Select Page
5 things your GP will ask before a referral to an OBGYN

5 things your GP will ask before a referral to an OBGYN

Women who experience vaginal blood loss during menopause will visit their GP due to menstruation when they are no longer supposed to be menstruating (post-menopausal).

Here are 5 key questions your GP will ask you before referring you to a specialist

  1. Is the blood loss only from your vagina? You might find this an awkward question, but this is to make sure to rule out any rectal blood loss which could look and feel like blood coming from the vagina. Especially if the woman is known to have haemorrhoids, it is a topic that your GP will want to briefly touch on and move on to the next question
  2. The 3 How’s: How does the vaginal blood loss occur, how often does it occur a day/week and how long does it last for. 
  3. Does vaginal blood loss occur after sexual intercourse. If this is the case, the GP will need to determine whether it is a cervical polyp or the lining of the vagina that is wearing thin and after friction bleeds easily. This is also known as vaginal atrophy. 
  4. Do you use any medication?
  5. Could you possibly be at risk of a sexually transmitted disease? May sound strange that your GP asks you this for vaginal blood loss, however diseases like chlamydia can cause similar symptoms. 

Things you must ask your GP during your consultation.

What are the changes that even after I have been referred to a specialist, I will be sent back to my GP for further treatment? 

50% of the women who have post menopausal blood loss and are referred to a specialist do not have any serious underlying medical condition. In the majority of the cases, the blood loss is due to vaginal atrophy. 

Do I have endometrial cancer with these symptoms?

Endometrial cancer is known to cause post menopausal blood loss. It occurs in about 2000 women per year in the Netherlands and of these 20% (400 women) will unfortunately die from this disease. In the majority of cases, when endometrial cancer is screened and treated early, just over 90% of women will make a full recovery.

Should my GP perform a PAP smear even if I’ve had one just recently?

Yes. For any woman with new onset of post menopausal blood loss regardless of the results of an old PAP smear, a new one must be requested. This is because it is important to rule out a cervical tumor. If a PAP smear is performed and the results are negative, then the GP will not need to refer you to a specialist. However if the laboratory finds slightly abnormal cells, they will proceed with further testing.

Your GP may decide to refer you for an ultrasound of your uterus and ovaries. 

How certain am I that an ultrasound will accurately determine I do not have cancer? 

A negative ultrasound has a strong predictive value, meaning if the ultrasound of the thickness of your uterus is small, then you can be 99% sure you do not have endometrial cancer. 

So in summary for new onset post menopausal vaginal blood loss your GP will request a PAP smear and/or transvaginal ultrasound. Once these results are known, then a decision will be made whether to refer you to a specialist. 

What if the vaginal blood loss returns despite the previous ‘ negative ‘ results? should I then get a referral? 

Absolutely! Early screening is very important, and if you develop a recurrence of vaginal blood loss, your GP should refer you immediately to a specialist for further work-up such as histology. 

Need to speak with HelloDoc about (post-menopausal) vaginal blood loss? Book an appointment with Dr. Irina Zenevica (GP with special interest in endocrinology and hormonal imbalance. She consults in English, Russian, Swedish and Dutch)

Hair loss

Hair loss

Hair loss is defined as loss of scalp hair. It is more common in males than in females. There are various causes of hair loss

  • Fungal infection (alopecia areata)
  • Excessive plucking (tricotillomania) or pulling (tractiealopecia) of the hair
  • Scar tissue formation (alopecia atrophicans)
  • Genetic

There are about 100,000 hair follicles on the hair of which 90% are in the growth phase. The growth phase lasts about 2 to 6 years. The next three months is the rest phase and after that the hair falls off. It is normal to lose about 50 to 100 hair strands per day.

Growth phase of hair can be affected and prematurely interrupted due to the following conditions

  • Chronic disease like cancer or kidney disease
  • Folium and Iron deficiency
  • Medication use
  • Hormonal changes such as during pregnancy or thyroid gland problems
  • Diabetes mellitus

A genetic condition called alopecia androgenetica is most common in males than in females and occurs when hair follicles are highly sensitivity to androgenic hormones. These hormones cause atrophy or thinning of the hair follicles

The GP should ask for

  • How long the hair loss has been
  • If it occurs in the family
  • Any use of medication of pre-existing conditions
  • Presence of dandruff
  • if you are stressed or overworked
  • Any previous trauma or scar
  • Repetitive plucking or pulling

How to test for abnormal hair loss

  • After you shampoo and rinse your hair, take 30-40 strands between your thumb and index finger, then pull on it. If more than 6 hair strands are pulled along then this could be a reason to contact your GP

There is no effective management for alopecia androgenetica. It is important for men or women to accept this hair loss and not resort to various treatments that do not work. However the GP can consider

  • Minoxidil scalp lotion 5% twice a day for 12 months
    • In case of irritation then a 2% solution can be used
  • Finasteride 1mg tablets one day for 12 months; this has shown to have some positive effect in hair growth.
    • Stopping this medication could result in hair loss again.

In the event of alopecia areata, the GP could prescribe local injection with corticosteroids.

The GP can make a referral to specialist in the event of obsessive plucking of the hair in children or adults.

Hair loss can cause anxiety for many people. In the majority of cases alopecia areata will resolve spontaneously without any treatment in 6 months. For those with a hormonal cause of hair loss, the chance of spontaneous hair growth is low. Scar tissue that causes hair loss does not resolve.