Is Objective Testing for Menorrhagia in General Practice Practical?: Results from a Qualitative Study

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Abstract
Objectives: To explore the interpretative character of medical knowledge and the way that clinicians respond to the patient's assertion that her menstrual blood loss is excessive. In particular, we are interested in the boundary between ‘normal’ and ‘abnormal’, and whether or not general practitioners would consider conducting objective tests for menorrhagia in their surgeries. We also wanted to explore the extent to which clinicians pay attention to women's subjective accounts of ‘heavy’ menstrual blood loss when making a diagnosis. The consequences of making a distinction between ‘normal’ and ‘abnormal’ blood loss may be considerable. A diagnosis of menorrhagia may crucially affect quality of life, morbidity and mortality. Method: Qualitative study using 73 semi-structured interviews with general practitioners in Northwest England. Results: Two thirds of the respondents indicated that they seriously attempt an assessment of menstrual blood loss, while one third of the respondents appeared to pay more attention to the women's subjective assessment of unacceptable ‘heavy’ bleeding. Some general practitioners had a very negative attitude to menstrual blood. Very few would consider conducting objective tests for menstrual blood loss if such tests involved the collection of soiled pads and tampons. However, about half of the respondents thought that a pictorial chart might be useful when trying to estimate menstrual blood loss. Conclusion: Since general practitioners are not in agreement about the manner in which women's complaints of heavy bleeding should be assessed, evidence-based clinical guidelines that deal with both ‘subjective’ and ‘objective’ menorrhagia are timely.

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