title: Listening to patients with unexplained menstrual symptoms: what do they tell the gynaecologist?
abstract: OBJECTIVE
  To describe how women present unexplained menstrual symptoms to gynaecologists; to find out whether presentation reflects how intense their symptoms feel or how much benefit they expect from gynaecological treatment; and to test the prediction that surgical treatment decisions are more likely to follow specific types of presentation.
  
  
  METHODS
  A cross sectional cohort study.
  
  
  METHODS
  Gynaecological outpatient clinics in a teaching hospital.
  
  
  METHODS
  Fifty-nine patients, referred for menstrual problems, in whom investigations had excluded physical disease.
  
  
  METHODS
  Patients indicated symptom intensity and expectations of treatment before consultation on self-completed questionnaires. Audiotape recordings of consultations with the gynaecologist were transcribed and patients' use of specific communication strategies was coded according to a previously reported scheme.
  
  
  METHODS
  Treatment decision was noted.
  
  
  RESULTS
  In a third to a half of patients, presentation extended beyond symptom report to include catastrophisation about consequences of symptoms, reference to other individuals to substantiate the patient's problems, criticism of previous or possible future interventions or request for hysterectomy. Those with greatest expectations of gynaecological treatment were more likely to catastrophise and request hysterectomy. Those with most intense subjective symptoms were more likely to catastrophise, refer to other individuals and request hysterectomy, and these strategies were more likely to be followed by surgical treatment decisions.
  
  
  CONCLUSIONS
  Surgical treatment for unexplained menstrual problems is not driven by gynaecologists. Reduction in unnecessary hysterectomies will require training in communication skills that reflects the challenging nature of many patients' presentation in the gynaecology clinic.
authors.affiliation: Department of Clinical Psychology, University of Liverpool, UK.
authors.forename: Dawn
authors.initials: D
authors.lastname: Echlin
authors.forename: Anne S
authors.initials: AS
authors.lastname: Garden
authors.forename: Peter
authors.initials: P
authors.lastname: Salmon
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006176:Gynecology; D006801:Humans; D016015:Logistic Models; D008599:Menstruation Disturbances / Q000523:psychology* / Q000601:surgery; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D012044:Regression Analysis