Hysterectomy for Menorrhagia
Please click here to view the full Hysterectomy for Menorrhagia Commissioning Statement.
NHS Vale of York CCG ONLY commissions hysterectomy for menorrhagia by prior approval, within criteria. ‘Patient choice’ to opt for hysterectomy without any form of prior conservative treatment is not routinely commissioned.
The CCG will ONLY fund hysterectomy for heavy menstrual bleeding when ALL of the following conditions are satisfied:
- There has been an unsuccessful trial (of at least 6 cycles) with a levonorgestrel intrauterine system (e.g Mirena®) unless medically contraindicated (see note 1)
- A second pharmaceutical treatment (unless contraindicated) has been tried and has also failed. These pharmaceutical treatments include:
- Tranexamic acid (2nd line pharmaceutical treatment)
- Non-steroidal anti-inflammatory drugs (NSAIDs) (2nd line)
- Combined oral contraceptives (2nd line)
- Oral progesterone (3rd line pharmaceutical treatment)
- Injected progesterone (3rd line)
- Endometrial ablation has been tried (unless the patient has fibroids >3cm, an abnormal uterus or other contraindications), or uterine artery embolization or myomectomy (if appropriate), and have failed to relieve symptoms or are contraindicated
- All other pharmaceutical, surgical and radiological treatment options have failed, or are contraindicated
- Fibroids are greater than 3cm in size
- Severe symptoms are present, or abnormality of the uterus
Note 1. Documented medical contra-indications to Mirena® coil insertion include:
- large fibroids (uterine size >12 weeks) or distorted uterine cavity
- severe anaemia, unresponsive to transfusion or other treatment whilst a Mirena trial is in progress or established or marked immunosuppression
- pelvic inflammatory disease
- genital malignancy or active trophoblastic disease (rare causes of menorrhagia)
- UKMEC 3 Criteria
Note 2. Endometrial ablation is suitable for women who do not want to conceive in the future and should only be offered after full discussion of risks and benefits and other treatment options.
Any requests outside the above criteria have to be made on the grounds of clinical exceptionality rom the NHS VOYCCG Individual Funding Request Panel.
Patient information menorrhagia