Abnormal vaginal bleeding in women of reproductive age: a descriptive study of initial management in general practice.
BACKGROUND
Abnormal vaginal bleeding (AVB) in women of reproductive age is a common reason for consulting a general practitioner. Nevertheless, how general practitioners (GPs) choose to initially manage AVB is largely unknown, as is the prevalence of underlying pathology of AVB in primary care.


METHODS
To investigate the initial diagnostic procedures and treatment for AVB used in general practice, we performed a descriptive study based on computerised medical records. New consultations for AVB in 2000 and 2001 were selected. Patient characteristics, diagnostic procedures and treatment were analysed.


RESULTS
In total, 270 new consultations were included. The majority of patients (75%) consulted the GP for AVB only once. GPs performed diagnostic procedures in 54% of all consultations. Overall, additional diagnostic procedures revealed abnormalities in 11% of women. However, the diagnostic procedures implemented by the GPs varied widely per bleeding type and contraceptive use. Anaemia was found in 36% of 45 women tested. Uterine fibroids were found in 41% of 27 women examined by ultrasound. Medication was prescribed in 34% of all consultations. A gynaecological referral was registered in 4% of all contacts.


CONCLUSIONS
Initially, GPs tend to follow a policy of expectant management in women of reproductive age with AVB. However, when additional diagnostic procedures were performed, anaemia and uterine fibroids were found in a considerable number of women.
de Vries
Corlien J H
CJ
Division of Clinical Methods and Public Health, Department of General Practice, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands. corlien.devries@amc.uva.nl
Wieringa-de Waard
Margreet
M
Vervoort
Cléo-Lotte A G
CL
Ankum
Willem M
WM
Bindels
Patrick J E
PJ
D000328:Adult; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology; D006801:Humans; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012098:Reproduction; D012189:Retrospective Studies; D014592:Uterine Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*