Women's health toolkit

This Women’s Health Hub is categorised into sections best representing the needs of women at different stages of their lives.

Background information for commissioners

Menstrual related problems affect a significant proportion of the 25% of the UK population who are female of reproductive age between puberty and menopause, affecting their physical, psychological and social well-being. If unmanaged some of these conditions can cause lifelong problems including metabolic disease or chronic pelvic pain.

In the UK an estimated:

  • One in five women of reproductive age suffer with heavy menstrual bleeding (HMB) 1
  • One in 20 women aged 30-49 contact their GP with HMB each year.1
  • One in 10 women of reproductive age in the UK suffer with endometriosis,2 affecting 1.5 million women - the same number diagnosed with diabetes3.
  • Endometriosis costs the health and social care economy an estimated £8.2 billion/year4.

There is an under-recognition of the problems that women with menstrual dysfunction face with many women not realising their periods are not ‘normal’, a direct result of lack of education about menstrual health. This under-recognition and the ‘taboos’ surrounding the subject mean that many women are compromised, as they are not empowered to request support to help them attend school, college or work for several days and months a year.

The psychological impact is also underestimated and a recent survey of women with heavy menstrual bleeding5 found that of 1000 surveyed:

  • 74% experienced anxiety
  • 67% suffered with depression.

There are opportunities to reduce the health and social impact resulting from menstrual-related problems, whilst improving patient choice and experience, in primary care and out-of hospital settings by applying recommendations from recently updated NICE guidance 1 and improved access to diagnostic and minimal intervention technologies.

Resources:

The 'All Party Parliamentary Group on Women’s Health Report; informed choice? Giving women control of their healthcare' report from the All Party Parliamentary Group on Women’s Health (WHAPPG) in the UK highlights insufficient care and concern for women with endometriosis and fibroids.

Their survey of over 2600 women (with endometriosis and fibroids) found:

  • 42% of women said that they were not treated with dignity and respect
  • 62% of women were not satisfied with the information that they received about treatment options for endometriosis and fibroids
  • Nearly 50% of women with endometriosis and fibroids were not told about the short term or long term complications from the treatment options provided to them.

The recommendations from the report are wide-ranging, including improving awareness and reducing stigma of menstrual concerns by improving education at secondary school as well as for healthcare professionals, by improving information resources on the conditions and management options and by endorsing best practice pathways and care provided consistently following NICE recommendations.

Annual Report of the CMO 2014 – The health of the 51%:women

The report, developed with the support of expert academic and clinician input, examines women’s health in England and makes a range of recommendations for improvement.

The report identifies several missed opportunities for intervention in women’s health, and brings attention to ‘embarrassment’ as a needless barrier to health.

The main themes include:

  • obesity and its impact on women’s health, including reproductive health
  • women’s health in later life (menopause)
  • women’s health in later life (pelvic floor dysfunction and incontinence)

Menstrual Health Coalition report. Heavy Menstrual Bleeding – Breaking Silence and Stigma

Many women struggle to manage their menstrual health for a number of reasons. The Menstrual Health Coalition conducted an inquiry to explore this in further detail. The recommendations from the inquiry have been published in the 'Menstrual Health Coalition report. Their suggestions were:

  • Improve awareness and education to inform women about what is normal and abnormal menstruation and remove stigma encouraging more women to seek help and ensure that those who are approached are able and qualified to provide help.
  • Adequate, easily accessible and evidence-based information should be available for women and clinicians. The information should be comprehensive, including input from Royal Colleges and patient voices, as well as NHS and PHE resources.
  • Access to services should be prioritised and systems linked up to ensure that women can access the help that they need in a timely manner.

Plan UK report

The 'Break the Barriers: Girls’ Experiences of Menstruation in the UK' report reveals a culture of stigma and silence have turned periods into a hidden public health issue – putting girls' physical, sexual and mental health at risk. The report demands action through a menstrual manifesto to end the challenges girls face and break down the taboos that continue to make them feel ashamed of their bodies when they have their period.

RCOG: Heavy Menstrual Bleeding Audit final report.

A national audit to assess patient outcomes and experiences of care for women with heavy menstrual bleeding in England and Wales.

The Royal College of Obstetricians and Gynaecologists undertook a first audit and a repeat audit after four years to describe the provision of services for HMB in hospitals in England and Wales and patient-reported outcomes in an outpatient setting.

The conclusions of this work include:

  • The existing referral pathways between primary and secondary care should be reviewed with nearly one-third of women reported that they had not received any treatment for their HMB in primary care.
  • There were differences to care provided to different ethnic and socio-economic groups and there is a requirement to address this to improve how the individual needs of women are being met.
  • Information for patients should be improved with women being informed adequately about the treatment options available.
  • Hospital services should compare themselves with peers to reduce variation in protocol, organisation and treatments offered.

NICE recommendations – putting this guideline into practice

NICE Guideline (NG88) Heavy Menstrual Bleeding: assessment and management. March 2018 (updated November 2018)

The guideline for assessment and management of heavy menstrual bleeding was updated in March 2018 with further amendments in 2021. It aims to help healthcare professionals investigate the cause of heavy periods that affect a woman’s quality of life and to offer the right treatments, taking into account the woman’s priorities and preferences.

Tools and resources have been produced to help put the guideline into practice noting specific issues including:

  • facilities and staffing for hysteroscopy services in community settings.
  • Providing hysteroscopy in line with best practice guidelines.

NICE Guideline (NG73): Endometriosis: diagnosis and management. September 2017

The guideline for diagnosis and management of endometriosis was published in September 2017. This aims to raise awareness of the symptoms of endometriosis, and to provide clear advice on what action to take when women with signs and symptoms first present in healthcare settings and of treatment options available.

Recommendations include that the community, gynaecology and specialist endometriosis centres should work together to provide coordinated care to provide prompt diagnosis and treatment of endometriosis to improve quality of life and reduce adverse consequences of untreated disease.

Commissioned service requirements

Specialist endometriosis centres

NHS England specialist commissioners have published the specification for the service for treating endometriosis with a recommendation to commission services from centres that meet the British Society of Gynaecological Endoscopy (BSGE) Accreditation criteria. The ambition is to deliver treatment by multidisciplinary teams working in specialist centres who have sufficient workload to maintain skills and audit their performance.

List of specialist endometriosis centres found online.

RCOG Advice for Heavy Menstrual Bleeding (HMB) services and commissioners.

The lessons learnt from the RCOG Heavy Menstrual Bleeding audit have informed a recommendation for commissioners and providers of HMB services. The purpose of this advice, endorsed by the Royal College of General Practitioners (RCGP), is to ensure that effective and patient focused clinical care can be delivered nationally in primary and secondary care.

References:

  1. NICE. Heavy menstrual bleeding: assessment and management. NICE Guideline 88. NICE, March 2018 (updated November 2018). www.nice.org.uk/ng88
  2. Rogers PA, D'Hooghe TM, Fazleabas A, et al. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci 2009;16(4):335-46
  3. Diabetes UK: Diabetes prevalence 2012. (April 2012). Diabetes affects around 2.9 million people, of which slightly less than half of this are women.
  4. Simoens S, Dunselman G, Dirksen C, et al. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod 2012;27(5):1292-9
  5. Wear White Again, Hologic survey 2017