WIREDGOV

Hysteroscopy has been recommended as a first line diagnostic test for women with heavy menstrual bleeding (menorrhagia), in updated NICE guidance.

The update makes new recommendations for diagnosing and treating the condition, which is estimated to affect around a quarter of women of a reproductive age. 

The guideline recommends that women with symptoms and/or risk factors for gynaecological diseases or conditions, such as persistent bleeding between periods, should be offered hysteroscopy.

Hysteroscopy uses a narrow telescope with a light and camera at the end, also called a hysteroscope, to examine the inside of the womb. Miniature hysteroscopes should be used and oral painkillers provided to ensure the procedure is as pain free as possible.

Professor Mark Baker, director of the centre for guidelines at NICE, said: “Heavy menstrual bleeding is a common condition that can have a major impact on a woman’s quality of life. Since we published our original guideline in 2007 there have been significant advances in diagnostic techniques which have been reflected in the new guideline.

“In many circumstances ultrasound has been replaced with hysteroscopy as a first line investigative test as it provides a more accurate diagnosis. This change should help ensure women with underlying endometrial diseases or conditions are more effectively diagnosed and can therefore receive better treatment. Not only this but the cost of additional hysteroscopy will be offset by savings from fewer ultrasound investigations and fewer appointments following the diagnostic test.”

It is estimated this recommendation will lead to a rise in the number of women having hysteroscopy from around 5,000 to around 15,000 in England each year, an increase of 10,000.

The heavy menstrual bleeding quality standard has also been amended to align with the updated clinical guideline.

NHS organisations should compare their current practice with these recommendations and consider what changes may need to be made to put them into practice. In considering any changes, they will need to take into account any extra costs and savings involved. The speed at which these recommendations are adopted by local NHS services will depend on the resources they have available and the other priorities they are dealing with.