Total Self-BAT scores associated with choice of heavy menstrual bleeding treatment

Abstract

Background Heavy menstrual bleeding (HMB) is frequently the indicating symptom of an underlying bleeding disorder. The self-administered bleeding assessment tool (self-BAT) provides an overview of the bleeding history and indication of a bleeding tendency. Research about the association between a bleeding tendency and choice of HMB treatment is scarce. Methods The self-BAT was sent to all adult patients with HMB seeking care at a gynecological clinic. Closed questions on medical and surgical HMB management were provided, as well as a free-text question to reflect on personal experiences and opinions concerning HMB management. For clinical assessment of bleeding tendency, the cut-off for an abnormal self-BAT score was ≥5 in young women (18-30 years) or ≥6 for women of 31-52 years. Results Overall, 36% (234/650) of eligible women completed the questionnaire. The median total self-BAT score was 6 (interquartile range: 0–17). An abnormal total self-BAT score was more prevalent in women who underwent a hysterectomy compared to those who had not for women age 31-52 years (OR 4.3; 95%CI,1.2; 15.3; p=0.02). Medical therapy (hormonal, tranexamic acid or iron) was more prescribed in women with an abnormal self-BAT score. The most frequently mentioned responses from patients were related to low awareness of the effects of HMB and the need for patient empowerment. Conclusions Findings imply that there is a substantial group of patients with HMB who experience a bleeding tendency. This bleeding tendency may influence the choice of HMB treatment like a hysterectomy. Structured bleeding assessment tools could guide optimal diagnostics and treatment for women with HMB.