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This commissioning statement refers to:
The CCGs do not commission Hysterectomy as a first line treatment for HMB in line with NICE guidance. https://www.nice.org.uk/guidance/CG44/chapter/Recommendations#choice
Therefore Hysterectomy for HMB will only be supported if other treatment options have failed or are contraindicated as outlined in NICE guidance [ Clinical Guidance CG44: Heavy Menstrual Bleeding: assessment and management: published January 2007: updated August 2016]
This means for women with fibroids of <3cm or no structural abnormality and history and examination deem that pharmaceutical treatment is appropriate and either hormonal or non-hormonal treatments are acceptable then at least 2 pharmaceutical options should be explored in the following order:
For women with HMB and with uterine fibroids of >3cm, pharmaceutical treatment should be considered if clinically appropriate as above. Additional pharmaceutical options recommended by NICE for women with large fibroids > 3cm include the following:
Note:
Obesity
Smoking
Hysterectomy is a major operation and is associated with significant complications in a minority of cases1. Since the 1990s the number of hysterectomies has been decreasing rapidly and it should not be used as a first-line treatment solely for HMB.. There are now a range of alternative treatment options for HMB
NICE clinical guidelines (2007)1 emphasise that:
A Cochrane systemic review showed that the Mirena® coil improved the quality of life of women with menorrhagia as effectively as hysterectomy (no ref provided)
Hysterectomy should be considered only when1:
.
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