The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey

Abstract

Purpose: Up to 30% of women of reproductive age experience HMB, which has a substantial impact on their quality of life. A clinical care pathway for women with HMB is an unmet need, but its development requires better understanding of the factors that characterise current diagnosis and management of the condition. Materials and methods: This observational, survey-based study assessed the burden, personal experiences, and path through clinical management of women with HMB in Canada, the USA, Brazil, France and Russia using a detailed, semi-structured online questionnaire. After excluding those reporting relevant organic pathology, responses to the questionnaire from 200 women per country were analysed. Results: Around 75% of women with HMB had actively sought information about heavy periods, mostly through internet research. The mean time from first symptoms until seeking help was 2.9 (Standard deviation, 3.1) years. However, 40% of women had not seen a health care professional about the condition. Furthermore, 54% had never been diagnosed or treated. Only 20% had been diagnosed and received appropriate treatment. Treatment was successful in 69% of those patients currently receiving treatment. Oral contraceptives were the treatment most commonly prescribed for HMB, although the highly effective levonorgestrel-intrauterine system was used by only a small proportion of women. Conclusions: This study provides insight into the typical journey of a woman with HMB which may help patients and health care professionals improve the path to diagnosis and treatment, although further research with long-term outcomes is needed.

Interventions to improve access to care for abnormal uterine bleeding: A systematic scoping review

“…This scoping review identified 20 studies that aimed at improving aspects of access to care for women with AUB. Given the high • Caregiver support -prevalence of AUB in women across countries 2 and consistent reporting of barriers for women with AUB to accessing care over the past two decades, 3,5,6 it is concerning that there is such a limited number of intervention studies focusing on this topic. There were studies targeting health service-based access dimensions including approachability, acceptability, appropriateness and population-based access dimensions such as the ability to perceive, seek, reach, and pay.…”

“…Abnormal bleeding can reduce quality of life. Women often experience AUB symptoms for years before seeking care or receiving treatment 3–6 . In a UK national audit including 14 545 women with heavy menstrual bleeding (HMB) attending secondary care, 74% of women had symptoms for more than 1 year before seeking treatment and 30.4% reported no previous treatment in primary care 5 .…”

“…Forty percent of women had not seen a health care professional about their HMB. Furthermore, over half (54%) had never been diagnosed or treated and only 20% had been diagnosed and received appropriate treatment 6 . Some of the barriers to healthcare access identified include taboo or stigma that prevented women from disclosing menstrual problems, embarrassment from exposing private body parts, discomfort with gynecologic examination, and fear of the possible diagnosis or gaps in health literacy resulting in normalizations of symptoms.…”

“…Women often experience AUB symptoms for years before seeking care or receiving treatment. 3 , 4 , 5 , 6 In a UK national audit including 14 545 women with heavy menstrual bleeding (HMB) attending secondary care, 74% of women had symptoms for more than 1 year before seeking treatment and 30.4% reported no previous treatment in primary care. 5 A multinational survey across women with HMB in Canada, the USA, Brazil, France, and Russia showed that the mean time from first symptoms to seeking help was 2.9 (±3.1) years.…”

“…Furthermore, over half (54%) had never been diagnosed or treated and only 20% had been diagnosed and received appropriate treatment. 6 Some of the barriers to healthcare access identified include taboo or stigma that prevented women from disclosing menstrual problems, embarrassment from exposing private body parts, discomfort with gynecologic examination, and fear of the possible diagnosis or gaps in health literacy resulting in normalizations of symptoms. Lack of trust, rapport, and shared decision making in doctor‐patient relationships can make communication about sensitive gynecologic issues difficult.…”