GP Connect Clinical Feature by Dr Sarah Smith, Hospital Liaison GP, Women and Newborn Health Service, King Edward Memorial Hospital
The Australian Commission on Safety and Quality in Health Care released the updated 2024 Heavy Menstrual Bleeding Clinical Care Standard on the 13 June 2024, and GPs may have seen this publicised in the media.
Heavy menstrual bleeding (HMB) affects one in four women in Australia, and more than 60 per cent of those affected are iron deficient.
Bleeding is not normal when it is described as:
- often flooding through clothing
- changing pads/tampons every 1-2 hours
- period lasting longer than 8 days
- resulting in person being unable to do normal activities.
There are many clinical resources available for GPs relating to implementation of this updated clinical care standard, including a summary factsheet, educational webinar and patient story.
The HMB clinical care standard was released as part of the 2024 Women’s Health Focus report, and contains eight quality statements describing safe and appropriate care.
GPs are well placed to manage heavy menstrual bleeding, and the clinical care standard highlights the importance of the following:
- Assessment and diagnosis – including detailed history, consideration of PALM-COEIN causes, iron deficiency investigations, exclusion of pregnancy, contraception needs, and impact on the affected person’s quality of life.
- Informed choice and shared decision making – provision of evidence based resources to aid understanding and decisions.
- Initiating medical management – with oral treatments for symptom relief offered at the first presentation when appropriate.
- Arranging a quality ultrasound – preferably transvaginal, on day 5-10 of normal menstrual cycle when investigating structural causes of heavy menstrual bleeding.
- Discussion and provision of intrauterine hormonal device – (52mg LNG IUD) as part of management
- Arranging non-GP specialist referral as needed – including discussing uterine preserving alternatives to hysterectomy and referral for hysterectomy as needed.
The HMB Clinical Care Standard highlights the importance of considering risk factors for endometrial cancer in those presenting with heavy menstrual bleeding, including:
- age, with increased suspicion warranted in a woman aged over 45
- personal or family history of endometrial cancer or colorectal cancer
- use of unopposed oestrogen or tamoxifen
- obesity
- young age at menarche or older age at menopause
- nulliparity
- diabetes
- endometrial hyperplasia
The potential treatments for heavy menstrual bleeding are summarised by the ACSQH in this table.
GPs are advised to familiarise themselves with the updated HMB Clinical Care Standard and available resources.
Referrals to public gynaecology outpatient services for non- urgent referrals are made via the Central Referral Service – see Clinician Assist WA (formerly HealthPathways WA) for details.
Information regarding non-urgent referrals to general gynaecology outpatient clinics for heavy menstrual bleeding at King Edward Memorial Hospital (KEMH) can also be found on the KEMH website.
For urgent referrals, please refer to the patient’s local gynaecology hospital service and make direct phone contact with the gynaecology team.