Experiences of women referred for urgent assessment of postmenopausal bleeding (PMB)

Abstract

Women with postmenopausal bleeding (PMB) are referred for specialist assessment within 2 weeks of presentation to their GP. No research has previously examined women's experiences of expedited referral. This was investigated in the present study using questionnaires (6-item State Anxiety Inventory (6-STAI)) and focus groups. A total of 55 women completed questionnaires. Results showed high levels of anxiety at first hospital visit (mean 47.0 (SD 14.27); 95% CI 43.14-50.93). Scores declined by 90 days, but were higher in those not undergoing hysteroscopy. Fifteen women who underwent hysteroscopy attended focus groups. Women recalled fear of cancer from symptom onset until receipt of results. Anxiety was exacerbated by poor knowledge of PMB and lack of awareness of expedited referral. Post-discharge, those with unexplained or recurrent symptoms expressed frustration and upset. Effective strategies to raise awareness of PMB and its causes are needed, including reasons for expedited referral. Women without cancer may also need more support.

Over-reassurance and undersupport after a ‘false alarm’: a systematic review of the impact on subsequent cancer symptom attribution and help seeking

“…It puts you off going again, because they don’t know and they don’t tell you anything else.” (P2). 47 Similar explanations for delayed help seeking were reported by patients with breast cancer: 37 45 “I’ve had no relief from seeing a physician.” 37 Also patients with ovarian cancer explained delays as due to frustration and not having previously discussed with the doctor any alternative diagnostic hypothesis or planned any follow-up or further actions. 38 Among patients with CRC, lack of communication of the next steps during the initial visit was associated with longer diagnostic delay (8.2 vs 3.4 months; p<0.001).…”

“…A number of studies reported that previous visits with a non-cancer diagnosis left the patients frustrated, with a sense that doctors could not help them and uncertainty about what to do next; these factors contributed to subsequent delays. 32 37–39 44 45 47 Of 155 patients with head and neck cancer having initially received an all-clear, 50% waited more than 3 weeks before returning to the doctor, and 10% more than 4 months; some explained their delay with the fact that the doctor could not help the first time. 32 Likewise, lack of explanation about the possible causes and meaning of symptoms, and lack of advice on further actions after investigations for postmenopausal bleeding can delay subsequent help seeking.…”

“… 32 Likewise, lack of explanation about the possible causes and meaning of symptoms, and lack of advice on further actions after investigations for postmenopausal bleeding can delay subsequent help seeking. 47 Women reported a sense of frustration and not knowing what to do in case of recurrent symptoms: “It’s the not knowing. It’s more frustrating.…”

“…The other explanation for delay was anxiety or distress following the previous non-cancer diagnosis, reported by some women with recurrent postmenopausal bleeding after a false alarm, 47 and by some patients with head and neck cancer. 32 Among patients with testicular cancer, some reported fear of painful investigations following previous health examinations: “And then when I did go and see this GP, there was a locum, and he gave me an inspection, and I found it quite uncomfortable, the way he went about the inspection.…”

Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: a retrospective cohort study

“…Around 90% of women eventually diagnosed with endometrial cancer initially presented with postmenopausal bleeding (PMB) . The aim in the evaluation of PMB is to exclude underlying malignancy . Clinical tests to evaluate the endometrium include transvaginal ultrasound scanning (TVS) to measure endometrial thickness (ET), endometrial sampling (ES), saline infusion sonography, and hysteroscopy .…”