Barriers to care for abnormal uterine bleeding

Every year, more than 1 million cases of abnormal uterine bleeding (AUB)—a condition that has a significant impact on women’s quality of life—are reported in the United States. A new literature review suggests that several major barriers exist to care for the condition.

Published in BMC Women’s Health by New Zealand researchers, the report assesses qualitative studies of the lived experiences of women with abnormal menstrual symptoms¹.

The authors performed a systematic literature review through August 8, 2019, and identified 12 studies involving interviews or focus groups related to women aged 18 years or older. The Clinical Appraisal Skills Program Checklist was used to assess the quality of the reports, which spanned 1999 to 2018.

Of the studies, 6 were from the UK, 3 from New Zealand, 2 from the United States, and 1 from Australia. The methodology used ranged from open, unstructured, and semi-structured interviews with 16 to 60 participants.

In half the studies, women were recruited from the community and the other half from attendance at clinics.

The three major barriers to care for AUB identified by the authors of the systematic review were: (1) lack of health literacy; (2) taboo around and normalization of menstrual issues; and (3) poor communication with health care providers.

Of note, in one of the US studies, women found identification of “normal” menstrual bleeding challenging and, they began to normalize heavy or excessive bleeding if it occurred for a long enough period of time. As a result, they may not have sought medical attention for AUB.

Over half the women surveyed who had fibroids minimized their symptoms and overall, the participants prioritized other health issues over those involving uterine or vaginal health.

Regarding communication with health providers, most of the studies assessed found that it was a key barrier to the investigation of AUB. Eight of the 12 studies identified normalization and dismissal of concerns of women’s concerns by general practitioners as an important impediment to accessing appropriate care.

Notably, in one US study of more than 400 general practitioners, 87% said they ask patients a quality-of-life question in relation to AUB but only 18% thought that was essential when evaluating a woman with AUB.

The findings from the literature review, the authors said, “indicate that improving access to care [for AUB] will require multi-level approaches that include consideration of local socio-cultural needs along with improved training for primary healthcare providers such as GPs.”

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Reference

1. Henry C, Ekeroma A, Filoche S. Barriers to seeking consultation for abnormal uterine bleeding: systematic review of qualitative research. BMC Womens Health. 2020 Jun 12;20(1);123 doi: 10.1186/s12905-020-00986-8