Abstract
BackgroundIn 2007–2008, two UK-based organisations, the National Institute for Health and Clinical Excellence and the Royal College of Obstetricians and Gynaecologists, published guidelines for the management of care and organisation of outpatient services for women with heavy menstrual bleeding (HMB). In 2010, this study was conducted to provide an update on guideline-related services provided in England and Wales, and whether they are consistent with national clinical guidelines two to three years after publication.MethodsAn organisational survey of outpatient gynaecology clinics was conducted of 221 hospitals in 154 acute National Health Service (NHS) trusts in England and Wales. A questionnaire was distributed to all hospitals to examine provision of diagnostic and therapeutic services in outpatient settings. Descriptive statistics were used to summarize results.ResultsThe response rate was 100%. For diagnosis, 80% of hospitals had ultrasound, 87% had hysteroscopy, and 98% had endometrial biopsy available. Overall, 76% of hospitals provided an information leaflet, 8% referred patients to a website for information, and 20% did not provide any written information. A dedicated menstrual bleeding clinic was present in 38% of hospitals. Only 30% of hospitals reported that they have a local written protocol regarding the care and management of women with HMB.ConclusionThe majority of hospitals offer appropriate diagnostic and surgical services for women with HMB. However, local protocol development may not reflect the local services. It may be that hospitals are finding it difficult to summon resources to provide clinics for women with menstrual disorders.
Highlights
In 2007–2008, two UK-based organisations, the National Institute for Health and Clinical Excellence and the Royal College of Obstetricians and Gynaecologists, published guidelines for the management of care and organisation of outpatient services for women with heavy menstrual bleeding (HMB)
The organisational survey presented here sought to answer the question as to whether outpatient care for women with HMB currently met national guidelines, which had been developed by National Institute for Health and Clinical Excellence (NICE) and Royal College of Obstetricians and Gynaecologists (RCOG) in response to “a lack of consensus about the best form of management of this condition” [6,7,11]
While we acknowledge that some specialised care for women with HMB may be provided by specialty primary care clinics or other women’s health clinics provided by the private sector, this national survey comprehensively describes the organisation of outpatient care in the National Health Service (NHS) across England and Wales
Summary
In 2007–2008, two UK-based organisations, the National Institute for Health and Clinical Excellence and the Royal College of Obstetricians and Gynaecologists, published guidelines for the management of care and organisation of outpatient services for women with heavy menstrual bleeding (HMB). Heavy menstrual bleeding (HMB) is estimated to affect approximately 5% to 30% of women of reproductive age. It is the fourth most common cause for referral to gynaecological services in the UK [1,2]. In 2007, the National Institute for Health and Clinical Excellence (NICE) published Heavy Menstrual Bleeding, a national guideline on the management of HMB [6]. Significant regional variation in surgical treatment rates did not diminish between 2006 and 2009 [8]
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