ArticleJournal of epidemiology and community health2000
Management of menorrhagia in primary care-impact on referral and hysterectomy: data from the Somerset Morbidity Project.
Article in Journal of epidemiology and community health, 2000. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
14 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Endometrial resection and ablation techniques for heavy menstrual bleeding.The Cochrane database of systematic reviews · 2019Pooled it
- Antifibrinolytics for heavy menstrual bleeding.The Cochrane database of systematic reviews · 2018Pooled it
- Pre-operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding.The Cochrane database of systematic reviews · 2013Pooled it
- Usual medical treatments or levonorgestrel-IUS for women with heavy menstrual bleeding: long-term randomised pragmatic trial in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2016Trial
- Heavy Menstrual Bleeding in the Gynecology Clinic: A Call for Awareness and Standardized Screening for Underlying Bleeding Disorders.Obstetrical & gynecological survey · 2026Review
- Article
- Rates of medical or surgical treatment for women with heavy menstrual bleeding: the ECLIPSE trial 10-year observational follow-up study.Health technology assessment (Winchester, England) · 2023Observational
- Is body mass index associated with irregular menstruation: a questionnaire study?BMC women's health · 2020Article
- Article
- Open-access transvaginal sonography in women of reproductive age with abnormal vaginal bleeding: a descriptive study in general practice.The British journal of general practice : the journal of the Royal College of General Practitioners · 2011Article
- Abnormal vaginal bleeding in women of reproductive age: a descriptive study of initial management in general practice.BMC women's health · 2008Article
- Heavy menstrual bleeding: delivering patient-centred care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2008Article
- Diagnosing menstrual disorders: a qualitative study of the approach of primary care professionals.The British journal of general practice : the journal of the Royal College of General Practitioners · 2004Article
- Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management.BMJ (Clinical research ed.) · 2001Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate the management of menorrhagia in primary care and its impact on referral and hysterectomy rates.
designProspective observational study.
setting11 general practices from the Somerset Morbidity Project. SUBJECTS: 885 women consulting their general practitioner with menorrhagia over four years.
main outcome measuresProportions 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.
resultsLess 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).
conclusionsSubstantial 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.
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