Too many women are having hysterectomies when other treatments are available, the Government’s healthcare advisers said.

The National Institute for Health and Clinical Excellence (NICE) issued guidance yesterday to the NHS on treatments to treat heavy menstrual bleeding (HMB). One in four women in England has menstrual problems during her lifetime, and an estimated 6.5 per cent of women aged 21 to 51 suffer HMB.

Despite a reduction in the number of hysterectomies being carried out, too many doctors still consider the operation to be the only option.

NICE urges women not to suffer in silence and says that patients and doctors should familiarise themselves with other treatments.

These include drugs and other forms of surgery that are less radical than a hysterectomy, the guidance says. For women with excessive bleeding, the rates have fallen fast, but there are huge regional differences. About 5,900 operations, costing £15 million, could be avoided every year if the average rate of hysterectomies in England could be reduced to that in the 20 per cent of the country with the lowest rates.

There should be discussion on other treatments before a hysterectomy is considered, the NICE guidance said. The first options should be drug interventions, including contraceptives, or an intrauterine device.

If they fail, surgery to stop the bleeding would be the next option. This may include removing the lining of the womb (endometrial ablation), treatment to block the blood supply to any fibroids (uterine artery embolisation, or UAE) or removing fibroids (myomectomy). A hysterectomy would be a last resort.

Mary Ann Lumsden, a consultant gynaecologist from Glasgow who worked on the guidance, said that the condition affected well over one million women at any one time. She added: “In the early 1990s, it was estimated that at least 60 per cent of women presenting with heavy menstrual bleeding would have a hysterectomy to treat the problem, often as a first-line treatment and without discussion of any alternative options.

“This should now be rare, as it is fundamental that all women with heavy periods know there is a range of treatment options, many of which don’t require surgery.”

The annual cost of treating HMB on the NHS is £48 million a year. Implementing the NICE guidelines would take that to £56 million.

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