National HMB Audit

The National HMB Audit is an audit of patient outcomes and experience of treatment for women with heavy menstrual bleeding, carried out by the RCOG in partnership with Ipsos-MORI and the London School of Hygiene and Tropical Medicine (LSHTM).

Overview of the National HMB Audit

The National HMB Audit has four components:

• Organisational audit: a national survey of all NHS acute trusts in England and Wales to evaluate current referral patterns, protocols and practice in the management of HMB (May–September 2012)
• Audit of patient-reported outcomes: a study of symptoms and health-related quality of life among women who attend outpatient gynaecology clinics with complaints of HMB (baseline questionnaire [PDF, 740 kb] distributed in clinics 1 February 2011–31 January 2012; 1-year follow-up questionnaire [PDF, 395 kb] and information sheet [PDF, 62 kb] sent to patients’ homes February 2012–February 2013)
• Second organisational audit: a national survey of NHS acute trusts in England and Wales, to compare the results with the 2010 survey and identify/evaluate changes in referral patterns, protocols and practice in the management of HMB (June–October 2013)
• Case note review: a review of hospital records for a sample of women participating in the audit, to evaluate patient reported data reliability (July–September 2013)

For full details of the audit, please read the National HMB Audit overview (PDF, 221 kb).

Outputs of the National HMB Audit

National HMB Audit annual reports

• Advice for Heavy Menstrual Bleeding (HMB) Services and Commissioners, November 2014 (PDF, 872 kb)
• Advice for HMB Services Checklist, November 2014 (PDF, 141 kb)
• Third Annual Report, 2013 (PDF, 1.72 mb)
• Second Annual Report, 2012 (PDF, 3.19 mb)
• First Annual Report – full report, 2011 (PDF, 3.11 mb)
• First Annual Report – summary for the general public, 2011 (PDF, 339 kb)
• First Annual Report – addendum, 2011 (PDF, 1.22 mb) – covering patterns of surgical treatment for women with HMB in Wales between 2003 and 2010, showing that women living in the most deprived areas of Wales were more likely to have hysterectomies while women in the least deprived areas were more likely to have endometrial ablation.
   

Other outputs

• Kiran A, Geary RS, Gurol-Urganci I, Cromwell D, Bansi-Matharu L, Shakespeare J, Mahmood T, van der Meulen J. Sociodemographic differences in symptom severity and duration among women referred to secondary care for menorrhagia in England and Wales: a cohort study from the National Heavy Menstrual Bleeding Audit. BMJ Open 2018;8:e018444. doi: 10.1136/bmjopen-2017-018444.
• Kiran A, Gurol-Urganci I, Tsang C, Knight H, Cromwell D, Mahmood T, van der Meulen J. National Heavy Menstrual Bleeding Audit: The association between ethnicity and treatment received in hospital. RCOG World Congress 2014. Hyderabad, March 2014 (presented by Knight H).
• Gurol-Urganci I. Use of PROMS in outpatients: heavy menstrual bleeding. King’s Fund PROMS Conference. London, December 2013.
• Cox SM, Cromwell DA, Mahmood TA, Templeton A, La Corte B, van der Meulen JH. The delivery of heavy menstrual bleeding services in England and Wales after publication of national guidelines: a survey of hospitals. BMC Health Services Research 2013;13:491.
• Kiran A , Knight HE, Tsang C, Gurol-Urganci I, Cromwell D, La Corte B, Dougall A, Johnson S, Bansi-Matharu L, Richmond D, Cameron A, Templeton A, Mahmood T , van der Meulen J. ORCA: audit and research in obstetrics and gynaecology. London School of Hygiene & Tropical Medicine – 25 years of health services research. London, November 2013.
• Gurol-Urganci I. Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: population-based cohort study. RCOG World Congress 2013. Liverpool, June 2013.
• Bansi-Matharu L, Gurol-Urganci I, Mahmood TA, Templeton A, van der Meulen JH, Cromwell D. Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: population-based cohort study. BJOG 2013;120:1500–7.
• Bansi-Matharu L. National Heavy Menstrual Bleeding (HMB) Audit. HQIP ESQH European National Clinical Registries and Audit Summit. London, April 2012.
• Thornton S. An audit of patient outcomes and experience of treatment for women with heavy menstrual bleeding. British Society for Gynaecological Endoscopy Annual Scientific Meeting, Wirral, April 2010.
• Cromwell D. Regional variation in surgery for menorrhagia in England. British International Congress of Obstetrics and Gynaecology. Belfast, June 2010.
• Templeton A. Research and clinical audit at the RCOG. British International Congress of Obstetrics and Gynaecology. Belfast, June 2010.
• Mahmood TA. An audit of patient outcomes and experience of treatment for women with heavy menstrual bleeding. British International Congress of Obstetrics and Gynaecology. Belfast, June 2010.

National HMB Audit news

The National HMB Audit team contributed to the National Institute of Health and Care Excellence (NICE) heavy menstrual bleeding quality standard, published in September 2013. The findings from the National HMB Audit helped inform the expert advice for development of the quality standard.

The National HMB Audit was identified as an eligible audit in the Prime Minister’s transparency agenda. The provider-level data from the second and third annual report is now available. For more information, please visit the National HMB Audit data transparency page.

HMB Audit contributors

View the full list of contributors to the recent HMB audit (Excel document, 52 kb).