Atlas report findings prompt local focus on treatment of heavy menstrual bleeding
Findings in the Australian Atlas of Healthcare Variation series prompted Ballarat gynaecologist Dr Natasha Frawley to review the use of hysterectomy to treat heavy menstrual bleeding at the local hospital.
The Second Atlas found that women living in Ballarat had the second highest rate of hospitalisations for hysterectomy for benign conditions in Australia in 2014–15.
The release of the Heavy Menstrual Bleeding Clinical Care Standard in 2017, which was developed as a result of Atlas findings, presented an opportunity for Dr Frawley to study whether Ballarat Hospital’s care of women with heavy menstrual bleeding aligned with best practice.
The Standard, which has recently been revised, sets out eight quality statements that describe the care that should be offered to a woman with heavy menstrual bleeding.
Dr Frawley, Clinical Director of Women’s and Children’s Services, Grampians Health, and Hospital Medical Officer Dr Madison Phung audited hospital and clinic data to identify patients who had hysterectomies for benign heavy menstrual bleeding at Ballarat Hospital in the 10 months before the release of the Standard and the 10 months after it. They have submitted their findings to a peer-reviewed journal.
‘Using the Clinical Care Standard was incredibly helpful to assess each patient’s journey to benign hysterectomy,’ Dr Frawley said.
Focus for improvement
Dr Frawley and Dr Phung identified areas for improvement that were specific to the Ballarat hospital context, including offering endometrial ablation and the 52 mg levonorgestrel-releasing intrauterine device (LNG-IUD) to patients with heavy menstrual bleeding considering hysterectomy.
The latest Atlas data show that the hysterectomy rate in Ballarat dropped by almost one-third (31%) between 2014–15 and 2021–22. However, Ballarat still has the second highest rate of hospitalisations for hysterectomy of any local area in Australia.
Dr Frawley said data from their audit showed more could be done to ensure women were offered alternatives to hysterectomy to treat heavy menstrual bleeding.
She said one way to do that was to increase gynaecologists’ and patients’ awareness of the morbidity associated with hysterectomy, which affects 4–8% of patients having hysterectomy. Complications can include organ injury, infection, prolonged stay and readmission.
Fast-tracked care
Ballarat Hospital is also working to offer women alternative medical treatments such as non-steroidal anti-inflammatory medications, treatment of iron deficiency, oral hormone treatments and the LNG-IUD, even when they’re referred to the hospital for surgery. In a new project that is part of the surgical reform pathway at the Grampians Health Service, women referred to Ballarat Hospital for heavy menstrual bleeding will be offered a fast-track appointment for medical management.
Registrar-led care will align with the Standard and include offering early insertion of the LNG-IUD.
Dr Frawley said the audit showed women were waiting a long time to get to the clinic. ‘These appointments outside the surgical pathway will mean women have quick access to good medical management treatment options. This will mean that patients will access treatment faster, and also in the end they may not need a hysterectomy.’