Adherence to Published Guidelines

1. Adherence to Published Guidelines for the Management of Menorrhagia in Primary and Secondary Care J WAHBA, R O’REILLY, T MISKRY Department of Obstetrics & Gynaecology, St. Mary’s Hospital, London, United Kingdom • Only 23 women (58.4%) were started on a form of medical management prior to referral. • 35 women (83.3%) were given medical management in Secondary Care. • Only 4 women (17%) were given LNG-IUS in Primary Care compared to 18 (51%) in Secondary Care. • 24 women (57.1%) underwent surgical treatment after unsuccessful medical management. INTRODUCTION RESULTS Heavy menstrual bleeding, or menorrhagia, is an important gynaecological problem for which 5% of women present to their GP annually. It can have physical, psychological, emotional and social effects on quality of life; and is classically defined as >80ml menstrual loss per month. According to the 2007 guidelines from the National Institute of Clinical Excellence (NICE), an ultrasound should be performed to identify any structural abnormalities if suggested by history and clinical examination, and an endometrial biopsy should be performed if indicated. Treatment should be tailored according to a woman’s wish to conceive and/or need for contraception. Levonorgestrel-releasing intrauterine system (LNG-IUS) should be considered as first-line treatment according to NICE. • 42 cases were identified • Mean age of 42.4 years of age at time of referral (range 25-61 year of age) • Parity: 21 nulliparous (50%), 21 parous (50%) CONCLUSIONS AIMS Compliance to published guidelines appears to be more prevalent in secondary care. Adherence to these guidelines in terms of investigations and management in primary care would mean fewer women would have to be managed in secondary care unnecessarily. • To compare the management of menorrhagia in Primary versus Secondary care • Assess adherence to the published NICE guidelines in Primary and Secondary Care METHODS REFERENCES We performed a retrospective analysis of women who were referred to secondary care for heavy menstrual bleeding from primary care. All women who had come for follow-up over a specific one month period were included in this analysis. • Heavy Menstrual Bleeding. NICE Guideline January 2007 • Sweet MGet al. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2012 ;85(1):35-43.