WOMEN’S HEALTH - ACCESS TO TREATMENTS IMPROVING

For years, women suffering from the painful and often debilitating condition memorrhagia (heavy menstrual bleeding - HMB) have had to endure major surgery (hysterectomy) to relieve their symptoms. 

However, the results of a new survey carried out by the Liberal Democrat Shadow Minister for Health Sandra Gidley MP, published today (Monday, 29^th January 2007), have shown significant improvements in the treatment options offered by the National Health Service (NHS).  Of the Acute Trusts surveyed, one in five now offer a full range of treatment options for the condition including:

• Hysterectomy - surgical removal of the uterus
• myomectomy - surgical removal of muscle tissue
• Intrauterine device (IUD) - a contraceptive device small device made from plastic and copper, previously known as 'the coil'
• Endometrial ablation (EA) therapy - a technique which aims to reduce the menstrual bleeding by destroying (ablating) the entire thickness of the innermost layer of the uterus (the endometrium)
• Embolisation - the blocking of an artery, the blood vessels supplying an organ, to stop blood flow
• Drug treatments - hormonal and non-hormonal medicines

Over 80% of the responding Trusts offering at least one other less invasive therapy. 

Ms Gidley, who is MP for Romsey, carried out the survey of treatment options available in UK Acute Trusts, after hearing that a large number of women are still being given unnecessary hysterectomies, despite effective alternative treatments being available.

It is estimated that one in four women in England suffer from menstrual problems over their lifetime, with approximately 6.5% of all women aged 12-51 suffering from HMB^[1]. Each year more than 5% of women in the UK visit their doctor because of excessively heavy periods. During 2002-3 the NHS carried out approximately 8,332 hysterectomies on women with HMB^[2].  

“Hysterectomies have many proven benefits and have helped many women through menorrhagia, relieving immediate unpleasant symptoms,” explained Ms Gidley MP.

“However, a hysterectomy is major surgery and patients will be off work for a significant period of time. It also means the patient is unable to have children after the operation. With so many innovative, minimally invasive procedures available, it is vital that women with HMB are equipped with all the facts and options before treatment is carried out. This survey is encouraging news for both patients and health professionals- access to these alternatives is improving.”

When asked about the allocations of resources to HMB, of the 93 trusts who responded^[3], the survey concluded that 18% (one in five) of Acute Trusts now offer a full range of treatment options. In addition 54 offered drug treatment, 77 offered implantation of an intrauterine device (IUD) and 76 offered a form of endometrial ablation (EA) therapy.

“These alternative treatments can save the NHS a lot of time and money as well as improve the quality of life of the patient.  Some patients are able return to their daily routines the very next day following a less invasive treatment such as endometrial ablation, meaning huge savings for the health service through shorter hospital stays.  Patients usually spend about six days in hospital following a hysterectomy, followed by a long and often painful recovery period.”

“Crucially, women need to know that there are alternatives to a hysterectomy.  Sometimes it is the best option but there are less traumatic options available.” 

Following the recent announcement (Tuesday, 23^rd January 2007) by the National Institute for Health and Clinical Excellence (NICE), which highlights the new guidelines on the diagnosis, treatment and management of HMB, it is important that the acute trusts implement these guidelines and help raise the awareness amongst medical professionals about the benefits of alternative treatments for HMB to reduce the need for hysterectomies. (NICE recommends that a hysterectomy should usually only be considered as a last option, when heavy bleeding has a severe impact on quality of life and other treatments are not suitable or have not worked)^[4].

“The new guidelines are very welcome.  We have a good starting point, but a lot of work will be needed to put into practice in full, as many of the Acute Trusts who responded to the survey do not have the necessary multi disciplinary teams to implement them,” explained Ms Gidley.

Ms Gidley hopes the survey will raise awareness of the number of women who silently suffer from HMB and help to ensure that patients are aware of the minimally invasive alternatives to hysterectomy that are available.

 

Notes

 

Menorrhagia – Heavy menstrual bleeding (Menorrhagia): Heavy Menstrual Bleeding (HMB). Menorrhagia is clinically defined as ‘greater than, or equal to, 80 mls blood loss per menstrual cycle or bleeding lasting more than seven days over several cycles’. However, in practice, the diagnosis is based on the woman’s subjective assessment of blood loss. The main effect is on the quality of life for the patient who may miss days from work each month, take to her bed and effectively be unable to lead a normal life.

The burden of menorrhagia to the NHS is considerable. It accounts for 12% of all gynaecological referrals and an estimated £7 million is spent on treatments to manage the condition annually.

Treatment Options

§         Hysterectomy (amenorrhea) has a high success rate, but it is a major surgical procedure with significant physical and emotional complications and high costs associated.

§         Endometrial ablation (EA) techniques aim to reduce the menstrual bleeding by destroying (ablating) the entire thickness of the innermost layer of the uterus (the endometrium).

§         Hysteroscopic techniques (‘1^st generation’) use electric, thermal or laser energy, the success rates of these techniques depend heavily on the skills and experience of the operator and they carry some potential fatal side effects such as fluid overload.  Second generation techniques use heated saline, heated balloon, lasers or microwaves. They are less operator-dependent and were introduced to provide simpler, quicker and more effective treatment options.