NOW UPDATED:
Ontario Health’s Heavy Menstrual Bleeding quality standard (originally published in 2017, updated in 2024) addresses care for people of reproductive age who have heavy menstrual bleeding, regardless of the underlying cause. The quality standard includes acute and chronic heavy menstrual bleeding, and it applies to all care settings. It does not apply to people with non-menstrual bleeding or with heavy menstrual bleeding occurring within 3 months of a pregnancy, miscarriage, or abortion.
The quality
standard includes 14 quality statements addressing areas that have
high potential for improving the quality of care in Ontario for people with
heavy menstrual bleeding.
Below
is a sample of tools that may help you implement the quality statements,
organized according to purpose. Several of these tools will help to support
multiple quality statements.
Are
there other tools or resources you use? Do you have experience implementing
these tools? If you have feedback about any of these tools, please use the
comments section below to share!
Tools
to Support Clinical Practice
- NICE Pathway: Heavy Menstrual Bleeding Overview – an
interactive flowchart from the National Institute for Health and Care
Excellence that provides detailed recommendations for the diagnosis,
assessment, and management of heavy menstrual bleeding
- Self-Administered Bleeding Assessment Tool (Self-BAT)
– a scientifically validated scoring tool developed by Dr. Paula James of
Queen’s University to help identify bleeding disorders that cause heavy
menstrual bleeding
- Iron Deficiency – Diagnosis and Management – clinical practice guidelines
from the British Columbia Guidelines and Protocol Advisory Committee that
provide recommendations for the diagnosis, investigation, and management of
iron deficiency in patients of all ages, including those with anemia due to
heavy menstrual bleeding
Shared
Decision-Making Aids
- Shared Decision Making Aid for Heavy Menstrual Bleeding – a tool
endorsed by the National Institute for Health and Care Excellence to help
health care professionals and patients work together to review the treatment
options for heavy menstrual bleeding, weigh the benefits and risks of each
option, and make a decision that is best for the patient. (Note: This tool is
from the United Kingdom; different oral progestins are used in Canada.)
- Menstrual Calendar – a paper-based tool
recommended by The Society of Obstetricians and Gynaecologists of Canada to
help determine the root cause of a person’s heavy menstrual bleeding by
auditing menstrual flow, medications taken, symptoms experienced, and other
impacts on life
Resources
for Patients and Families
- Patient Guide: Heavy Menstrual Bleeding – a resource by Ontario Health
to help patients recognize high-quality care for this condition and learn how
to ask informed questions about their care
- YourPeriod.ca: Heavy Menstrual Bleeding Overview – a
website by
The Society of Obstetricians and Gynaecologists of Canada that was created to provide people with information
on the definition of heavy menstrual bleeding, its causes, and treatment
options
- Women With Bleeding Disorders
– a website by Heroixx with information about women with bleeding disorders,
including Von Willebrand disease
- Abnormal Uterine Bleeding: Should I Have a Hysterectomy? – a patient decision aid from The
Ottawa Hospital Research Institute for people with heavy menstrual bleeding
- Uterine Fibroids: Should I Have Uterine Fibroid Embolization?
– a tool available through HealthLinkBC to help patients whose heavy menstrual
bleeding is caused by uterine fibroids to decide if uterine fibroid
embolization is right for them
- Clue Period and Ovulation Tracker – a highly rated, free
smartphone application that enables users to track menstrual flow, fertility,
and other menstrual-cycle symptoms such as pain, emotions, sleep, energy, etc.
Other Tools
and Resources