RCOG World Congress 2025

Title

Validation of a scoring system to triage HMB patients for treatment options.

Authors Dr Humaira Ali (MBBS, DNB , MRCOG), Trust Doctor, South tyneside and Sunderland NHS Trust, UK, Dr Laura Hewitt (Teaching Fellow Obstetrics and Gynaecology) South Tyneside and Sunderland NHS Foundation Trust, UK and Dr Shamma Al-Inizi (Consultant Obstetrician and Gynacologist, South Tyneside and Sunderland Foundation Trust, UK)

Background:

•Heavy Menstrual Bleeding (HMB) is a common referral to gynaecology.

•Effective triage can guide women toward appropriate treatments, including uterine-sparing options or hysterectomy.

•A scoring system was previously developed using clinical parameters to streamline treatment decisions

Objective
To validate a scoring system designed to triage women with heavy menstrual bleeding (HMB) into appropriate treatment pathways, including hysterectomy or uterine-sparing modalities to be introduced and assesed in an RCT.

Design

• Retrospective observational study

• Setting: Secondary care centre

Duration: January 2021 – December 2021

Methods

•44,225 gynaecology referrals reviewed.

•25,510 attended appointments.

•1,830 women identified with HMB.

•364 patient met the criteria to be analysed via scoring system

•Data collected from Meditech and entered into Excel.

•Scoring system used from previous published data to study association between the scores with likelihood of needing hysterectomy

Scoring System Parameters (Score)

•Fibroid >3 cm (1)

•Adenomyosis (1)

•Chronic pelvic pain (CPP),Dysmenorrhoea and/or dyspareunia or known endometriosis (1)

•Severe anaemia (requiring transfusion/iron infusion) (1)

•Desire for amenorrhoea/hysterectomy (1)

•, Endometrial cavity measuring more than 10.5cms (2)

Results

Proportion of patients ending in hysterectomy:

Score < 3: 4.95%

Score ≥ 3: 47.37%

This shows a strong association between higher scores and likelihood of hysterectomy.

Strongest associations are
seen with:

• Large endometrial cavity
(↑ 38.5% vs 7.0%)
• Adenomyosis and large
fibroids (↑ ~30%)

Logistic regression analysis confirms that as the score increases, the likelihood of hysterectomy rises sharply

Conclusion

The scoring system reliably predicts treatment pathways for women with HMB.

Enables evidence-based, standardized clinical decisions.

May reduce treatment variability and enhance personalized care.

RCOG World Congress 2025

Validation of a scoring system to triage Heavy menstrual bleeding treatment options.

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