Hysterectomy for Heavy Menstrual Bleeding (Surgery to remove the womb due to heavy periods)

Threshold

Norfolk and Waveney Integrated Care Board will not fund Hysterectomy as the first line treatment solely for heavy periods (menstrual bleeding). This procedure will be funded for the treatment of heavy periods (menstrual bleeding), after appropriate clinical assessment and only in the following circumstances:

• There has been a prior trial in primary care using second line pharmaceutical treatment with either tranexamic acid, non-steroidal anti-inflammatory agents, other hormone methods (combined oral contraceptives, progestogens, GnRH analogue) or where indicated in line with NICE guidance and is supported by the local formulary, and it has failed to relieve symptoms or is not considered appropriate or contraindicated; https://www.norfolkandwaveneyformulary.nhs.uk/

AND

• There has been a prior trial with a levonorgestrel-releasing intrauterine system (LNG-IUS) for a minimum of 12 months which has not successfully relieved symptoms; OR LNG-IUS is not considered appropriate or contraindicated

If, after thorough counselling in both primary and secondary care, the patient chooses not to accept a particular treatment modality, this should be documented before considering other options for the patient.

AND

For women with heavy periods (menstrual bleeding) who have a normal uterus and/or uterine fibroid less than 3cm:

• Endometrial ablation has been offered and failed to relieve symptoms or is not considered appropriate or is contra-indicated.

OR

For women with heavy periods (menstrual bleeding) and fibroids greater than 3cm:

• Uterine artery embolisation (UAE) has been offered and failed to relieve symptoms or is not considered appropriate or is contra-indicated

AND

• myomectomy has been offered and failed to relieve symptoms as second-line therapy

OR

• myomectomy is not clinically appropriate, or it is not indicated.

Overview | Heavy periods (menstrual bleeding): assessment and management | Guidance | NICE

Cases for Individual Funding Consideration (Patients who do not meet the policy criteria)

On a case to case basis, patients might be eligible for this intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.