Abnormal Uterine and Post-Menopausal Bleeding Pathway
Management of Pathway of Care for: Abnormal Uterine Bleeding (AUB) in pre-menopausal women and post-menopausal women and Post-Menopausal Bleeding (PUB)
Investigations, treatment and claiming
ULTRASOUND CRITERIA:
Note POAC funding of ultrasound is ONLY for Counties Manukau residents. For Auckland and Waitemata refer ATD or eReferral.
Indication for ultrasound with abnormal uterine bleeding (as described below):
Abnormal uterine bleeding (AUB) – bleeding that is abnormal in duration, volume, and/or frequency.
Heavy menstrual bleeding (HMB) – the most common complaint of AUB. It is defined as excessive menstrual blood loss which interferes with a woman's physical, social, emotional and/or material quality of life. It can occur alone or in combination with other symptoms.
Intermenstrual bleeding (IMB) – vaginal bleeding at any time other than during normal menstruation or following intercourse.
Post-coital bleeding (PCB) – bleeding following intercourse.
Post-menopausal bleeding (PMB)
PLUS, any one of the following
BMI ≥ 30
> 3 months of intermenstrual bleeding
> 3 months of failed medical treatment
Suspected pelvic mass on clinical examination
Haemoglobin ≤ 90 g/dL
ULTRASOUND REFERRAL:
Counties Manukau: POAC will coordinate a community ultrasound for eligible patients who reside in Counties Manukau. Submit referral HERE or create a POAC referral via PMS and email radiology form to referral@poac.co.nz
Auckland: Refer to ATD or submit eReferral
Waitemata: Submit eReferral
See more: Ultrasound pelvis pathway
CLAIMING:
Funding is available to claim under POAC for eligible patients. Submit claim to POAC via PMS using diagnosis code "Abnormal Uterine Bleeding". The following can be claimed by clinicians who are following the AUB or PMB HealthPathway and are competent in providing the service within their scope of practice. No formal accreditation is required.
Pipelle biopsy (device + procedure) $212.20
Mirena dispensing fee: $5.00
Mirena insertion: $176.83
Administration fee NOT claimable
For Ferinject Iron Infusion for HMB - see www.poac.co.nz/ferinject
Training for primary care providers
Training for primary care providers is available, including:
Theory:
A one hour online training module for Abnormal uterine bleeding and pipelle biopsy is available. Go to: https://www.goodfellowunit.org/group/186
In clinic training for pipelle biopsy is also available. Please contact Pooja Prasad (Pooja.Prasad@waitematadhb.govt.nz) for more information and to arrange in clinic training.
In clinic:
Please note that competency within scope of practice is the responsibility of the clinical practitioner. Self-assessment of competency is accepted. Training resources (above) are available to support familiarisation with the pathway, the procedure and in clinic training as required to achieve competency.