A Review of the Management of Heavy Menstrual Bleeding (HMB) at Sunderland Royal Hospital (SRH)

ABSTRACT NUMBER: NESTAC_01

AUTHORS
Umar R1, Gudipati M2

AFFILIATIONS
1Medical Student, Newcastle University, Newcastle Upon Tyne. 2Consultant Obstetrics and Gynaecologist, Sunderland Royal Hospital, Sunderland.

CORRESPONDING AUTHOR CONTACT EMAIL
ku.shn.tfshc@itapidug.ivadham

MAIN ABSTRACT TEXT

Background
• HMB affects one quarter of women of reproductive age and is one of the most common referrals to secondary care.
• Sunderland Clinical Commissioning Group (SCCG) advocates that all treatments should be used prior to hysterectomy, unless previously failed or contraindicated.(1)
• A quality improvement project found that 17.08% of hysterectomies at SRH were performed in women <40 years, higher than the national average.(2)

Aims
• To evaluate compliance with SCCG guidelines to treatments available before hysterectomy.(1,2)

Method
• Retrospective cohort study (January 2016 to December 2018) identified all women with benign hysterectomies.
• Electronic notes, correspondence letters and investigation results were retrieved to collect information on management of HMB.

Results
• 131 of the 459 women identified had a hysterectomy for HMB.
• In 84.7-98.5% of women, treatments were considered (i.e. offered/tried, contraindicated, attempted or patient declined).
• Undocumented data ranged from 1.5-15.3% across all treatments.
• 22.9% and 25.2% of women for Depo-Provera® and endometrial ablation respectively, were unsuitable options due to large symptomatic fibroid uterus.
• 36.6% of women declined Depo-Provera® for concerns over weight gain and irregular bleeding.

Conclusions
• Hysterectomies in women <40 years were after failure of all treatments before hysterectomy.
• Overall, all treatments were well considered as per SCCG recommendations, however a high proportion particularly Depo-Provera® was declined.
• I recommend a proforma for treatment options, to act as aide memoire for clinicians, improve documentation and help with future audits.

References
1) Value Based Clinical Commissioning Policies Sunderland CCG. 2016 Version 4.0.
2) Getting It Right First Time (GIRFT): Obstetrics and Gynaecology Review 2017 City Hospital Sunderland NHS Foundation Trust.