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
Heavy menstrual bleeding of benign causes should initially be treated medically, if clinically appropriate.
A hysterectomy should only be considered for heavy menstrual bleeding for non-pregnant, premenopausal patients when treatment options, both pharmacological or other surgical procedures (for example, endometrial ablation, uterine artery embolisation), have been considered and are unsuccessful or contraindicated.
When is the procedure indicated?
Hysterectomy may be recommended for heavy menstrual bleeding when a non-pregnant, premenopausal patient no longer wishes to conceive and where medical management is contraindicated or unsuccessful.
Best care recommendations
The aetiology of heavy menstrual bleeding should be evaluated, and treatment should not be initiated until premalignant or malignant disease is excluded.
The initial approach for heavy menstrual bleeding usually involves pharmacological treatment. Surgical approaches are commonly reserved for when medical therapy is contraindicated or unsuccessful.
Evidence
Australian Commission on Safety and Quality in Health Care. Heavy menstrual bleeding clinical care standard. Sydney (NSW): Australian Commission on Safety and Quality in Health Care; 2017 [cited 2020 Jun 13].
Marrer H, Fauconnie A, Chabbert-Buffet N, Cravello L, Golfier F, Gondry J, et al. Clinical practice guidelines on menorrhagia: management of abnormal uterine bleeding before menopause. European Journal of Obstetrics, Gynecology and Reproductive Biology [Internet]. 2010 Oct [cited 2020 Jun 16]; 152(2): 133-7.
National Institute for Health and Care Excellence. Heavy menstrual bleeding. London (UK): National Institute for Health and Care Excellence; 2018 [cited 2020 Jun 29].