Audit of Referrals and Outcomes of Patients with Post-Menopausal Bleeding on HRT

 

                    By: Wesal Yahya Hamed (ST3), Nathiira Ali (ST3), Sarra Merzougui (ST7)

                                                Supervised by: Miss S Shanbhag

The use of HRT has increased in the UK by 47% from 2022-2023. In response, referrals for unscheduled bleeding on HRT have increased causing increased pressure on the suspected cancer pathway. CcHRT is a protective factor for endometrial cancer

 

1. Aims

• Assess if referrals (Oct–Dec 2023) met 2WW referral criteria
• Evaluate if the new BMS guideline will reduce USCP and hysteroscopy    referrals

 

2. Methods

Retrospective review of all PMB referrals (Oct–Dec 2023)
Inclusion: PMB patients on HRT
Data from referral letters, clinic notes, electronic records

 

3. Results

• 123 women: Mean age 56, BMI 29, Menopause Age 50

• Risk Factors: BMI 30-39: 41 BMI >40 : 6 PCOS: 1 Diabetes: 1 Lynch: 1
• 121 on CcHRT, 1 sequential, 1 unknown

• Referral to scan: Average 9 days; Consult: 11.6 days
• 63 (51.2%) had hysteroscopies; 15 with ET <5mm
• GA hysteroscopies: 3 (avg. delay: 21–59 days)
• New BMS (>4mm ET): would ↑ referrals by 41.17%

 

Based on Ultrasound findings (not accounting for risk factors/ re-referrals) :

       Old guidance (≥ 5mm ET)-  51/123 referrals

       New guidance (>4mm ET) - 72/123 referrals

 If risk stratification is not used number of referrals for hysteroscopy will increase by 41.17% 

 

4. Recommentdations

• Risk-stratify to guide appropriate pathway (6-week vs    USCP)

• Adhere to local guidelines for indication of hysteroscopy

• GP referrals should include examination and HRT documentation
• Educate on new BMS guideline
• Audit communication timelines for histology results
• Implement local referral adjustments to improve FDS targets