Are You Confident Managing Women’s Bleeding Issues in Primary Care?

When it comes to women’s health, bleeding issues are among the most common, and often complex, presentations seen in primary care. From the onset of heavy menstrual bleeding in adolescence to unexpected postmenopausal spotting, patients frequently turn to their primary care teams for answers, reassurance, and effective management.

Despite the frequency with which these issues arise, navigating abnormal bleeding can remain a challenge. With a spectrum of potential causes, evolving guidelines, and the necessity of sensitive communication, it’s crucial for all primary care professionals to stay current and confident in this area.

Why This Topic Matters

Women’s bleeding issues are incredibly common, yet they can be the first sign of various underlying conditions, from hormonal imbalances and benign growths like fibroids, to more serious concerns such as endometrial cancer. In England, menstrual disorders consistently rank among the top reasons women seek primary care appointments.

Consider the impact:

• Around 1 in 4 women in the UK experience heavy menstrual bleeding (HMB) significant enough to interfere with their daily life, making it a leading reason for GP visits and gynaecology referrals.
• Concerningly, it’s estimated that over 50% of women with HMB do not seek medical help, often due to normalising their symptoms or embarrassment.
• As women approach menopause, fluctuating bleeding patterns are common. However, distinguishing normal perimenopausal changes from bleeding that warrants urgent investigation (like endometrial hyperplasia or cancer) is a critical skill.
• Conditions like endometriosis and fibroids, frequently presenting with pain and abnormal bleeding, can take years to diagnose, leading to prolonged suffering and impact on quality of life.
• Bleeding irregularities are a significant contributor to missed school and work days among teenagers and working-age women.

These issues aren’t just statistics; they represent real women seeking guidance, reassurance, and effective management. The challenge lies in effectively assessing these varied presentations, knowing when and what to investigate, and navigating the appropriate pathways for referral or management within the primary care setting. Let’s delve a little deeper into some common conditions patients might present with:

Heavy Menstrual Bleeding (HMB)

This is one of the most common reasons women consult their GP. It’s estimated that HMB affects up to 1 in 4 women of reproductive age in the UK, with some studies suggesting it could be as high as 1 in 3. Beyond the physical discomfort, HMB can lead to iron-deficiency anaemia, impacting energy levels and cognitive function, and significantly disrupt daily activities, work (studies show HMB can lead to lost productivity and absenteeism), and social life. The NICE guidelines underscore the importance of timely and appropriate management to improve patient outcomes and reduce unnecessary referrals

Irregular Bleeding & Polycystic Ovary Syndrome (PCOS)

Irregular menstrual cycles are a hallmark symptom of PCOS, a common endocrine disorder affecting approximately 1 in 10 women in the UK. However, awareness and diagnosis rates can vary, meaning many women may live with undiagnosed symptoms. Early recognition in primary care is vital, not only for managing the bleeding patterns (which can range from amenorrhoea to very frequent, unpredictable bleeding) but also for addressing associated long-term health risks such as type 2 diabetes, cardiovascular disease, mental health issues like anxiety and depression, and fertility challenges.

Endometriosis

This debilitating condition, where endometrial-like tissue grows outside the uterus, often presents with cyclical or chronic pelvic pain, painful periods, and abnormal bleeding (including intermenstrual bleeding or heavier periods). Shockingly, the average UK diagnosis time for endometriosis still hovers around 8 years from symptom onset. This significant delay means prolonged suffering for patients. Primary care plays a crucial role in early suspicion, initiating empirical management, and timely referral to specialist centres to shorten this diagnostic journey and mitigate the impact on quality of life, fertility, and mental wellbeing.

Uterine Fibroids

These benign tumours of the uterus are extremely common, affecting an estimated 70-80% of women by the age of 50, though not all are symptomatic. When they do cause issues, heavy or prolonged menstrual bleeding, pelvic pain, or pressure symptoms frequently lead women to their GP. Their prevalence means primary care clinicians are regularly consulted by women whose lives are impacted by fibroid-related bleeding.

Perimenopausal and Post-Menopausal Bleeding

As women transition towards menopause (perimenopause), menstrual patterns naturally change. The key challenge is distinguishing these physiological changes from abnormal uterine bleeding requiring investigation. Post-menopausal bleeding (PMB) – any vaginal bleeding more than 12 months after the last menstrual period (without HRT), or unexpected bleeding on HRT – is a red flag. While many causes are benign, it must always be investigated promptly to exclude endometrial cancer, as PMB is the presenting symptom in approximately 90% of endometrial cancer cases.

Empowering You With Practical Knowledge

The scale and impact of gynaecological bleeding issues in primary care are clear and highlight the need for up-to-date, practical knowledge. We’re delighted to announce our next FREE Lunchtime News session will tackle this topic in more detail:

Women’s Health – Bleeding Issues in Primary Care

Date: Thursday 5th June 2025
Time: 12:30pm – 1:30pm (UK Time)
Platform: Zoom (Link provided on registration)
Cost: Absolutely FREE!

Join us for an insightful hour dedicated to understanding and managing bleeding concerns across the reproductive life cycle. This session is tailored for anyone working in, or with an interest in, primary healthcare in the UK.

Our expert speaker, Donna Loose (Specialist Women’s Health Nurse, General Practice Nurse, and Clinical Educator), will guide you through a practical approach to these presentations, sharing her wealth of experience.

Key topics include:

• Recognising bleeding problems across different life stages.
• Common conditions to consider and crucial red flags.
• Practical tips on appropriate initial investigations in primary care.
• Navigating local guidelines and referral pathways.
• Effective management strategies for primary care.
• An interactive Q&A session to address your specific questions.

Who should attend?

This session is ideal for:

• General Practice Nurses and Advanced Nurse Practitioners
• GPs and GP trainees
• Community Nurses
• PCN staff involved in women’s health
• Any professional with an interest in primary care and women’s health

Don’t miss this opportunity to refresh your knowledge and gain practical strategies for supporting women with bleeding concerns.

➡️ Register here to join us on Thursday 5th June 2025, 12:30–1:30pm.

Bleeding issues can be a source of significant concern for patients. By equipping ourselves with up-to-date knowledge and practical skills, we can provide better care, improve patient outcomes, and manage these presentations more effectively and confidently.