The role of primary care in the diagnosis and management of menorrhagia: a qualitative study of women with menorrhagia

Abstract

There is increasing emphasis on including patients in decision making about treatment. In order to do this, they need to have access to appropriate information about treatment options. The study reported here reports initial work carried out in the development of a decision analysis tool to assist women about treatment for menorrhagia. Women referred to secondary care with a diagnosis of heavy menstrual bleeding were interviewed. Our study shows that women had limited and often inaccurate knowledge of most treatment options. They expressed feelings of diagnostic uncertainty, the need for a ‘label’ for their symptoms and a perception of the failure of the general practitioner (GP) to provide this. The women in our study referred to secondary care with a diagnosis of menorrhagia do not seem to have had their concerns about their menstrual symptoms addressed prior to the referral. In addition, the women in this study do not feel that their GP has communicated a diagnosis to them. Women must be able to feel that they have been diagnosed in order that treatment options can then be properly discussed, and a shared management decision reached. Reasons for the apparent lack of adherence to guidelines are discussed. There is a need for a decision aid for use in primary care to assist women and their doctors in the management of menorrhagia.