COVID-19: Get the latest updates or take a self-assessment.
Patients presenting acutely with uncontrolled heavy menstrual bleeding receive interventions to stop the bleeding, therapies to rapidly correct severe anemia, and an outpatient follow-up appointment with a health care professional at or immediately following their next period (roughly 4 weeks).
Patients presenting with acute heavy menstrual bleeding should be managed promptly to minimize morbidity and reduce the likelihood of requiring blood transfusions. Interventions to stop the bleeding include pharmacological therapies, intracavitary tamponade, dilation and curettage with hysteroscopy, resectoscopic endometrial ablation, uterine artery occlusion, and hysterectomy. Hysterectomies in the acute setting should be a last resort due to the risks associated with surgery in patients with acute anemia.
First-line therapy to correct severe anemia (a hemoglobin level of 90 g/L or lower) is intravenous iron. Red blood cell transfusion using the least number of units required is recommended when the patient has serious symptoms of anemia such as hypotension, chest pain, syncope, or tachycardia.
A follow-up appointment scheduled to correlate with the patient’s next period is important as it allows health care professionals to assess whether the problem is ongoing and to review the efficacy of any medications started in the hospital.
If your bleeding is suddenly extremely heavy, your health care professional will try to stop it with medication or a procedure. You may also be given iron intravenously or a blood transfusion. You should have a follow-up appointment near your next period.
When a patient presents with acute heavy menstrual bleeding, stabilize and manage them in a way that minimizes the need for blood transfusions. Ensure the patient has a follow-up outpatient appointment booked within 4 weeks, at or immediately following their next period, to assess whether the problem is ongoing and to review the efficacy of any medications started to treat the bleeding.
Ensure systems, processes, and resources are in place such that patients have access to all options to stop acute bleeding, receive rapid resuscitation, and start appropriate anemia treatment while in hospital. Ensure resources are available to enable timely follow-up appointments.
Percentage of patients who have an outpatient follow-up visit with a health care professional within 4 weeks of leaving the hospital for an unplanned emergency department visit or hospital admission for heavy menstrual bleeding
Denominator: number of patients who had an unplanned emergency department visit or hospitalization for heavy menstrual bleeding
Numerator: number of patients in the denominator who had an outpatient follow-up visit with a health care professional within 4 weeks of leaving hospital
Data sources: local data collection; for system level, Ontario Health Insurance Plan claims database (OHIP), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)
Note: Follow-up appointments should be scheduled to coincide with the patient’s next period, which is estimated to be within 4 weeks. OHIP, DAD, and NACRS at system level can measure follow-up with a physician but cannot capture follow-up appointments with other health care professionals.
Percentage of patients who had an unplanned emergency department visit for heavy menstrual bleeding within 60 days (i.e., to allow time for one or more subsequent menstrual cycles) after an initial emergency department visit or hospital discharge for heavy menstrual bleeding
Denominator: number of patients who had unplanned emergency department visit or hospital discharge for heavy menstrual bleeding
Numerator: number of patients in the denominator who had an unplanned emergency department visit for heavy menstrual bleeding within 60 days after the initial visit or hospital discharge
Data sources: local data collection; for system level, Discharge Abstract Database, National Ambulatory Care Reporting System
An episode of heavy menstrual bleeding, not related to pregnancy, that is of sufficient quantity to require immediate intervention to prevent further blood loss.
Patients, families and the public are central to improving health quality.
Are you passionate about quality health care for all Ontarians? Stay in-the-know about our newest programs, reports and news.