Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management

Objectives to describe the menstrual experience of women referred for menst rual problems, in particular menorrhagia (excessive menstrual loss), and to assess associations with reasons for referral given by; their general prac titioners, the women's understanding of the reasons for their attendance at the hospital-clinics, and clinic outcome. Design Questionnaire survey, with partial review of case notes after 8 mont hs. Setting Three hospital gynaecology clinics in Glasgow. and Edinburgh. Participants 952 women completed the questionnaire, and the first 665 were reviewed. Outcome measures Reason for referral, women's reported menstrual problems a nd reason for clinic attendance, diagnosis, and treatment. Results Only 38% (95% confidence interval 34% to 41%) of women reported exc essive 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 ga ve 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 agains t pain (0.54, 0.4 to 0.7, P<0.001). Dysfunctional uterine bleeding was diag nosed in 37% (31-42%) of the 259 women who gave as reason for attendance so mething other than bleeding . Women who were economically disadvantaged dif fered in prevalence of the main diagnoses and were more likely to fail to r eattend. Hysterectomy was associated with referral for bleeding (relative r isk 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 featur e among women attending clinics for bleeding problems. Broad menstrual comp laint tends to be reframed as excessive bleeding at referral and during man agement This may result in women receiving inappropriate care. Conceptualis ation and assessment of menorrhagia requires reconsideration.