prospective cohort study was carried out to determine whether certain patients with unexplained HMB have an underlying platelet function defect (PFD). The Genotyping and Phenotyping of Platelets (GAPP) study recruited 175 women with HMB and 44 unrelated volunteers from 25 Haemophilia Centres across the UK, and a tertiary gynaecology service. Bleeding history was assessed using the International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT). Platelet count, platelet size, haemoglobin and mean corpuscular volume were measured in whole blood using the Sysmex XN-1000 Haematology Analyzer. Platelet function testing using lumiaggregometry and flow cytometry was performed in patients included in this study. A PFD was identified in 47% (82/175) of patients with HMB. Cutaneous bleeding was the most frequent additional bleeding symptom (89% in PFD and 83% with no PFD). Whole blood platelet count was significantly lower ( P < 0.0001) between the PFD group and no PFD group. The prevalence of anaemia did not differ between patients and healthy volunteers. Clinical evaluation alone is insufficient to determine presence of an underlying PFD in patients with HMB. Platelet function tests may be considered and clinical guidelines may include them in their algorithms. An appropriate diagnosis and subsequent tailored management of HMB may prevent unnecessary surgery and help manage future haemostatic challenges.

show abstract

Is heavy menstrual bleeding investigated and managed appropriately?

Cited by 2 publications

References 12 publications

Should outpatient hysteroscopy be used in preference to transvaginal ultrasound to identify endometrial pathology in premenopausal women with heavy menstrual bleeding? Revisiting NICE Guideline 88

Should outpatient hysteroscopy be used in preference to transvaginal ultrasound to identify endometrial pathology in premenopausal women with heavy menstrual bleeding? Revisiting NICE Guideline 88

Investigation of the contribution of an underlying platelet defect in women with unexplained heavy menstrual bleeding

Contact Info

Product

Resources

About