Heavy menstrual bleeding in adolescents: incidence, diagnostics, and management practices in primary care.

Background: Heavy menstrual bleeding (HMB), self-reported by 37% of adolescents, can be the first sign of a bleeding disorder (BD) during adolescence. The Dutch general practitioner (GP) guideline demands laboratory diagnostics and referral for patients at risk for a BD. How often adolescents consult the GP for HMB and which diagnostic and management strategies are used are unknown. Objectives: This study aims to estimate the incidence of HMB in adolescents in primary care and to identify diagnostic and management practices for HMB, considering the HMB GP guideline. Methods: Retrospective analyses of a GP network database containing over 200 Dutch GPs were performed. Adolescents aged 10 to 21 years, with a new diagnosis of HMB between 2010 and 2020, and a 6-month follow-up were eligible. The incidence rate and diagnostic and therapeutic strategy data were extracted. Results: We identified 1879 new diagnoses of HMB in adolescents. The average incidence rate was 7.91 per 1000 person-years. No diagnostic studies were performed in 67%. Laboratory studies were mainly restricted to hemoglobin levels (31%). Full coagulation screening occurred in 1.3%, and ferritin levels in 10%. Medication was prescribed in 65%; mostly hormonal treatment (56%) and/or nonsteroidal antiinflammatory drugs (NSAIDs) (18%). The referral rate was higher after >2 follow-up visits (6.7%) vs after 1 GP visit for HMB (1.6%; Odds ratio: 8.8; 95% CI: 5.1-15), mostly to gynecologists (>85%). Conclusion: According to this GP database study, few adolescents visit their GP with HMB despite its high self-reported incidence. Most adolescents were prescribed hormonal contraception without further diagnostics. Referral was rare and mostly occurred after multiple follow-up visits.

[Summary of the Dutch College of General Practitioners (NHG) practice guideline on 'Diverticulitis']. / Samenvatting van de NHG-standaard 'Diverticulitis'.

The NHG practice guideline on 'Diverticulitis' provides general practitioners with directions on the diagnosis and treatment of uncomplicated and complicated diverticulitis. Diverticulitis is primarily a clinical diagnosis which can be supported by assessment of CRP. Uncomplicated diverticulitis is strongly suspected if the patient reports the development of persistent sharp, stabbing pain in the lower left abdomen within a couple of days; if there is pressure or rebound tenderness only in the lower left abdomen; and if there are no alarm signals. Alarm signals of complicated diverticulitis are: guarded muscle response, signs of intestinal obstruction, locally palpable resistance, rectal loss of blood, hypotension, and high fever. The policy for uncomplicated diverticulitis is waiting without specific measures, provided that the general practitioner monitors the course actively. There is no indication for antibiotics in patients with uncomplicated diverticulitis. Patients with signs of complicated diverticulitis or with persisting symptoms should be referred.

[Summary of the practice guideline 'Venous leg ulcer' from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Ulcus cruris venosum' van het Nederlands Huisartsen Genootschap.

The practice guideline 'Venous leg ulcer' from the Dutch College of General Practitioners provides recommendations for the diagnosis and treatment of venous leg ulcer by the general practitioner. When counseling the patient it is important to make clear that the healing process can take a long time. Compression therapy remains the most important treatment for venous leg ulcer; it also reduces recurrence rates. The choice of wound dressing is dependent on the wound phase, the degree of moisture in the wound and the infection grade. In some patients the recurrence rate can be further reduced by treating any varices that are present. Referral to secondary care is rarely necessary. The practice guideline is very similar to the multidisciplinary guideline on this matter; the differences concern small details.

[Summary of the practice guideline 'Erectile dysfunction' from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Erectiele disfunctie' van het Nederlands Huisartsen Genootschap.

The Dutch College of General Practitioners recently published the practice guideline 'Erectile dysfunction'. The prevalence of erectile dysfunction increases with age. A lot of the men suffering from erectile dysfunction do not consult their general practitioner, or only do so after a lot of delay. It is recommended that inquiry about erectile dysfunction be made during routine follow-up consultations for co-morbid conditions.