Author(s): Grant C, Gallier L, Fahey T, Pearson N, Sarangi J
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Abstract OBJECTIVE: To investigate the management of menorrhagia in primary care and its impact on referral and hysterectomy rates. DESIGN: Prospective observational study. SETTING: 11 general practices from the Somerset Morbidity Project. SUBJECTS: 885 women consulting their general practitioner with menorrhagia over four years. MAIN OUTCOME MEASURES: Proportions of these women investigated and treated with drugs in primary care, referred to a gynaecologist and undergoing operative procedures. The relation between investigation and prescribing in primary care and referral to and surgery in secondary care. RESULTS: Less than half of women had a vaginal examination (42\%, 95\% CI 39\% to 45\%), or a full blood count (39\%, 95\% CI 36\% to 43\%). Almost a quarter of women, 23\% (95\% CI 20\% to 26\%), received no drugs and 37\% (95\% CI 34\% to 40\%) received norethisterone. Over a third, 38\% (95\% CI 34\% to 40\%), of women were referred, and once referred 43\% (95\% CI 38\% to 48\%) of women were operated on. Women referred to a gynaecologist were significantly more likely to have received tranexamic acid and/or mefenamic acid in primary care (chi(2)=16.4, df=1, p<0.001). There were substantial between practice variations in management, for example in prescribing of tranexamic acid and/or mefenamic acid (range 16\% to 72\%) and referral to gynaecology (range 24\% to 52\%). There was a significant association between high referral and high operative rates (Spearman's correlation coefficient=0.86, p=0.001). CONCLUSIONS: Substantial differences in management exist between practices when investigating and prescribing for menorrhagia in primary care. Rates of prescribing of effective medical treatment remain low. The decision to refer a woman impacts markedly on her chances of subsequently being operated on. Effective management in primary care may not reduce referral or hysterectomy rates.
This article was published in J Epidemiol Community Health
and referenced in Journal of Health Education Research & Development