Practical tips for the busy GP
1. Testing thyroid function is rarely
necessary; but look out for a history of weight gain, cold
intolerance, fatigue etc. as indicating a possble thyroid
problem.
2. Focus on the impact on the woman’s daily life rather than
ways to assess vloume of blood loss.
3. Take in to account other menstrual symptoms in agreeing the
management plan - eg the extent of the pain.
4. Elicit the woman's own ideas, concerns and
expectations before discussing management options:
-
How does she understand the problem? What does she herself think
might help?
-
What is it about the heavy periods that worries her? Is it just
simply coping in a practical sense? Does she fear some serious
underlying disorder?
-
What does she expect from you? Further investigations?
Treatment with medication? Referral for hysterectomy?
-
What are her plans around fertility? Is her family complete? Might
she be considering pregnancy in the near future?
-
What has made her decide to seek help with the problem now?
-
What effect is having on her life now?
Check out what you do in your own practice
Do you think that the management of menorrhagia in your own
practice is in line with this guidance? pose these questions to
your practice team. You might discuss them in a practice
educational meeting:
1. Do all GPs/practice nurses who see patients with menorrhagia
know about the range of treatments available and able to discuss
them with patients? You could discuss the clinical cases (below) as
a group or in pairs and compare your answers. Take the summary of
recommended treatments (see in the clinical scenario section) and
work in pairs to describe the pros and cons of each treatment. Jot
down any learning needs and read the EGP Update item again or go to
the original source material or futher reading to find out
more.
2. Or you might undetake one or more of these simple
audits comparing what you do in your own practice against the
recommendations in this EGP Update item in relation to:
- Prescriptions for tranexamic acid
- Fitting of Mirena intrauterine systems
(if you or a practice colleague are trained to fit a Mirena
IUS)
- Urgent and routine gynaecology referrals for
menorrhagia in the last twelve months – what was the
indication? What was the outcome?
After making any changes to your management in
line with best practice relayed in this EGP Update item, re-audit
and see if you can demonstrate increased use of tranexamic acid and
Mirena and reduced gynaecology referrals for menorrhagia.
Self-Assessment
>>
EGP 1. May 2008