A 51-year old woman first saw our member, a GP, in February. The patient presented with menopausal symptoms, and the GP undertook appropriate investigations. A blood test result was received in July showing an FSH level of 66, indicating that the patient was menopausal.

Having considered her options, the patient decided to proceed with Hormone Replacement Therapy (HRT). The GP prescribed Elleste-Solo tablets – an unopposed oestrogen treatment.

In December, the patient returned to see the GP complaining of vaginal bleeding after intercourse. The GP referred her for an ultrasound scan, which was performed in January. The report mentioned a bulky uterus with several rounded mixed echo structures suggestive of fibroids.

The GP referred her to the local gynaecology clinic where she was booked for a diagnostic hysteroscopy and endometrial biopsy. A uterine polyp was identified and removed and an endometrial biopsy was taken.

The endometrial biopsy showed moderate atypical glandular hyperplasia with no features of malignancy. The patient was seen for follow up one month later. The consultant explained that the findings indicated that the endometrium had been affected by the course of unopposed oestrogen. Although there was no absolute indication for a hysterectomy, the patient was very anxious about the results and opted to have a hysterectomy.

A claim for compensation was made on the basis that it had been negligent to prescribe unopposed oestrogen to a patient with an intact uterus, leading to the patient undergoing an unnecessary hysterectomy. The MDU obtained reports from a GP expert and a gynaecology expert.

The error came after the wrong product had been inadvertently selected from the computer medication list

The member had originally documented in the notes that the patient would need combined therapy because she had an intact uterus. Unfortunately, the error came after the wrong product had been inadvertently selected from the computer medication list, and this had gone unnoticed.

The GP expert agreed that this treatment was inappropriate. The gynaecology expert considered that it was likely that the moderate atypical glandular hyperplasia was caused by the prescribing of unopposed oestrogen tablets.

Our expert agreed with the patient’s treating gynaecologist that there was no absolute indication for a hysterectomy in this case. The claim was subsequently settled for £28,000 in damages and £14,000 in legal costs.


This article was correct at publication on 15/03/2016. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.