Threshold

Norfolk and Waveney Integrated Care Board (ICB) will not fund Hysterectomy as the first line treatment solely for heavy menstrual bleeding. This procedure will be funded for the treatment of heavy menstrual bleeding, after appropriate clinical assessment and only in the following circumstances:

• There has been a prior trial in primary care with a levonorgestrel-releasing intrauterine system (LNG-IUS) for a minimum of 12 months which has not successfully relieved symptoms; OR LNG-IUS is not considered appropriate or contraindicated;

AND

• There has been a prior trial in primary care using second line pharmaceutical treatment with either tranexamic acid, non-steroidal anti-inflammatory agents, other hormone methods (combined oral contraceptives, progestogens, GnRH analogue) or ulipristal acetate where indicated in line with NICE guidance and is supported by the local formulary, and it has failed to relieve symptoms or is not considered appropriate or contraindicated;

AND

For women with HMB who have a normal uterus and uterine fibroid less than 3cm:

• Endometrial ablation has been offered and failed to relieve symptoms or is not considered appropriate or is contra-indicated.

OR

For women with HMB and fibroids greater than 3cm:

• Uterine artery embolisation (UEA) has been offered and failed to relieve symptoms or is not considered appropriate or is contra-indicated; AND myomectomy has been offered and failed to relieve symptoms as second-line therapy OR myomectomy is not clinically appropriate or it is not indicated.
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