Publication:

How can a heavy menstrual bleeding scoring system be utilized in practice?

Background The objective of the study was to utilise a scoring system which aims to triage women with heavy menstrual bleeding (HMB) into hysterectomy or conservative options in practice. The design of the study was a retrospective study in a UK single centre.

Methods A six-factor scoring tool to triage women with HMB was identified based on different published evidence. These factors are the presence of a uterine fibroid, chronic pelvic pain/endometriosis, adenomyosis, patient desire for hysterectomy, large uterine cavity and anaemia needing parental therapy. Each factor scores 1, apart from uterine cavity length which scores 2. Hysterectomy would be advised if the score is ≥3, otherwise conservative options would be indicated. For this tool to be clinically recognised, it needed to be validated retrospectively over one year. In order to validate this scoring tool, 327 women aged 25-54 referred with HMB between January 2021 and December 2021 were identified and reviewed. Data was retrieved from patients` records, then divided by outcome. The score was applied to the collected data, patients followed for two years. Differences and associations between variables were examined. Sensitivity and specificity of the scoring system in triaging women with HMB was measured. The application of the validated scoring tool in practice was considered depending on the validation outcome.

Results 38/327 (11. 6%) of patients had hysterectomy. There was a significant association between having each factor of the score and hysterectomy and a significant association of having a total score of ≥3 and hysterectomy OR 6.23 (95% CI 4.80 – 7.67). The score has a calculated sensitivity of 0.84 (0.68-0.93), specificity of 0.99 (0.97-0.99) and positive predictive value of 0.91 (0.75-0.98). The strongest predictive factor for hysterectomy was large uterine cavity, followed by woman’s desire for hysterectomy, then adenomyosis (p<0.001). Other demographic and clinical variables did not predict hysterectomy as an outcome with the exception of dysmenorhea which when added to the score, it decreased positive predictive value affecting performance. To apply this validated scoring tool in practice, a prospective feasibility trial needs to be conducted prior to a definitive randomised control trial which is on the way.

Conclusions To use this scoring tool to triage women with HMB in practice, it needed to be validated. Validation has confirmed that this scoring system has high sensitivity and specificity in predicting outcome. Further evaluation of this validated tool in a randomised clinical feasibility trial prior to the definitive trial is needed so the scoring tool can be utilised in practice.