Menstrual Wellbeing Toolkit

Menstrual Wellbeing toolkit header

Menstrual related problems affect a significant proportion of the 25% of UK population who are female of reproductive age, from menarche to menopause, affecting their physical, psychological and social well-being.

The opportunity for early management of ‘period problems’ is often delayed because of the associated stigma and myths leaving women unsupported and in some cases at risk of developing long-term consequences of untreated disease.

This Menstrual Wellbeing toolkit is an ‘easy to use’, logical, evidence based resource for GPs and other primary care clinicians when diagnosing, supporting and managing the concerns of women with problems caused by menstrual dysfunction.

Key facts about menstrual dysfunction

  1. Dysfunction of the menstrual cycle causes physical, social and psychological impact, compromising education, work, social and family life.1,2,3
  2. There are many myths and stigma about periods meaning many women and girls are too embarrassed to discuss their problems. Empowering women of all ages to raise their concerns openly, including any problems related to sex, improves the short and long-term outcomes.
  3. Not all menstrual dysfunction causes bleeding problems. Taking a careful history or using a symptom diary can be helpful in determining a cyclical pattern of associated bowel or urinary or mood problems.
  4. One in five women of reproductive age suffer with heavy menstrual bleeding (HMB), causing one in 20 women aged 30-49 to contact their GP each year.1
  5. One in 10 women of reproductive age suffer with endometriosis4 affecting 1.5 million women - the same number diagnosed with diabetes5 – costing the health and social care economy an estimated £8.2 billion/year.
  6. Early management of endometriosis is important to reduce the long-term consequences of untreated disease: subfertility, ectopic pregnancy and chronic pelvic pain.2
  7. Premature ovarian insufficiency (POI), defined as menopause aged less than 40, affects 1 in 100 women. Management with replacement hormone therapy reduces the long-term consequences of POI: cardiovascular disease, osteoporosis and cognitive impairment.3
  8. The psychological impact of menstrual disorders is underestimated; a recent survey of women with heavy menstrual bleeding found that of 1000 surveyed6:
    • 74% experienced anxiety
    • 67% suffered with depression.
  9. Endometrial cancer is the commonest gynaecological malignancy in the UK with increasing incidence exacerbated by obesity, with nearly 9000 new cases diagnosed in 20157.
  10. Recently published NICE guidance provide evidence based recommendations on the management of menstrual dysfunction, much of which can be managed in primary care with specialist referral for diagnosis and treatment when indicated or chosen.1,2,3

References:

  1. Heavy menstrual bleeding: assessment and management.  NICE Guideline (NG88).  NICE, March 2018 (updated November 2018) 
  2. NICE. Endometriosis: diagnosis and management. NICE Guideline (NG 73).  NICE, September 2017
  3. NICE. Menopause:  diagnosis and management.  NICE Guideline (NG23).  NICE, November 2015, updated December 2019. https://www.nice.org.uk/guidance/NG23
  4. Rogers PA, D'Hooghe TM, Fazleabas A, et al. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci 2009;16(4):335-46
  5. Diabetes UK: Diabetes prevalence 2012. (April 2012). 
  6. Wear White Again, Hologic survey 2017 
  7. Uterine Cancer Statistics. 

Top tips for managing heavy menstrual bleeding in primary care

  1. Heavy menstrual bleeding is common; one in five women experience heavy periods with one in 20 women aged 30-49 presenting to primary care each year.
  2. HMB affects a woman’s physical, psychological and social health and wellbeing.
  3. The history of the problem and any co-morbidities determine if examination and investigations are required.
  4. HMB occurring in women with obesity or any condition causing unopposed oestrogen excess requires investigation to exclude endometrial hyperplasia and cancer, rates of which are rising in the UK.
  5. Treat without further need to examine or investigate if there are no additional symptoms and low risk for endometrial pathology.
  6. Basic laboratory investigations include:

No indication for testing thyroid function, hormone levels or ferritin without the presence of additional symptoms.

  • FBC for all
  • Testing for coagulation disorders only if HMB since menarche or personal/FH of coagulation disorder
  • Consider sexual health screen
  • Cytology if due
  1. Recommended investigations for women with HMB:
    Pelvic ultrasound scan (trans-vaginal preferably) for possible larger fibroids or adenomyosis:
  • Enlarged uterus/ pelvic mass/ pelvic pressure symptoms
  • Dysmenorrhea

  • Hysteroscopy for possible endometrial pathology (hyperplasia/polyps/submucosal fibroids).Persistent irregular and/or intermenstrual bleeding:
  • Infrequent heavy bleeding plus obesity or PCOS
  • Late menopause (over 55)
  • Use of tamoxifen
  • FH Breast/bowel/ovary cancer
  • Abnormal ultrasound scan findings
  • If previous treatment unsuccessful
  1. Treat with tranexamic acid +/- analgesia at first visit, including while waiting for further investigations or referral.
  2. Future treatments depend on investigation findings, imminent fertility requirements, risk assessment and informed patient choice:

    Hormonal: 
    i. Levonorgestrel intra-uterine system
    ii. Combined hormonal contraception
    iii. Long-cycle or continuous progestogens 

    Non-hormonal:
    i. Tranexamic acid (1.5g three or four times daily)
    ii. Plus/or NSAID of choice

    Surgery referral:
    i. Fibroid resection or embolization
    ii. Endometrial ablation
    iii. Hysterectomy

  3. Following endometrial ablation women require reliable contraception and combined HRT preparations for menopausal symptoms even if amenorrhoeic.

Top tips for managing endometriosis in primary care

Adapted from Top Tips developed by Primary Care Women's Health Forum.

  1. Endometriosis is common affecting approximately 10% of women of reproductive age. There are as many women with endometriosis as there are with either diabetes, asthma or back pain. The average time to diagnosis is 7.5 years.

  2. Endometriosis usually causes cyclical problems. Using a 3 month menstrual diary found on line or as an app is a good diagnostic tool. This can also be used to determine the pattern of urinary and bowel symptoms.

  3. Endometriosis affects a woman’s physical, psychological and social health and wellbeing.

  4. NICE recommend an abdominal +/- pelvic and speculum examination is performed. Sexual health screening should also be considered.

  5. An UltraSound Scan, preferably transvaginally if acceptable, is recommended to exclude endometriomas or adenomyosis. BUT a normal result does not exclude endometriosis or adenomyosis.

  6. Simple analgesia or combined hormonal contraception or desogestrel should be commenced at the first visit. An understanding of imminent fertility requirements assists treatment choices.

  7. On review the use of continuous hormonal treatment (any hormonal contraception) should be commenced to control symptoms if the diagnosis of endometriosis is likely. Signposting to patient information for support i.e. Endometriosis UK is recommended.

  8. Referral to secondary care should be considered if symptoms change, continue, recur or if there are symptoms of bowel or urinary tract involvement or for patient choice.

  9. Early prevention of ovulatory bleeding will reduce the longer-term complications of endometriosis such as reduced fertility and chronic pelvic pain. These issues require management as appropriate with early referral to fertility services for women with endometriosis if conception is delayed.

  10. For women with endometriosis who have required surgical treatment with pelvic clearance (hysterectomy and BSO) use consider use of continuous HRT or tibolone for 12 months before considering  changing to oestrogen only HRT.

Top tips for managing menopause in primary care

Adapted from Primary Care Women’s Health Forum top tips, with permission

  1. The diagnosis of menopause in women aged over 45 is clinical and based on symptoms. It does not usually require confirmation with an Follicle-stimulating hormone (FSH) level.

  2. Remember that contraception is needed until infertility can be assumed.  The use of intra-uterine progestogen offers endometrial protection and contraception. Refer to FSRH CEU Guideline Contraception for women over 40 for further information.

  3. Consider menopause as a possible cause of amenorrhoea in women under 45 who are not using hormonal contraception once pregnancy is excluded.

  4. Recommend Hormone Replacement Therapy (HRT) routinely to women who are menopausal aged under 45, even if they are asymptomatic, to reduce the consequences of long-term hypo-oestrogenism such as osteoporosis and cardiovascular disease.

  5. Provide and signpost women to reliable patient information, for example, menopause matters and manage my menopause, to allow informed and shared decision making between the woman and her healthcare professional.

  6. Prescribing is not difficult and decision-making guides are available. Refer to Primary Care Women's Health guidance on management and prescribing HRT in primary care.

  7. HRT is much safer than you think. NICE Clinical Guidance (2015); Diagnosis and Management provides the evidence and reassurance for use.

  8. Support the woman to initiate HRT and continue with a review after three months. Once stable review annually to reassess the risk/benefits of ongoing HRT use for her. There is no arbitrary limit to length of use.

  9. The benefits of HRT outweigh the risks for most women who start treatment aged under 60.  Women with any cardiovascular or thrombotic risk factors who are eligible for HRT would benefit from a transdermal preparation.

  10. Low dose vaginal oestrogens are safe to use for as long as required in most women.  Some women will require the use of vaginal oestrogen in addition to their systemic HRT to control their genito-urinary problems.

     

Clinical resources for training and appraisal

The RCGP Women's Health Library

The RCGP Women’s Health Library has been developed in conjunction with The Royal College of Obstetricians and Gynaecologists (RCOG) and The Faculty of Sexual and Reproductive Healthcare (FSRH) to provide educational resources and guidelines on women’s health that are relevant to GPs and other primary healthcare professionals. These resources will be helpful for those who wish to develop a more specialised interest in women's health.

NICE Guidelines and pathways

NICE Guideline (NG88) Heavy Menstrual Bleeding: assessment and management. March 2018, updated November 2018

The Guideline covers the assessment and management of women with heavy menstrual bleeding.  It aims to help healthcare professionals appropriately investigate the causes of the heavy periods that are affecting a woman’s quality of life and to offer information and access to treatments allowing the woman to choose the right treatment for her dependent on her priorities and preferences.

The NICE NG88 guideline includes a pathway for improving the assessment and management of heavy menstrual bleeding.

NICE Guideline (NG73):  Endometriosis: diagnosis and management. September 2017.

This Guideline covers the diagnosis and management of endometriosis.  It aims to raise awareness of the symptoms with an ambition to reduce the short and long-term consequences of untreated endometriosis.  It also provides advice on the treatment options available.

The NICE NG88 guideline includes a pathway for improving the diagnosis and management of endometriosis

UK Guidance

The RCOG Green Top Guideline:  Long-term consequences of Polycystic Ovary Syndrome

Polycystic Ovary Syndrome is one of the commonest endocrine disorders of women of reproductive age.  It is often complicated by chronic anovulatory infertility and hyperandrogenism, with the clinical manifestations of oligomenorrhoea, hirsutism and acne. Many women with the condition are obese and have long-term consequences of impaired glucose tolerance, type 2 diabetes and adverse cardiovascular risk profile.  Women with obesity and chronic anovulation are also at risk of endometrial hyperplasia and cancer.

This guideline provides information, based on clinical evidence, on the advice required for women about the long-term health consequences of what is fundamentally an endocrine disorder.

RCOG  Green Top Guideline: Management of endometrial hyperplasia

Endometrial cancer is the most common gynaecological malignancy in the Western world and endometrial hyperplasia is its precursor.  The most common presentation of endometrial hyperplasia is abnormal uterine bleeding including heavy menstrual bleeding, intermenstrual bleeding, irregular bleeding, unscheduled bleeding on hormone replacement therapy and postmenopausal bleeding.

The 'RCOG Green Top Guideline: Management of endometrial hyperplasia' provides recommendations regarding the management of endometrial hyperplasia.

FSRH CEU Clinical Guidance: Problematic Bleeding with hormonal contraception

Management of women presenting with problematic bleeding while using hormonal contraception is a frequent challenge. It may result from the contraceptive method or from other causes. This guidance provides evidence-based recommendations and good practice points for health professionals on the management of problematic bleeding in women using hormonal contraception currently available in the UK.

RCOG Green Top Guideline: Premenstrual Syndrome, Management (Green-top Guideline No. 48)

Premenstrual syndrome (PMS) affects an estimated 4 in ten women with 5-8% of these women suffering with severe symptoms.  Women may be affected by a range of psychological symptoms including depression, anxiety, irritability, lack of confidence and mood swings and also by physical symptoms including bloating and mastalgia.

The aim of this guideline is to review the diagnosis, classification and management of PMS.

European Guidance

Management of women with endometriosis. Guideline of the European Society of Human Reproduction and Embryology

This guideline offers best practice advice on the care of women with suspected and proven endometriosis. The guideline includes recommendations on the diagnostic approach for endometriosis, including which symptoms suggest the diagnosis, use of diagnostic medical technologies and of clinical examination. Treatments for endometriosis, as medical treatment, non-pharmacological treatment and surgery, are discussed for both relief of painful symptoms and for infertility due to endometriosis.

Information is also included for the management of patients in whom endometriosis is found incidentally (without pain or infertility), for primary prevention of endometriosis, for the treatment of menopausal symptoms in patients with a history of endometriosis and for women with questions about the possible association of endometriosis and malignancy.

Management of women with premature ovarian insufficiency. Guideline of the European Society of Human Reproduction and Embryology 

This guideline offers best practice advice on the care of women with premature ovarian insufficiency (POI), both primary and secondary.  The recommendations are for women younger than 40 years (which includes Turner Syndrome patients) and those who are older with disease onset before 40.

The guideline includes recommendations on the initial assessment and management of women with POI, including with hormonal treatment. POI has consequences for health apart from gynaecological issues, including fertility and contraception, bone health, cardiovascular issues, psychosexual function, psychological function, and neurological function and recommendations about the management are also included.

International evidence-based guideline for the assessment and management of polycystic ovary syndrome (PCOS)

This international evidence-based guideline aims to provide health professionals, consumers and policy makers with transparent evidence-based guidance on timely diagnosis, accurate assessment and optimal treatment of PCOS, to reduce variation in care, optimise prevention of complications and improve health outcomes.

Quality Standards

NICE Quality standards help you improve the quality of care provided or commissioned.  Relevant NICE Quality Standards:

Additional resources

RCGP Endometriosis elearning

This free-to-access 30 minute course uses the recommendations of the NICE guideline on endometriosis to follow a case study typically seen in primary care.  The case illustrates common issues with diagnosis, when to investigate, when and how to manage in primary care and when to refer..

An educational grant was received from Endometriosis UK to produce this course.

RCGP Heavy Menstrual Bleeding elearning

This free-to-access 30 minute course applies the recommendations of the NICE guideline on HMB using case studies commonly seen in primary care.  The cases illustrate common issues with diagnosis, when to investigate, when and how to manage in primary care and when to refer.

An educational grant was received from Endometriosis UK to produce this course.

NICE Clinical Knowledge Summaries (CKS)

Providing primary care practitioners with a readily accessible summary of the current evidence base and practical guidance on best practice:

Guidelines in Practice:

 Other resources: 

Information and support for patients and carers

Period problems are very common and may affect physical, social and psychological health and well-being. Many women experience one or a number of concerns including; heavy periods, painful periods, infrequent periods, no periods or irregular bleeding. 

Many women do not feel confident discussing the period problems they have because they do not realize that what they are experiencing is not normal and they may feel embarrassed to discuss concerns. NHS Choices has an excellent overview of periods and the conditions that can cause the problems women experience. 

In addition to the resources listed below there is much useful information to be found on women’s health concerns on the website patient.info.

Menstrual diaries/period trackers are useful and can be found on line or as an app.  Useful examples of free-to-download apps:

Further information and resources

Endometriosis

Endometriosis is a condition where tissue similar to the lining of the womb starts to grow in other places, such as in the pelvis, ovaries and fallopian tubes.

Women with endometriosis suffer from a range of concerns but the main symptoms are painful periods, painful sex and infertility. 

Further information about endometriosis and the care provided can be found from the resources listed below.

Heavy Menstrual Bleeding (heavy periods)

Heavy periods are common and can have a significant effect on a woman’s quality of life and ability to function at work or socially.  There is not always an underlying cause for the heavy periods but sometimes it is due to problems such as fibroids or endometriosis. 

Further information about heavy periods and the care provided can be found in the resources listed below:

Fibroids

Fibroids are benign (non-cancerous) growths made up of muscle that develop in the womb. They are very common and many women are unaware that they have fibroids as they often do not cause any symptoms.

In women who do have symptoms they may cause a range and severity of symptoms including heavy periods, pelvic pressure symptoms including the need to pass urine frequently, pain during sex. 

Further information about fibroids can be found in the resources listed below:

Polycystic Ovarian Syndrome (PCOS).

Polycystic ovary syndrome is a common endocrine condition which may cause a variety of concerns including irregular periods, symptoms of having high levels of androgens, including acne and facial hair, and subfertility.  The condition may also affect long-term health such as developing type 2 diabetes and high cholesterol later in life.

Further information about PCOS can be found in the resources listed below.

Pre-Menstrual Syndrome/Dysphoric Disorder. (PMS/PMDD)

Pre-menstrual syndrome is the name for the physical and emotional symptoms that some women experience in the two weeks before a period.  The symptoms usually start to resolve once the period starts.

The syndrome affects women in different ways with variable severity and can alter from month to month.

Symptoms include mood swings, anxiety, tiredness, bloating, constipation, headaches which can affect the ability to function at work or socially.

Some women experience more severe symptoms, having a significant impact on life and this is known as pre-menstrual dysphoric disorder.

Further information about PMS/PMDD can be found in the resources listed below:

Premature Ovarian Insufficiency (POI)

The average age of the menopause in the UK occurs between age 47 and 53.  Early menopause happens when a woman’s periods stop before the age of 45. This can happen naturally, or as a side effect of some treatments.

Premature ovarian insufficiency is classified as menopause occurring before the age of 40. Spontaneous POI affects about 1% of women but there are increasing numbers of women experiencing iatrogenic POI caused by surgery or cancer treatments.

The investigations and treatment recommendations are different to those for women experiencing a ‘normal’ menopause.

Further information about POI and the management options can be found in the resources listed below: 

Support organisations

  • Endometriosis UK is a support organization with a vision to improve the lives of people affected by endometriosis and work towards a future where it has the least possible impact on those living with the condition
  • Fibroid Network is a UK based, patient led volunteer, support group, serving as a focal point for women’s fibroid and health issues with the aim to improve women with fibroids, healthcare and health education in the United Kingdom and internationally
  • National Association for Pre-menstrual Syndrome supports individual PMS sufferers and promote a greater awareness of PMS and of its treatment
  • Vicious Cycle is a patient-led project, passionate about raising awareness of Premenstrual Dysphoric Disorder, and improving the standards of care for those living with the condition
  • The Daisy Network is dedicated to providing support to women with Premature Ovarian Insufficiency (POI), also known as Premature Menopause
  • Verity – PCOS is a self-help group with a goal to improve the lives of women with polycystic ovary syndrome (PCOS).

Background information for commissioners

Menstrual related problems affect a significant proportion of the 25% of the UK population who are female of reproductive age between puberty and menopause, affecting their physical, psychological and social well-being.  If unmanaged some of these conditions can cause lifelong problems including metabolic disease or chronic pelvic pain.

In the UK an estimated:

  • One in five women of reproductive age suffer with heavy menstrual bleeding (HMB) 1
  • One in 20 women aged 30-49 contact their GP with HMB each year.1
  • One in 10 women of reproductive age in the UK suffer with endometriosis,2 affecting 1.5 million women - the same number diagnosed with diabetes3.
  • Endometriosis costs the health and social care economy an estimated £8.2 billion/year4.

There is an under-recognition of the problems that women with menstrual dysfunction face with many women not realising their periods are not ‘normal’, a direct result of lack of education about menstrual health. This under-recognition and the ‘taboos’ surrounding the subject mean that many women are compromised as they are not empowered to request support to help them attend school, college or work for several days and months a year.

The psychological impact is also underestimated and a recent survey of women with heavy menstrual bleeding5 found that of 1000 surveyed:

  • 74% experienced anxiety
  • 67% suffered with depression.

There are opportunities to reduce the health and social impact resulting from menstrual-related problems, whilst improving patient choice and experience, in primary care and out-of hospital settings by applying recommendations from recently updated NICE guidance1 and improved access to diagnostics and minimal intervention technologies.

Resources

The 'All Party Parliamentary Group on Women’s Health Report;  Informed choice? Giving women control of their healthcare' report from the All Party Parliamentary Group on Women’s Health (WHAPPG) in the UK highlights insufficient care and concern for women with endometriosis and fibroids. 

Their survey of over 2600 women (with endometriosis and fibroids) found:

  • 42% of women said that they were not treated with dignity and respect
  • 62% of women were not satisfied with the information that they received about treatment options for endometriosis and fibroids
  • Nearly 50% of women with endometriosis and fibroids were not told about the short term or long term complications from the treatment options provided to them.

The recommendations from the report are wide-ranging including improving awareness and reducing stigma of menstrual concerns by improving education at secondary school as well as for healthcare professionals, by improving information resources on the conditions and management options, by endorsing best practice pathways and care provided consistently following NICE recommendations.

Annual Report of the CMO 2014 – The health of the 51%:women

The report, developed with the support of expert academic and clinician input, examines women’s health in England and makes a range of recommendations for improvement.

The report identifies several missed opportunities for intervention in women’s health, and brings attention to ‘embarrassment’ as a needless barrier to health.

The main themes include:

  • obesity and its impact on women’s health, including reproductive health
  • women’s health in later life (menopause)
  • women’s health in later life (pelvic floor dysfunction and incontinence)

Menstrual Health Coalition report.  Heavy Menstrual Bleeding – Breaking Silence and Stigma

Many women struggle to manage their menstrual health for a number of reasons.  The Menstrual Health Coalition conducted an inquiry to explore this in further detail. The recommendations from the inquiry have been published in the 'Menstrual Health Coalition report.  Heavy Menstrual Bleeding – Breaking Silence and Stigma' report:

  • Improve awareness and education to inform women about what is normal and abnormal menstruation and remove stigma encouraging more women to seek help and ensure that those who are approached are able and qualified to provide help.
  • Adequate, easily accessible and evidence-based information should be available for women and clinicians. The information should be comprehensive, including input from Royal Colleges and patient voices, as well as NHS and PHE resources.
  • Access to services should be prioritised and systems linked up to ensure that women can access the help that they need in a timely manner.

Plan UK report 

The 'Break the Barriers: Girls’ Experiences of Menstruation in the UK' report reveals a culture of stigma and silence have turned periods into a hidden public health issue – putting girls' physical, sexual and mental health at risk. The report demands action through a menstrual manifesto to end the challenges girls face and break down the taboos that continue to make them feel ashamed of their bodies when they have their period.

RCOG.  Heavy Menstrual Bleeding Audit final report. 

A national audit to assess patient outcomes and experiences of care for women with heavy menstrual bleeding in England and Wales.

 The Royal College of Obstetricians and Gynaecologists undertook a first audit and a repeat audit after four years to describe the provision of services for HMB in hospitals in England and Wales and patient-reported outcomes in an outpatient setting.

The conclusions of this work include:

  • The existing referral pathways between primary and secondary care should be reviewed with nearly one-third of women reported that they had not received any treatment for their HMB in primary care.
  • There were differences to care provided to different ethnic and socio-economic groups and there is a requirement to address this to improve how the individual needs of women are being met.
  • Information for patients should be improved with women being informed adequately about the treatment options available.
  • Hospital services should compare themselves with peers to reduce variation in protocol, organisation and treatments offered.

NICE recommendations – putting this guideline into practice

NICE Guideline (NG88) Heavy Menstrual Bleeding: assessment and management. March 2018 (updated November 2018)

The guideline for assessment and management of heavy menstrual bleeding was updated in March 2018 with further amendments in November 2018.  It aims to help healthcare professionals investigate the cause of heavy periods that affect a woman’s quality of life and to offer the right treatments, taking into account the woman’s priorities and preferences.

Tools and resources have been produced to help put the guideline into practice noting specific issues including:

  • facilities and staffing for hysteroscopy services in community settings.
  • Providing hysteroscopy in line with best practice guidelines.

NICE Guideline (NG73):  Endometriosis: diagnosis and management. September 2017

The guideline for diagnosis and management of endometriosis was published in September 2017.  This aims to raise awareness of the symptoms of endometriosis, and to provide clear advice on what action to take when women with signs and symptoms first present in healthcare settings and of treatment options available.

Recommendations include that the community, gynaecology and specialist endometriosis centres should work together to provide coordinated care to provide prompt diagnosis and treatment of endometriosis to improve quality of life and reduce adverse consequences of untreated disease.

Commissioned service requirements

Specialist endometriosis centres

NHS England specialist commissioners have published the specification for the service for treating endometriosis with a recommendation to commission services from centres that meet the British Society of Gynaecological Endoscopy (BSGE) Accreditation criteria. The ambition is to deliver treatment by multidisciplinary teams working in specialist centres who have sufficient workload to maintain skills and audit their performance.

List of specialist endometriosis centres found online.

RCOG Advice for Heavy Menstrual Bleeding (HMB) services and commissioners.

The lessons learnt from the RCOG Heavy Menstrual Bleeding audit have informed a recommendation for commissioners and providers of HMB services. The purpose of this advice, endorsed by the Royal College of General Practitioners (RCGP), is to ensure that effective and patient focused clinical care can be delivered nationally in primary and secondary care.

References: 

  1. NICE.  Heavy menstrual bleeding: assessment and management.  NICE Guideline 88.  NICE, March 2018 (updated November 2018).  www.nice.org.uk/ng88
  2.  Rogers PA, D'Hooghe TM, Fazleabas A, et al. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci 2009;16(4):335-46
  3. Diabetes UK: Diabetes prevalence 2012. (April 2012). Diabetes affects around 2.9 million people, of which slightly less than half of this are women.
  4. Simoens S, Dunselman G, Dirksen C, et al. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod 2012;27(5):1292-9
  5. Wear White Again, Hologic survey 2017

 

Menstrual wellbeing podcasts

Endometriosis: managing its impact.

RCGP Menstrual Well-being Spotlight Project Clinical Champion Dr Anne Connolly talks to Jody Stewart, a patient diagnosed with endometriosis who is also a member of the project steering group, about her experiences of suffering with painful periods, diagnosis, treatment and support from Endometriosis-UK.

Heavy Menstrual Bleeding

RCGP Menstrual Well-being Spotlight Project Clinical Champion Dr Anne Connolly talks to Jillian Neckar, a patient who suffered with heavy menstrual bleeding, about her experiences at school and in the workplace, her management and her treatment choices.

Endometriosis: Diagnosis and management

Dr Sally Higginbottom interviews RCGP Clinical Champion for Women’s Health, Dr Anne Connolly, on the diagnosis and management of women suffering with endometriosis, based on the recommendations of the NICE guideline.

Managing pelvic pain

Dr Thomas Round interviews Dr Louise Newson on the management of women presenting with chronic pelvic pain, based on the RCOG guideline, explaining the important aspects of history taking, examination, investigation and management.

This toolkit has been developed in partnership between the RCGP Clinical Innovation and Research Centre (CIRC) and Endometriosis UK. 

Please send any feedback or suggestions to circ@rcgp.org.uk

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