Heavy Menstrual Bleeding: Can a scoring system predict the likelihood of hysterectomy? - Abstract
Heavy menstrual bleeding (HMB), a common gynaecological condition which affects many women in their reproductive age, described as excessive menstrual blood loss which can affect the woman`s physical, social, and emotional quality of life. Different medical and surgical interventions are usually offered prior to hysterectomy. The commonest are the intrauterine system (IUS) and endometrial ablation (EA). These interventions might temporality relief some of the symptoms, however; several women continue to suffer with HMB & other related symptoms for years before definitive management for HMB is offered. We aim to reduce the time spent by women with HMB prior to hysterectomy to reduce their suffering. We studied several factors that women with HMB present with, including associated chronic pelvic pain (CCP), dysmenorrhoea, dyspareunia, endometriosis, symptomatic anaemia, women`s desire for definitive treatment, large uterine cavity, ultrasound evidence of uterine fibroid >=3cm and/or adenomyosis. We correlated these factors to histology of the removed uterus at hysterectomy. We reviewed 300 women who underwent hysterectomy for HMB over 5 years at South Tyneside & Sunderland hospitals. We identified that most of those women had received medical and surgical uterine sparing modalities prior to hysterectomy. We propose to introduce a scoring system based on the mentioned factors (score 1-6) which can triage women referred with HMB into hysterectomy or uterine sparing medical and surgical modalities. We suggest if the score is >=3, this could indicate that the woman will more likely benefit from hysterectomy rather than uterine sparing interventions which most likely would fail in relieving the patients` symptoms.