Treatment for menstrual problems may be misdirected

July 06, 2001

Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management BMJ Volume 323, pp 24-28

Many women who seek help for menstrual problems are referred to gynaecology clinics for treatment of menorrhagia (excessive blood loss during menstruation) when actually they have pain or broader problems with their period. This may result in women receiving inappropriate care, conclude the study authors in this week's BMJ.

A research team in Scotland surveyed 952 women, newly referred for menstrual complaints to gynaecology clinics in Glasgow and Edinburgh, about their menstrual experience and their main reason for seeking help. Responses were compared to reasons for referral extracted from general practitioners' letters.

Only 38% of women reported excessive menstrual loss as a severe problem. However, 76% of general practitioners gave it as the predominant reason for referral. Overall, of the 725 women referred for excessive bleeding, less than half had reported it as a reason for seeking help.

This tendency for women's menstrual complaints to be interpreted as excessive bleeding at referral and during treatment is a concern because treatment typically involves potent drugs or invasive surgery, with 60% of women having hysterectomy within 5 years. It may also explain the finding in other studies that the majority of women referred with menorrhagia have a normal volume of blood loss. Assessment of menstrual complaints needs to be reviewed, conclude the authors.
Pamela Warner, Lecturer in Medical Statistics, Department of Community Health Sciences, University of Edinburgh Medical School, Edinburgh, Scotland.


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