Table 1 Questionnaire design for the organisational survey of gynaecological outpatient services for heavy menstrual bleeding

Services and care for women with Heavy Menstrual Bleeding (HMB)

• Local written protocol or guideline for HMB*

 ◦ Local protocols derived from national guidelines should be in place for speedy and evidence-based management of heavy menstrual bleeding in primary care. (RCOG)

• Dedicated menstrual bleeding clinic*

 ◦ There should be a dedicated one-stop menstrual bleeding clinic with facilities within the clinic for diagnostic gynaecology, including hysteroscopy and ultrasound. (RCOG)

• If yes, is the clinic ‘one-stop’ (i.e., a clinic designed only to see patients with menstrual bleeding issues)?*

 ◦ There should be a dedicated one-stop menstrual bleeding clinic with facilities within the clinic for diagnostic gynaecology, including hysteroscopy and ultrasound. (RCOG)

• Facilities available within the department

• Investigations at first consultation

• Surgical treatment options*

 ◦ In women with HMB alone, with uterus no bigger than a 10-week pregnancy, endometrial ablation should be considered preferable to hysterectomy. (NICE)

Referral to secondary care

• Referral system in the local area*

 ◦ Referral pathways between primary and secondary care should be agreed locally and reviewed annually. (RCOG)

• Baseline investigations generally carried out in primary care

• Treatment offered in primary care*

 ◦ Adequate facilities and trained individuals should be available for the insertion of levonorgestrel-releasing intrauterine system (LNG-IUS) in the outpatient clinic and in primary care settings. (RCOG)

• Proportion of women with no treatment in primary care*

 ◦Adequate facilities and trained individuals should be available for the insertion of levonorgestrel-releasing intrauterine system (LNG-IUS) in the outpatient clinic and in primary care settings. (RCOG)

• Reasons for referral to secondary care

• Average waiting time from referral to appointment

• Management options in secondary care

• Direct GP referral to diagnostic procedures*

 ◦ Guidelines should be in place for direct referral to imaging services from primary care. (RCOG)

Information for patients

• Written information for patients about HMB*

 ◦ An information leaflet should be available that includes each treatment option for heavy menstrual bleeding, together with outcomes and complications. (RCOG)

 ◦ A woman with HMB referred to specialist care should be given information before her outpatient appointment. The Institute’s information for patients (‘Understanding NICE guidance’) is available from http://www.nice.org.uk/CG044publicinfo (NICE)

• Timing of information

• Who provides it

Patient questionnaires

• Formal questionnaire to assess how HMB affects women*

 ◦ For clinical purposes, HMB should be defined as excessive menstrual blood loss which interferes with the woman’s physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms. Any interventions should aim to improve quality of life measures. (NICE)

 ◦ The treatment should aim to improve quality of life rather than focusing on menstrual blood loss alone. (RCOG)

• Timing of questionnaire

• Who provides it

Departmental information

• Number of first appointments in clinic overall

• Number of first appointments for HMB