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RCOG announcement: Advice for heavy menstrual bleeding (HMB) services and commissioners

News 14 November 2014

The Royal College of Obstetricians and Gynaecologists (RCOG) has produced an advisory report summarising the results of the heavy menstrual bleeding (HMB) Audit and current guidelines to provide commissioners with recommendations for clinical care.

Heavy menstrual bleeding (HMB) is a prevalent condition that affects 20 – 30% of women of a reproductive age.

The RCOG, commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme, conducted a four-year national audit from 2010 to 2013 to examine the care received by women with HMB and to assess patient outcomes and experience of care. The audit consisted of an organisational audit of acute NHS providers in England and Wales and a prospective audit of patient-reported outcomes for women with the condition.

Comparing the results of the audit with the recommendations in the clinical guideline (2007) and quality standard (2013) issued by NICE and the RCOG standards for gynaecology (2008), the RCOG concludes that:

  • The existing local referral pathways between primary and secondary care should be reviewed given that nearly a third of women reported that they had not received any treatment for their HMB in primary care.
  • Care provided to women of non-white ethnicity and those from more socio-economically deprived areas should be reviewed as these women are less likely to have surgical treatment and they report smaller improvements of their conditions than white women.
  • For patients with severe symptoms and a poor quality of life, surgical treatment could be considered earlier in the decision making process for treatment as it produced the greatest improvement in this group of women.
  • Written protocols for the management of women with HMB should be more widely available as only about 50% of the hospitals report to have local protocols in place.
  • Hospitals should continue to compare themselves against their peers with regards to the treatments they offer to women with HMB given the considerable variation that we observed across hospitals in treatments offered in secondary care.

The RCOG also makes the following recommendations to commissioners of services:

  • Commissioners should have a women’s health clinical lead to champion the implementation of an integrated care pathway for women with HMB across both primary and secondary care.
  • Commissioners should ensure that all women can be offered the full range of treatments, investigations and interventions as defined in the guidance provided by NICE and the RCOG.
  • Commissioners should review access to first line treatments in primary care and the process of referral to secondary care of women who need more specialised assessment and treatment.

Dr Tahir Mahmood, Co-Chair of the National HMB Audit, said:

“The lessons learnt from our four-year audit have informed the development of this advice for the provision of HMB services. The purpose of this guidance is to ensure that effective and patient focused clinical care can be delivered nationally in primary and secondary care.

“In addition, in support of these recommendations, we have developed a checklist to improve the integration of primary and secondary care services for women with HMB in order to support a seamless care pathway.”


For further information, please contact the RCOG Media and PR team on +44 20 7772 6300 or email

This advice is endorsed by the Royal College of General Practitioners (RCGP).

About HQIP, the National Clinical Audit Programme and how it is funded

The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands.