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Patients with heavy menstrual bleeding who have chosen to have a hysterectomy have it performed by the least invasive method possible.
If a patient chooses hysterectomy as treatment for heavy menstrual bleeding, they should be offered the least invasive method possible, to minimize complications and recovery time. Both vaginal and laparoscopic approaches are less invasive than open abdominal hysterectomy and are associated with reduced morbidity and length of stay in hospital. Prior to the surgery, management of anemia is recommended with oral or intravenous iron to optimize the patient’s hemoglobin level to greater than 120 g/L.
If you choose a hysterectomy, you should be offered the type of surgery that is safest for you.
If your patient elects to have a hysterectomy, always use the least invasive method possible. If your patient has a hemoglobin level of less than 120 g/L, use oral or intravenous iron to get their hemoglobin above 120 g/L before surgery.
Ensure systems, processes, and resources are in place such that patients have access to the least invasive options possible for hysterectomy, and that physicians have the training and equipment necessary to use newer and less invasive techniques, such as vaginal and laparoscopic approaches versus abdominal hysterectomies.
Proportion of hysterectomies among patients with heavy menstrual bleeding that are performed as vaginal, laparoscopic, or abdominal
Denominator: number of patients with heavy menstrual bleeding who had a hysterectomy
Numerator: number of patients in the denominator who had a hysterectomy, by method:
Vaginal
Laparoscopic
Abdominal
Data sources: Discharge Abstract Database, Ontario Health Insurance Plan claims database
Percentage of patients with heavy menstrual bleeding who had a hysterectomy and who had a preoperative hemoglobin concentration higher than 120 g/L
Numerator: number of patients in the denominator who had a preoperative hemoglobin level higher than 120 g/L
Data source: local data collection
Note: When auditing, ensure you use the patient’s hemoglobin level most recent to the surgery.
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