Heavy Menstrual Bleeding Clinical Care Standard

The Heavy Menstrual Bleeding Clinical Care Standard was first released in 2017 in response to the Atlas of Healthcare Variation series which found substantial variation in the rates of hysterectomy and endometrial ablation across Australia^3,4, with Australian women undergoing hysterectomy at a higher rate than women in comparable Organisation for Economic Co-operation and Development (OECD) countries.⁵

The Women’s Health Focus Report 2024 examines trends in these procedures since the second Atlas in 2017. The Report shows:

• A decrease in hysterectomy rates of 20% nationally between 2014–15 and 2021–22. 
• An increase in endometrial ablation hospitalisation rates of 10% nationally between 2013–16 and 2019–22.

Despite these improvements, variation remains. Rates of hysterectomy remain high by international standards, and are higher in regional areas compared to major cities and remote areas. 

While the reasons for this variation are not fully understood, it is evident that access to, and uptake of, appropriate care is influenced by several factors. These include low patient awareness of suitable options; treatment costs to patients; limited availability of services; and limited numbers of clinicians with the knowledge, skills and equipment, or willingness to deliver services such as intrauterine device (IUD) insertion^6,7, endometrial ablation or uterine artery embolisation. Women living in rural and remote Australia face additional challenges when it comes to accessing investigations and services such as ultrasound, IUD insertion and appropriate specialist medical care.

Read more about the scope and goal of this standard or see further background in the full standard. 

To ensure that women with heavy menstrual bleeding are offered the least invasive and most effective treatment appropriate to their clinical needs and preferences, and are able to make an informed choice from the range of treatments suitable to their individual situation.

This clinical care standard relates to the care of women of reproductive age with heavy menstrual bleeding. It covers management from first recognition of clinically significant heavy menstrual bleeding until its resolution in women before or at menopause.

The standard was reviewed in consultation with a topic working group of clinicians, researchers and consumers. A targeted consultation process was conducted with key stakeholders.

The standard has been endorsed by 21 key organisations.

Further information is available on the evidence sources which underpin the Heavy Menstrual Bleeding Clinical Care Standard (2024).

1. Fraser IS, Mansour D, Breymann C, Hoffman C, Mezzacasa A, Petraglia F. Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey. Int J Gynaecol Obstet. 2015 Mar;128(3):196-200.
2. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management (NG88). London: NICE; 2018 [updated 24 May 2021].
3. Australian Commission on Safety and Quality in Health Care and National Health Performance Authority. Australian atlas of healthcare variation. Sydney: ACSQHC; 2015. 
4. Australian Commission on Safety and Quality in Health Care and Australian Institute of Health and Welfare. The second Australian atlas of healthcare variation. Sydney: ACSQHC; 2017.
5. Organisation for Economic Co-operation and Development. Healthcare utilisation: surgical procedures – hysterectomy [Internet]. OECD; 2023 [cited 2023 Mar 14]. Available from: stats. oecd.org/index.aspx?queryid=30167#
6. Mazza D, Watson CJ, Taft A, Lucke J, McGeechan K, Haas M, et al. Pathways to IUD and implant insertion in general practice: a secondary analysis of the ACCORd study. Aust J Prim Health 2023 Jul;29(3):222–8.
7. Stewart M, Digiusto E, Bateson D, South R, Black KI. Outcomes of intrauterine device insertion training for doctors working in primary care. Aust Fam Physician 2016 Nov;45(11):837–41.