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Proposed new policy: Hysterectomy for menorrhagia

In March 2018 NICE published an update to their Heavy Menstrual Bleeding: Assessment and Management guideline.  A summary of the revised is highlighted below: 

Referral for hysterectomy should be considered only if the following three criteria are met:

1. There has been a prior unsuccessful trial with a levonorgestrel-releasing intrauterine system, unless medically contraindicated


2. At least two of the following treatments have failed, are not appropriate or are contraindicated in line with the NICE guidelines:

•           Non-steroidal anti-inflammatory agents

•           Tranexamic acid

•           Combined oral contraceptives

•           Oral norethisterone

•           Injected long-acting progestogens

•           Ulipristal


3a. Endometrial ablation has been considered


3b. Patient has fibroids >3cm or the uterus is bigger than a 10-week pregnancy.

Women who have contraindications or ethical reasons for not trying LNG-IUS must have tried two or more of the second line treatments and failed. These include:

•           Three cycles of tranexamic acid or NSAID treatment

•           Three cycles of alternative hormonal contraceptive treatment in line with NICE guidelines (NICE CG44)