A landmark UK study has revealed that acute heavy menstrual bleeding (HMB) is placing a significant hidden burden on the NHS, with around £13 million spent annually on hospital admissions and post-discharge care.
The study, led by Dr Bassel Wattar of Anglia Ruskin University and published in The Lancet Obstetrics, Gynaecology, & Women's Health journal, is the first UK-based multicentre study to evaluate the prevalence of acute HMB and number of women requiring red blood cell transfusion.
The observational study analysed data from 98 NHS gynaecology units between January and June 2024. Researchers found that 1,332 women were admitted to receive a total of 3,025 units of red blood cells as a last measure to manage acute HMB.
The average hospital stay was two days, with most patients receiving additional treatments such as tranexamic acid, iron supplements, or hormonal therapy. Nearly half of the women had uterine fibroids, and 20% were discharged while still anaemic.
The authors believe many of these cases could be handled in the community or by outpatient services, reducing the need for expensive hospital admissions.
The study estimates the mean cost per admission at £2,972 and the average cost of post-discharge management at £1,735. When extrapolated over 12 months, the total cost to the NHS is estimated to be £13,018,448.
The findings highlighted a lack of standardised pathways for managing acute HMB, which differs from chronic menstrual disorders. Despite existing NICE guidelines for chronic HMB, there is no specific coding or national strategy for acute cases, making it difficult to track and treat effectively.
The study also found wide regional variation in admissions and treatment approaches, with London regions reporting the highest numbers.
Heavy menstrual bleeding affects approximately one in four women of reproductive age.
Researchers are calling for urgent investment in community-based gynaecology services, including one-stop clinics with access to diagnostics and minor surgical procedures. They also recommend developing national guidelines and coding systems to better identify and manage acute HMB.
Dr Wattar, Associate Professor of Reproductive Medicine at Anglia Ruskin University (ARU), said: "This is a silent crisis in women's health. We are seeing thousands of women admitted to hospital for a condition that could often be managed earlier and more effectively in the community.
"Current guidelines and services offered in the NHS do not offer a clear pathway for managing acute heavy menstrual bleeding efficiently.
"This mismanagement leads to women are being discharged with temporary fixes, often still anaemic, and left to navigate long waiting lists for definitive care. We need to shift from reactive to proactive care."
The study involved over 100 NHS clinicians and researchers through the UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG).
