title: Management of menorrhagia in primary care-impact on referral and hysterectomy: data from the Somerset Morbidity Project.
abstract: OBJECTIVE
  To investigate the management of menorrhagia in primary care and its impact on referral and hysterectomy rates.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  11 general practices from the Somerset Morbidity Project.
  
  
  METHODS
  885 women consulting their general practitioner with menorrhagia over four years.
  
  
  METHODS
  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.
authors.affiliation: Division of Primary Health Care, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR. clare.grant@bristol.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Grant
authors.forename: L
authors.initials: L
authors.lastname: Gallier
authors.forename: T
authors.initials: T
authors.lastname: Fahey
authors.forename: N
authors.initials: N
authors.lastname: Pearson
authors.forename: J
authors.initials: J
authors.lastname: Sarangi
mesh_terms: D000328:Adult; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D008595:Menorrhagia / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011320:Primary Health Care; D011446:Prospective Studies