Public health policy and practice
Management of menorrhagia in primary care
impact on referral and
hysterectomy: data from the Somerset Morbidity Project
Clare Granta, Lesley Gallierb, Tom Faheya, Nicky Pearsonb, Joyshri Sarangib
a Division
of Primary Health Care, University of Bristol, Canynge Hall,
Whiteladies Road, Bristol BS8 2PR, b Somerset Health Authority, Taunton
Correspondence to: Dr Grant (clare.grant{at}bristol.ac.uk)
Accepted for publication 1 March 2000
OBJECTIVE
To
investigate the management of menorrhagia in primary care and its
impact on referral and hysterectomy rates.
DESIGNProspective
observational study.
SETTING11 general
practices from the Somerset Morbidity Project.
SUBJECTS885 women
consulting their general practitioner with menorrhagia over four years.
MAIN OUTCOME
MEASURESProportions 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.
RESULTSLess 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 (
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).
CONCLUSIONSSubstantial
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.
© 2000 by Journal of Epidemiology and Community Health
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