Understanding primary care usage, treatment and referral patterns for women with common menstrual disorders

Problem

Menstrual disorders have an adverse impact on women’s physical, social, emotional and material quality of life. It is estimated that among women of reproductive age, one in four suffers from menorrhagia, one in five from severe dysmenorrhea, and one in ten from endometriosis. In the United States, dysmenorrhea alone has been estimated to cause an annual loss of nearly 140 million working hours. Recent studies highlight concerns about how effectively menstrual disorders are being managed and treated in primary care. However, the number of women seeking help from GPs for heavy and/or painful periods is not well understood and neither are their healthcare needs. Most studies that report the prevalence of these conditions in the UK are surveys carried out in the 1960s to early 1990s. In this study, we use a nationally representative sample of electronic primary care records to estimate the prevalence of common menstrual disorders and to understand primary care use, treatment and referral patterns among women affected by these conditions.

Approach

We are conducting a retrospective cohort study using a random sample of 500,000 patients drawn from the Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES). Our sample is restricted to female patients aged 8 to 60 years in 2013 who meet acceptable data quality criteria. Code lists for common menstrual disorders are being developed following best practice guidelines. We will use an expert panel of clinicians to reach consensus on inclusion and exclusion of codes and allow sensitivity analysis to explore the impact of uncertainty in coding.

Findings

Based on preliminary code lists, of the 500,000 women in the cohort 117,873 (23.6%) have one or more codes to indicate a menstrual disorder during the study period. We will describe the incidence and point prevalence of menstrual disorders (overall and by sub-condition) in 2013 and primary care utilisation over a 5-year follow-up period, exploring associations with age, ethnicity and deprivation status. We also show sensitivity analysis on the impact of coding uncertainty on estimates.

Consequences

The code list development and analysis will be complete by June 2020 and will inform a grant application for a larger, mixed-methods programme of work to explore which aspects of care are particularly important to women with menstrual disorders and how they can be improved or better integrated in the services that are already available. The study aims to support GPs, gynaecologists and commissioners to understand the health service needs of patients with menstrual disorders, to identify opportunities to improve access to existing treatments and to highlight any disparities that exist in the care that they are given.