Decision report 201100691

Summary
Ms C had been on Depo-Provera contraceptive injections for a number of years, from 1994-2002, then from around 2005-2010. In May 2010 she developed back pain and other symptoms which she reported to the GPs at her local surgery. She was given various possible causes but after referral to a dermatologist, rheumatologist and an MRI scan she was eventually diagnosed in February 2011 with a probable chronic syndrome.

Ms C considers that had her contraceptive medication been appropriately monitored she would not have developed the condition ‘SAPHO syndrome’. She also considers that the GPs failed to diagnose her syndrome.

Our medical adviser considered the case and found that the monitoring of Ms C's contraceptive use, particularly in the earlier years had lacked detail. He found that blood pressure monitoring had been sporadic and there was no evidence of systematic review of the method of contraception. The adviser noted guidelines regarding review periods had not been issued until 2004, and that the notes had improved significantly from 2010 onwards – nonetheless the complaint regarding monitoring was upheld.

In relation to investigation and diagnosis, the adviser found the GPs’ actions to be a demonstration of good practice, in that appropriate and detailed referrals to specialist departments were made timeously. The adviser also found the probable syndrome was extremely rare and would not have expected a GP to diagnose it. Finally, no causative link between the contraceptive and SAPHO syndrome has been established. We did not uphold this complaint.

Recommendation
We recommended that the practice:
• apologise to Ms C for failing to monitor her appropriately whilst she was on Depo-Provera.