Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.
This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.
Advice
Do not offer dilatation and curettage as a treatment option for heavy menstrual bleeding.
A dilatation and curettage is a diagnostic, not a therapeutic, procedure.
When is the procedure indicated?
Diagnostic indications for dilatation and curettage include (but are not limited to):
- inability to sample endometrium in the office due to patient anxiety or cervical stenosis (where sampling is indicated)
- those at increased risk of hyperplasia or carcinoma (for example, persistent abnormal uterine bleeding, inconsistent ultrasound and office biopsy results, thickened or abnormal endometrium on ultrasound, atypical hyperplasia on office sampling)
- when a concomitant procedure such as hysteroscopy, laparoscopy or insertion of an intrauterine device is planned.
Best care recommendations
Treatment of heavy menstrual bleeding should not be initiated until the aetiology has been evaluated and premalignant or malignant disease excluded.
The initial approach to heavy menstrual bleeding is usually pharmacological treatment, which can be hormonal or non-hormonal. Surgical approaches may be used where medical therapy is contraindicated or unsuccessful. Where pharmacological treatment has failed, there are several surgical options to control bleeding.
Evidence
Australian Commission on Safety and Quality in Health Care. Heavy menstrual bleeding clinical care standard consumer fact sheet. Sydney (NSW): Australian Commission on Safety and Quality in Health Care; 2017 [cited 2020 Jun 13].
National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management guideline. London (UK): National Institute for Health and Care Excellence; 2018 [Updated 2020 Mar; cited 2020 Jun 25].
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Heavy menstrual bleeding. Melbourne (VIC): The Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 2018 [cited 2020 Jun 13].