Heavy Menstrual Bleeding - Referral for Surgical Management

Scope

This is a summary of the NEW Devon CCG commissioning policy for Referral for the Surgical Management of Heavy Menstrual Bleeding.

National Institute for Health and Care Excellence (NICE) Clinical Guideline 44 (Heavy Menstrual Bleeding) recommends consideration of specific surgical treatment options for heavy menstrual bleeding; including in women where bleeding is having a severe impact on quality of life or where other treatment options are declined.

Referral for specialist advice and surgery, if appropriate, is only commissioned in women without significant fibroids or structural or histological abnormalities, if they have failed treatment with appropriate pharmacotherapy. NICE recommend a range of both hormonal and non-hormonal pharmaceutical treatment options, some of which provide additional benefits which may be desirable.

Levonorgestol-releasing intrauterine system, which represents the first-line hormonal treatment option, is more cost-effective than other medical or surgical treatment options considered by NICE. After failure of a first pharmacological treatment, some women respond to a different form of pharmacological management and can obtain benefit therefore avoiding the need for surgery.

Although surgical treatment options were found to be clinically and cost-effective, they cost more for the CCG to commission than effective pharmacological treatments. Pharmacotherapy has been found to be effective, proving a good response in a proportion of women.

Supporting referral guidelines

Referral Criteria

Referral for specialist advice and surgery, if appropriate, will only be routinely commissioned in:

  • Women with significant fibroids, for example; fibroids which are palpable abdominally, measured as greater than 3cm in diameter at ultrasound, causing distortion of the uterine cavity or intracavity fibroids.
  • Women in whom there is suspicion of structural or histological abnormalities (indications for a biopsy include, for example, persistent intermenstrual bleeding, and in women aged 45 and over treatment failure or ineffective treatment).
  • Women whose uterine length is measured at ultrasound, as greater than 12cm.
  • Women for whom appropriate pharmacotherapy has failed.

Referral Instructions

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of the CCG upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.

Individual Funding Request New Devon CCG link

Applications for consideration for funding approval should be sent to:

Email: d-ccg.ifr-newsdt@nhs.net

Alternatively, please send to: The Panel administrator at Bridge House, Collett Way, Newton Abbot, TQ12 4PH

​Supporting Information

Patient Information

Individual Funding Request (IFR) Patient information leaflet

Pathway Group

Northern, Eastern and Western Devon Clinical Commissioning Group

South Devon and Torbay Clinical Commissioning Group

Publication date: April 2015

 

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