Criteria for referral to secondary care are (1):

• very heavy bleeding with shock, or,
• anaemic secondary to heavy bleeding, or,
• failure of medical treatment in women under 40 years old, or,
• irregular or heavy period in a woman of any age with a structurally abnormal uterus, or,
• if the patient has polycystic ovarian disease where anovulatory menstrual abnormalities do not respond to medical therapy, or,
• if a woman is over 40 years old with menorrhagia of recent onset or persistent intermenstrual bleeding. A patient over 40 years old may require referral for irregular periods because it may be difficult to distinguish between intermenstrual and menstrual loss.

Reference:

1. Update (8/10/97)