STREAMLINING CARE: A SERVICE EVALUATION OF A NEW GP DIRECT ACCESS PATHWAY FOR UNSCHEDULED BLEEDING ON HRT

Annette Brammer, The Rotherham NHS Foundation Trust

Background:
Increasing use of Hormone Replacement Therapy (HRT) has led to a rise in unscheduled bleeding presentations amongst peri- and postmenopausal women. While such bleeding is often benign (and expected) within the first six months of HRT use, it frequently triggers referrals to urgent suspected cancer pathways, placing strain on gynaecology services. In response and supported by guidance from the British Menopause Society (BMS), the South Yorkshire and Bassetlaw Cancer Alliance (SYB CA) introduced a new pathway in 2024, which enabled GPs to refer patients directly for ultrasound imaging (USS).

Method:
This retrospective quantitative study reviewed 158 patients referred via the new pathway over a six-month period. Ethical approval was obtained from Sheffield Hallam University. Anonymised data was collected using the Radiology Information System (RIS) and Business Intelligence (BI) tools. Descriptive statistics were used to evaluate patient outcomes for HRT regimes using endometrial thickness (ET) thresholds of >4mm for continuous combined HRT, >7mm for sequential HRT.

Results:
Findings showed high compliance with the new pathway: 90.5% of patients were managed appropriately, with 98% scanned within 14 days. No malignancies were detected, although thickened

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