Implementation and value of providing a multidisciplinary haematology and gynaecology service for individuals with bleeding and thrombotic disorders

The management of gynaecological issues forms a significant part of the care of girls and women with haematological diagnoses, with differing needs relating to specific life stages such as menarche, need for contraception, fertility, pregnancy and management of menopause. There is an overlap in presentation to haematology and gynaecology services of individuals with heavy menstrual bleeding (HMB). Bleeding disorders, inherited or acquired, or the use of anti-coagulant or anti-platelet therapy can be complicated by HMB or other types of abnormal uterine bleeding (AUB). Corpus luteal haemorrhage (CLH) may also occur.These may be the first presentation of a bleeding disorder or an exacerbation of pre-existing problems. A previous history of thrombosis, or the presence of thrombotic risk factors, may influence choices in relation to the hormonal management of contraception, HMB or menopausal symptoms.Provision of a multidisciplinary haematology and gynaecology service for individuals with bleeding and thrombotic disorders, whereby patients are seen jointly by specialists from both specialties, or there is communication between specialties, with management by clinicians interested in this area, has the potential to offer best clinical care and cross-specialty education.This good practice paper is relevant to clinicians, clinical nurse specialists and other multidisciplinary team (MDT) members in haematology, particularly haemostasis and thrombosis and gynaecology. It is also relevant to those who are responsible for developing patient-centred services, such as service managers and healthcare commissioners.