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Referral rules queried for postcoital bleeding

Younger women are being left at risk by age limits on referral for postcoital bleeding, an analysis concludes.

Researchers called for GPs to urgently refer all women with bleeding lasting for more than four weeks after finding age was no indicator of the likelihood of significant pathology.

Among 120 patients whose referrals were analysed, 105 had postcoital bleeding for more than four weeks at presentation and 22% had significant pathology – more than half of whom were under 35. The findings, presented at this week's British International Congress on Obstetrics and Gynaecology, suggest younger women are at greater than expected risk and question Department of Health guidance, which only recommends referral for four weeks of bleeding in the over-35s.

A companion study found huge variation in the management of postcoital bleeding once patients were seen in hospital, with 61% of consultants saying national guidelines were needed. Dr Fadi Alfhaily, a registrar in obstetrics and gynaecology at Ipswich Hospital NHS Trust, who led both studies, said: 'There is a need for national guidelines. Postcoital bleeding can be a very serious and significant symptom. There must be regulations to at least guide the management of these patients.'

Dr Alfhaily added: 'There is no correlation between age and pathology. Age should not restrict urgent referral.'

Dr Sarah Jarvis, RCGP spokes-person for women's health and a GP in Shepherd's Bush, west London, said: 'It is in line with my experience that few PCTs or hospitals have any guidance on postcoital bleeding. I agree there needs to be standard management guidance in the UK.'

But Dr Elizabeth Goodburn, a GP in Camden, north London, with a special interest in sexual health, warned of the dangers of over-referral: 'Postcoital bleeding is a fairly common symptom and we don't want to refer constantly. You need to screen in practice, and rule things out such as chlamydia, in younger women particularly.' She agreed national guidelines would be useful, adding: 'Postcoital bleeding can be a symptom of serious problems – or not. We all know it is something to take seriously, but at the moment dealing with it is quite ad hoc.'

Study findings

• 120 women studied who were referred to Ipswich Hospital NHS Trust for postcoital bleeding

• 22% had significant pathology

• Of these, 54% were under 35, 89% had had PCB for more than four weeks and 19% had suffered severe episodes

• Bleeding duration, rather than age or severity, seemed strongest criterion for urgent referral

• Referral should not be limited to over-35s, researchers conclude

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