Primary Care Endometrial Sampling for Abnormal Uterine Bleeding: A Pilot Study

Background

Most cases of abnormal uterine bleeding (AUB) could potentially be managed in primary care but lack of access to endometrial sampling leads to avoidable referrals to hospital to rule out endometrial hyperplasia and cancer.

Aims

To design and evaluate a pilot service for primary care endometrial sampling (PCES).

Design

Retrospective analysis of data from two service evaluations.

Setting

General practices and the gynaecology department in a large city in the United Kingdom.

Methods

1) To design the new service we identified all the endometrial samples taken in the city’s gynaecology department in 2012/13 and estimated the proportion of these with AUB that would be suitable for PCES. 2) To evaluate the new PCES service we analysed data from the first year of activity.

Results

1) 1894 endometrial samples were taken in hospital in 2012/13. An estimated 424 (22.4%) of these were from patients with AUB who fitted the criteria for PCES. 2) In the first year of the PCES service 108 samples were taken by GPs. Initial management of these patients was exclusively in primary care in 97.2% (104/108), most patients were treated with Mirena IUS (79/109; 73.1%) and there were no cases of hyperplasia or cancer.

Conclusions

Most pre-menopausal patients with AUB could potentially be managed in primary care without referral to hospital if ES was made available to appropriately trained and supported GPs. However, this study was limited by it’s retrospective non-interventional design and more research is required to demonstrate safety and cost-effectiveness.

Key Message Points

Primary care is a crucial part of the care pathway for patients with abnormal uterine bleeding. In the first instance, the majority of patients with AUB can be managed exclusively in primary care without referral to hospital. Primary care management of AUB may be cost effective but an economic model of the care pathway is required to make accurate comparisons between primary care and secondary care.