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Patients with heavy menstrual bleeding have a comprehensive initial assessment and pharmacological treatments offered prior to referral to a gynecologist. Once the referral has been made, patients are seen by the gynecologist within 3 months.
Before being referred to a gynecologist, patients with heavy menstrual bleeding should receive a comprehensive initial assessment (see Statement 1 for details), be offered a trial of pharmacological therapy (see Statement 3), and be offered ultrasound of the uterus if indicated (see Statement 5). Some patients may not want to try a pharmacological treatment, but these options should be offered to every patient. Taking these steps will decrease the wait time for the start of treatment and for specialist consultation and will provide the gynecologist with vital information to help identify the cause of the bleeding. Specialists should see referred patients within 3 months of referral.
Before referring you to a gynecologist, your family doctor or nurse practitioner should do a full assessment and offer you a prescription to relieve your symptoms. If referred, you should receive an appointment within 3 months.
Primary care providers: Always do a comprehensive initial assessment before considering referral to a gynecologist. The combination of results from the history, physical exam including pelvic exam, laboratory tests, and imaging (as indicated) should be shared with the gynecologist before they see the patient.
Gynecologists: Ensure you see the patient within 3 months of receiving the referral.
Ensure systems, processes, and resources are in place such that all patients have access to a gynecologist, if needed, within 3 months of referral by their primary care provider.
Percentage of patients with heavy menstrual bleeding who were seen by a gynecologist within 3 months of referral
Denominator: number of patients with heavy menstrual bleeding who were referred to a gynecologist
Numerator: number of patients in the denominator who were seen by the gynecologist within 3 months of referral
Data source: local data collection
Percentage of patients with heavy menstrual bleeding who were seen by a gynecologist and who had a comprehensive initial assessment prior to referral (including detailed history, complete blood count, gynecological exam, and pregnancy test if indicated)
Denominator: number of patients with heavy menstrual bleeding who were seen by a gynecologist
Numerator: number of patients in the denominator who had a comprehensive initial assessment prior to referral including:
Detailed history
Complete blood count
Gynecological exam
Pregnancy test (if pregnancy is possible)
Percentage of patients with heavy menstrual bleeding who were seen by a gynecologist and who were offered pharmacological treatment to address heavy menstrual bleeding prior to referral
Numerator: number of patients in the denominator who were offered pharmacological treatment to address heavy menstrual bleeding prior to referral
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