title: Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management.
abstract: OBJECTIVE
  To describe the menstrual experience of women referred for menstrual problems, in particular menorrhagia (excessive menstrual loss), and to assess associations with reasons for referral given by their general practitioners, the women's understanding of the reasons for their attendance at the hospital clinics, and clinic outcome.
  
  
  METHODS
  Questionnaire survey, with partial review of case notes after 8 months.
  
  
  METHODS
  Three hospital gynaecology clinics in Glasgow and Edinburgh.
  
  
  METHODS
  952 women completed the questionnaire, and the first 665 were reviewed.
  
  
  METHODS
  Reason for referral, women's reported menstrual problems and reason for clinic attendance, diagnosis, and treatment.
  
  
  RESULTS
  Only 38% (95% confidence interval 34% to 41%) of women reported excessive menstrual loss as a severe problem. However 60% (57-63%) gave it as reason for attending a clinic, and 76% (73-79%) of general practitioners gave it as reason for referral. Reason for referral was significantly biased towards bleeding (McNemar odds ratio 4.01, 3.0 to 5.3, P<0.001) and against pain (0.54, 0.4 to 0.7, P<0.001). Dysfunctional uterine bleeding was diagnosed in 37% (31-42%) of the 259 women who gave as reason for attendance something other than bleeding. Women who were economically disadvantaged differed in prevalence of the main diagnoses and were more likely to fail to reattend. Hysterectomy was associated with referral for bleeding (relative risk 4.9, 1.6 to 15.6, P<0.001) but not with the patient stating bleeding as the reason for clinic attendance.
  
  
  CONCLUSIONS
  Intolerance of the volume of their bleeding is not a key feature among women attending clinics for bleeding problems. Broad menstrual complaint tends to be reframed as excessive bleeding at referral and during management. This may result in women receiving inappropriate care. Conceptualisation and assessment of menorrhagia requires reconsideration.
authors: Public Health Sciences, Department of Community Health Sciences, University of Edinburgh Medical School, Edinburgh EH8 9AG. p.warner@ed.ac.uk
authors: P
authors: P
authors: Warner
authors: H O
authors: HO
authors: Critchley
authors: M A
authors: MA
authors: Lumsden
authors: M
authors: M
authors: Campbell-Brown
authors: A
authors: A
authors: Douglas
authors: G
authors: G
authors: Murray
mesh_terms: D000328:Adult; D017677:Age Distribution; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005194:Family Practice; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000209:etiology / Q000523:psychology / Q000628:therapy; D008599:Menstruation Disturbances / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010817:Physician-Patient Relations; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012606:Scotland; D011795:Surveys and Questionnaires