Women’s experiences of heavy menstrual bleeding and medical treatment: Qualitative study

Background: Heavy menstrual bleeding (HMB) is common and can affect women’s lives. Evidence on women’s experiences and their treatment of this problem after seeking primary care is lacking. Aim: To explore women’s experiences of HMB and their medical treatment up to ten years after initial management in general practice. Design and setting: Qualitative study in primary care. Method: Semi-structured interviews with purposeful sample of 36 women, who had participated in the ECLIPSE trial of medical treatments for HMB in primary care (levonorgestrel-releasing intra-uterine system [LNG-IUS] or other usual medical treatments [oral tranexamic acid, mefenamic acid, combined oestrogen–progestogen; or progesterone alone]. Data were analysed thematically, including process of respondent validation. Results: Women reported wide-ranging and debilitating impacts of HMB on their lives. They had often normalised their experience, underlining persisting societal taboos about menstruation and reflecting low general awareness of HMB as treatable. Women commonly delayed seeking help for several years. They could then be frustrated by lack of a medical explanation for HMB. Women who had pathology identified felt able to make better sense of their HMB. Experiences of medical treatments varied considerably but were strongly influenced by the perceived quality of health care interactions with clinicians. Other influences on women’s treatment included considerations for their fertility, health concerns, family and peers, and views when approaching menopause. Conclusion: Clinicians should be aware of the considerable challenges faced by women with HMB; widely differing experiences of, and influences on their treatment; and the value of patient-centred communication in this context.