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National Collaborating Centre for Women's and Children's Health (UK). Heavy Menstrual Bleeding. London: RCOG Press; 2007 Jan. (NICE Clinical Guidelines, No. 44.)

Appendix CGuideline questions

Background questions

1.

How is HMB defined?

2.

What risk factors are associated with developing HMB?

3.

How is clinical effectiveness of treatment for HMB defined?

4.

What impact does HMB have on quality of life of the women? (Why do women consult for HMB?)

5.

What are the current trends in treatment for HMB in the UK?

4.3.a.

The guideline will provide advice on patient educational interventions and information provision to improve patient satisfaction.

4.3.b.

The guideline will provide advice on diagnosis of women presenting with HMB, including guidance on appropriate investigations and referral, and the cost-effectiveness of undertaking such investigations.

6.

What are the indications for, effectiveness of, and cost-effectiveness of menstrual blood loss estimation in the diagnosis and management of HMB?

7.

What is the effectiveness of patient education/information provision/counselling on patient satisfaction with treatment for HMB?

8.

How much should patient choice influence management?

9.

Do lifestyle indications/interventions affect HMB?

10.

What questions need to be asked in routine history taking for HMB?

4.3.b.

The guideline will provide advice on diagnosis of women presenting with HMB, including guidance on appropriate investigations and referral, and the cost-effectiveness of undertaking such investigations.

11.

Physical examination on women with HMB?

12.

What are the indications for, effectiveness of, and cost-effectiveness of imaging for excluding other conditions?

13.

What are the indications for, effectiveness of, and cost-effectiveness of tests for excluding other conditions?

14.

What are the indications for, effectiveness of, and cost-effectiveness of a full blood count to test for anaemia?

4.3.c.

The guideline will provide advice on the medical management of HMB, including short-and long-term outcomes, adverse events, cost-effectiveness and subsequent treatment.

15.

What are the indications for, effectiveness of, and cost-effectiveness of using antifibrinolytics for treating HMB?

16.

What are the indications for, effectiveness of, and cost-effectiveness of using NSAIDs for treating HMB?

17.

What are the indications for, effectiveness of, and cost-effectiveness of using etamsylate for treating HMB?

18.

What are the indications for, effectiveness of, and cost-effectiveness of using the combined oral contraceptive pill for treating HMB?

19.

What are the indications for, effectiveness of, and cost-effectiveness of using oral progestogens for treating HMB?

20.

What are the indications for, effectiveness of, and cost-effectiveness of using injected/depot progestogens for treating HMB?

21.

What are the indications for, effectiveness of, and cost-effectiveness of using intrauterine levonorgestrel-releasing systems for treating HMB?

22.

What are the indications for, effectiveness of, and cost-effectiveness of using HRT for treating HMB?

23.

Medical management of HMB using other pharmaceutical interventions?

24.

What are the indications for, effectiveness of, and cost-effectiveness of using gonadotrophin-releasing hormone analogue for treating HMB?

4.3.d.

The guideline will provide advice on the indications for referral to secondary care management.

25.

What are the indications for surgery?

4.3.e.

The guideline will provide advice to determine whether, and when, surgical procedures are most appropriate.

26.

Are there situations where non-pharmaceutical treatment should not be the first line of treatment for HMB?

4.3.f.

The guideline will provide advice on operative procedures used for endometrial ablation/ resection in HMB, including short- and long-term outcomes, cost-effectiveness, adverse events, and subsequent treatment.

27.

What are the indications for, effectiveness of, and cost-effectiveness of using dilatation and curettage for treating HMB?

28.

What are the indications for, effectiveness of, and cost-effectiveness of using endometrial ablation/resection for treating HMB?

4.3.g.

The guideline will provide advice on operative procedures used for uterine artery embolisation in HMB, including short- and long-term outcomes, cost-effectiveness, adverse events, and subsequent treatment.

29.

What are the indications for, effectiveness of, and cost-effectiveness of using radiological interventions for treating HMB?

4.3.h.

The guideline will provide advice on operative procedures and other techniques used for hysterectomy and myomectomy in HMB, including short- and long-term outcomes, adverse events, and subsequent treatment. This will include guidance on minimal access techniques (laparoscopically).

30.

What are the indications for, effectiveness of, and cost-effectiveness of using myomectomy for treating HMB?

31.

Are there any indications for using hysterectomy as first-line treatment for HMB?

32.

What are the indications for, effectiveness of, and cost-effectiveness of using hysterectomy for treating HMB?

4.3.i.

When hysterectomy is the most appropriate option, issues relating to the removal of healthy ovaries will be examined.

33.

What are the indications for, effectiveness of, and cost-effectiveness of removing ovaries during hysterectomy versus not removing?

4.3.j.

The competencies required by practitioners who wish to carry out surgical techniques and other interventions, such as UAE, will be provided.

34.

What are the competencies required by practitioners who wish to carry out surgical techniques and other interventions for HMB?

35.

Competencies for investigations?

Copyright © 2007, National Collaborating Centre for Women's and Children's Health.

No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK [www.cla.co.uk]. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

Cover of Heavy Menstrual Bleeding
Heavy Menstrual Bleeding.
NICE Clinical Guidelines, No. 44.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2007 Jan.

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