Many women with menorrhagia can be managed successfully in primary care. They should, however, be referred if (1):

*** there is a suspicion of underlying cancer. Suspicious findings would include, for example, a pelvic mass, an abnormal cervix or cervical smear, irregular bleeding, repeated intermenstrual bleeding, or post-coital bleeding

* despite 3 month’s drug treatment, the heavy bleeding persists and is interfering with the quality of life. Failure is best based upon the woman’s own assessment

* they wish to explore the possibility of surgical intervention rather than persist with drug treatment

+ they have severe anaemia that has failed to respond to treatment

+ the diagnosis is, or has become, uncertain

+ drug treatments are contraindicated or causing severe unwanted effects

Key to referral times:

**** immediate referral (a)

*** urgent referral (b)

** soon (b)

* routine (b)

+ times will be discretionary and depend on clinical circumstances

(a) within a day

(b) Health authorities, trusts and primary care groups should work to local definitions of maximum waiting times in each of these categories. The multidisciplinary groups considered that a maximum waiting time of 2 weeks is appropriate for the urgent category

Reference:

1. NICE (May 2000). Referral Practice A guide to appropriate referral from general to specialist services.