Heavy menstrual bleeding (HMB) affects one in four women of reproductive age. It is a condition that impairs the quality of life of many women who are otherwise healthy. Every year in England and Wales, an estimated 50000 women with HMB are referred to secondary care in the NHS. This constitutes approximately 20% of referrals to specialist gynaecology services, and approximately 28000 women undergo surgical treatment.
In the majority of women, the cause of their HMB is not known. Medical treatments for HMB include (oral) medication and the levonorgestrel -releasing intrauterine system(LNG-IUS). Surgical treatment, including endometrial ablation (EA) and hysterectomy, is an option if medical treatment is ineffective or undesirable.
In this paper, Geary et al. investigate the factors that determine whether women who have been referred to secondary care for HMB get surgical treatment. The study explores the impact that symptom severity, treatment received in primary care and patient characteristics including age, ethnicity and socioeconomic deprivation have on the chance that women receive surgical treatment in the first year after their referral to secondary care.