Managing menorrhagia: who and when to refer

Abstract 

GPs have different referral rates for menorrhagia despite the existence of authoritative explicit guidelines. Ideally a referral should be necessary, timely and effective. It is impractical to objectively measure menstrual loss in primary care. A woman is regarded as having menorrhagia if she perceives that the heaviness of her periods is interfering with her life, and affecting her overall well being. Practitioners use idiosyncratic criteria to assess patients, namely their personal and professional experience. Of women referred for menorrhagia, 27% did not actually perceive this to be the reason for their referral, illustrating the difficulty doctors have in assessing menstrual problems. Perceived patient pressure affects what a GP does and has great resource, and potential iatrogenic, implications. Inappropriate assessments of patients' expectations can result in actions deemed unnecessary by the doctor and unwanted by the patient. To maximise the benefit of the referral, the problem and reason for referral should be adequately communicated to the specialist. Reasons for referral are: 1 If serious pathology is suspected. 2 Failed medical treatment. 3 Patient choice. The decision to refer rests with the clinician in partnership with the patient. As with most decisions made in general practice, good communication skills are the key. Pressure to keep referral rates low should not stop access to a specialist. However using more adequate medical management and more detailed counselling and information, there is the potential for managing more women in primary care, to the benefit of women and health care resources.

Keywords:  menorrhagia and other menstrual problems , referral , menstrual problems , primary care , communication , health-care resources

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