TY - JOUR T1 - Heavy menstrual bleeding: delivering patient-centred care JF - British Journal of General Practice JO - Br J Gen Pract SP - 151 LP - 152 DO - 10.3399/bjgp08X277258 VL - 58 IS - 548 AU - Miriam Santer Y1 - 2008/03/01 UR - http://bjgp.org/content/58/548/151.abstract N2 - The last decades of the 20th century saw rising rates of surgery for heavy menstrual bleeding with associated high costs and morbidity.1,2 GPs have been implicated as contributing to this as referral rates vary widely between practices and high referral rates are significantly associated with high operative rates.3 GPs have also been criticised for being dismissive of menstrual problems and not addressing patients' concerns.4 A NICE guideline has been published recently which could lead to better primary care management of heavy menstrual bleeding and improve patients' quality of life.5In the past, heavy menstrual bleeding has been defined in terms of volume of menstrual blood loss.6 However, volume of loss is not routinely measured in clinical practice and there is a poor correlation between measured loss and women's perceptions of their blood loss.7 It was thought that psychological problems could explain the lack of correlation between measured and perceived blood loss, but we now know that the relationship between heavy menstrual bleeding and psychiatric illness is no different to the relationship between psychiatric illness and other physical symptoms.8 There are several alternative explanations. Firstly, for individual women a change in volume of loss may be more significant than absolute volume of loss, for instance in leading to concern that something might be wrong or in challenging menstrual concealment strategies.4,9 Secondly, women's ability to contain heavy loss depends on their social circumstances; for … ER -