Evaluating Primary Care Referrals for Heavy Menstrual Bleeding in Adolescents: A Retrospective Medical Record Review

Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with physical, social, emotional, or material quality of life. Several societies, including the Society of Obstetricians and Gynecologists of Canada (SOGC) and North American Society for Pediatric and Adolescent Gynecology (NASPAG), have created algorithms to guide investigations and management. We aim to evaluate the extent to which primary care providers (PCPs) initiate first-tier guideline investigations and management before specialist referral.

A retrospective review of adolescents referred to pediatric and adolescent gynaecology (PAG) for HMB over a 2-year period was conducted. Patient demographics, investigations, and management initiated by the referring PCPs were extracted. These investigations were compared with SOGC and NASPAG guidelines to assess completion of first-tier investigations. In addition, diagnosis, investigations, and management initiated by the PAG team at the first visit was captured.

In total, 242 patients were included for review. The minority of referrals included all first-tier investigations defined by SOGC or NASPAG (34.3% and 16.1%, respectively). Despite this, 80% of adolescents were started on a treatment modality by their PCP. Commonly prescribed treatments included oral combined hormonal contraceptives (44%) and non-steroidal anti-inflammatories (43%). After PAG consultation, the majority of adolescents completed first-tier investigations (SOGC 87% and NASPAG 67%).

The study provides an understanding of how PCPs are investigating, managing, and referring adolescents with HMB and the potential impact on decision-making at first PAG consultation. This serves to inform collaboration between PCPs and PAG providers, with the goal of promoting judicious use of health care resources and timely care.