New clinical care standard for heavy menstrual bleeding

“Heavy periods can seriously impact a woman’s quality of life. I know, I have had very personal experience of this, along with one in four women,” said Minister Kearney, a RN and former Federal Secretary of the Australian Nursing and Midwifery Federation (ANMF).

“As a former nurse, I implore all women who are concerned to talk to a trusted healthcare provider about menstrual bleeding. You don’t need to suffer in silence, there are many options to get help.”

One in four Australian women experience significantly heavy periods that can seriously affect their quality of life. Despite its prevalence, the condition remains under-recognised and under-treated. Around 50% of women do not seek medical care despite the debilitating impact on daily life, often because they don’t know their period is not ‘normal’ or due to the stigma of menstruation.

Latest national trend data published by the Australian Commission on Safety and Quality in Health Care (the Commission) reveals a 20% fall in hysterectomy rates over eight years, an encouraging sign that women may be opting for less invasive treatments to manage heavy periods.

The Commission’s new Women’s Health Focus Report examined two procedures commonly used for heavy menstrual bleeding – hysterectomy and endometrial ablation. The report follows efforts by the Commission since 2015 to encourage alternatives to hysterectomy – by publishing local-level surgical data to highlight inconsistencies in care and establishing a national standard for heavy menstrual bleeding.

Australia’s rate of hysterectomy remains significantly higher than comparable OECD countries like New Zealand and the United Kingdom, suggesting women who seek help may have a more invasive procedure than is necessary.

The new data reveal a 20% decrease since 2014–15 in the rate of hysterectomy, the most invasive treatment for heavy periods. At the same time, the report found a 10% increase in the rate of the less invasive procedure endometrial ablation, one of several alternatives for treating heavy periods.

The findings were positive and showed Australia was trending in the right direction, said Associate Professor Liz Marles, Clinical Director for the Commission and a GP. However, the data revealed a rural-urban disparity, with both hysterectomy and endometrial ablation rates higher in regional areas than major cities and remote areas, she said.

“Every woman should have access to care that is tailored to her needs. Yet we know that women’s concerns about heavy menstrual bleeding can be overlooked, and it can be hard to access suitable care. The fact that treatment differs based on where people live suggests there is more work to do,” A/Professor Marles said.

The 2024 Heavy Menstrual Bleeding Clinical Care Standard was also released by the Commission. The Standard was first developed in 2017 in response to unexplained variation in rates of hysterectomy across Australia.

The new data and revised Standard aims to build understanding of the risks and benefits of treatments for heavy menstrual bleeding, empowering women to make informed choices about their own healthcare.

A/Professor Marles said the Commission was seeking three important outcomes. “Firstly, we want women to know they don’t have to put up with symptoms, to feel comfortable talking about their periods and to be aware that there are a range of treatments, which don’t necessarily involve a major operation.

“Let’s also upskill the healthcare workforce so women are offered the full suite of treatment options, and practitioners can deliver minimally invasive treatments if appropriate, such as the hormonal IUD.

“Finally, health practitioners need to ask women about their menstrual health and tailor care to individual needs, so they receive the most suitable treatment, which differs for each woman,” she said.

Higher hysterectomy rates among First Nations women emphasised the need for culturally appropriate care, said A/Professor Marles, and the new Standard offered guidance to help improve equity.

“While some women may choose hysterectomy, we want to avoid them going straight to the most invasive procedure, without being offered less invasive and effective alternatives and information on the risks and benefits. Hysterectomy cannot be reversed and has increased risk of complications,” she said.

Professor Kirsten Black, a gynaecologist with the University of Sydney and a member of expert advisory groups for the Standard and the Women’s Health Focus Report, welcomed the shift towards less invasive gynaecology procedures.

“We know that many women with heavy menstrual bleeding can be successfully managed by their GP or other primary care practitioner using medical treatments like the hormonal IUD.”

Professor Black urged clinicians to perform a proper initial assessment to identify whether there was a specific cause that may need to be addressed and to check for iron deficiency and anaemia.

“Healthcare providers need to understand their patient’s menstrual history and whether the bleeding prevents them from going about daily activities and interacting socially. Some women feel they can’t leave the house when they’ve got their period because of fear of excessive bleeding.

“For women with heavy menstrual bleeding, finding the right treatment has the potential to be life changing.”

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