The final report of a four-year national audit published today shows improved treatment for women with heavy menstrual bleeding, with 90% of women rating their care as good, very good or excellent.
One in four women aged between 15 and 50 experience heavy menstrual bleeding (HMB) which often has a severe impact on their quality of life. Each year approximately 30,000 women undergo surgical treatment for heavy menstrual bleeding in an NHS hospital in England and Wales.
The report, commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme*, published by the Royal College of Obstetricians and Gynaecologists (RCOG) and co-led by the London School of Hygiene & Tropical Medicine, describes the outcome of hospital care for over 8,000 women with heavy menstrual bleeding, who were referred by their GP to a gynaecological outpatient clinic.
The audit, carried out in England and Wales between 2010 and 2014, is unique as it is based on information provided by the women themselves. The women were asked about their menstrual problems, the hospital treatments they received after their GP referral, and their outcomes and experiences one year on.
The study found that most women had a large improvement in their quality of life (QOL) in the year following their first gynaecological outpatient appointment and that women who received surgical treatments reported the largest improvement in their QOL.
The report also shows considerable variation in the hospital treatments that women with heavy menstrual bleeding received. For example, the percentage of women who had some form of surgical treatment varied between 20% and 60% across NHS hospitals. The results presented in this report will allow NHS hospitals to review the treatments they offer.
The women’s ethnic background had a considerable impact on the treatments received. Fewer women from a non-white ethnic background had surgery than white women. Non-white women also reported smaller improvements of their condition. The report highlights the need for greater awareness of cultural differences and recommends hospitals set up more dedicated HMB clinics where the care for women can be better coordinated.
Dr Tahir Mahmood, Co-Chair of the National HMB Audit, representing the RCOG, said:
“We have seen improvements, since the start of the audit in 2010, in the management of HMB. Half of all NHS hospitals now have written protocols in place, and have introduced new care pathways. This is key to ensuring that primary care and secondary care are working together efficiently and that local resources are used to their best potential.
“However, this important national audit has also identified a potential inequality in access to care for women of non-white ethnicity as well as those who live in more deprived areas.
“Overall the audit has provided significant insights into the treatment and hospital care received by women with HMB as well as the impact of the condition on their quality of life. The audit also highlights areas where improvements can be made. Clinicians, health care providers and commissioners of women’s health services should take note of the findings and their implications for services.”
Joint lead author, Professor Jan van der Meulen, from the London School of Hygiene & Tropical Medicine, said:
“This clinical audit is unique as it mainly used information reported by the women about their condition, the treatments they received and outcomes and experiences they had one year after their first hospital appointment. It is not the doctors but the women themselves who had the strongest voice in this evaluation of gynaecological services.”
The Audit is funded by the Healthcare Quality Improvement Partnership and is led by the Royal College of Obstetricians and Gynaecologists, in collaboration with the London School of Hygiene & Tropical Medicine and Ipsos MORI.
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*About HQIP, the National Clinical Audit Programme and how it is funded: The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium.