Mitigating Low Patient Awareness of Treatment Options for Abnormal Uterine Bleeding

Have you ever ended a patient visit knowing that a question was left unasked? I have been in this position, and it often worries me. Practicing gynecology for over 30 years has given me the unique opportunity to treat women through every stage of their reproductive lives. Naturally, women have questions about their experiences related to any number of reproductive health concerns, but I’m discomforted by how hesitant patients are to ask questions they perceive to be embarrassing. No more is this evident than when it comes to their questions about their menstrual cycle. When it comes to abnormalities related to menstruation, my patients are often reluctant to share their concerns unless very specifically prompted. It’s common for a woman that is desperate for help to voice a concern at the end of their appointment, almost as if an afterthought. I am most relieved and gratified when a patient asks targeted and specific questions to understand if what she is experiencing is normal or something to be concerned about. My goal is to help more women find their voice to get their needs met so that neither she, nor I, feel like the visit was a missed opportunity. These discussions are a critical first step in helping women realize that they do not need to live with the toll that uterine health conditions often take on quality of life.

In my experience, patients dealing with symptoms of abnormal uterine bleeding (AUB), or heavy periods, will generally be characterized by their silence. This is likely because, despite its prevalence (about 1 in 5 women suffer from AUB¹), women don’t know if their heavy period is “normal” because AUB is rarely discussed. Because women have no concrete benchmark for what is considered a normal level of bleeding, they don’t know whether they should be raising their cycle to my attention. For instance, women often don’t realize that passing clots larger than a quarter or changing their tampon or pad every hour is actually indicative of a true medical condition.¹ The lack of discussion not only makes it difficult to discern the status of their health, but also limits their understanding of existing treatment options for AUB.

A recent survey conducted by Hearst publications found that 85 percent of women believed that heavy periods were “normal”, and 69 percent of women agreed that menstrual pain is “something to be expected.” ² I was troubled, but not surprised by these statistics. What was more troubling, was that the survey found that among the respondents who experienced at least one heavy period symptom, 57 percent did not discuss those symptoms with a doctor or other medical professional.²

The survey findings also revealed that 48 percent of women incorrectly assume that hormones are the only way to lighten a heavy flow. I find this to be consistent with the beliefs of my younger patients who are familiar with oral contraceptives and IUDs. Older patients often believe that hysterectomy is the only option available to them at their stage of life, which makes them apprehensive to raise concerns. In either case, it’s critical that patients are informed about the full spectrum of treatment options so that they can make a choice based on their medical needs, stage of life and personal preferences. Consistent with my own experience, the survey reported that only 3 in 10 women are aware of endometrial ablation as a treatment option for AUB.²

Endometrial ablation serves a population of patients seeking a middle ground, as it is an effective solution to heavy bleeding for women who no longer want hormonal therapy, but are not ready, or not looking to have a hysterectomy. Further, the procedure has also proven to be mutually beneficial for both patients and practice. In a clinical study, 92.8% of patients who had the NovaSure® endometrial ablation procedure for treatment of AUB were satisfied with their results 12 months post-procedure.3 The NovaSure procedure can also be performed right in the office, making it more convenient for the patient and a time and cost-effective option for the practice. As with any minimally invasive procedure, there are risks associated. To learn more, visit the NovaSure website.

I encourage my colleagues to take the findings of the survey as a call-to-action to help patients recognize and address symptoms of AUB and know their options. With the rise of digital healthcare technologies, patients have become much more involved in decision-making as it relates to their care. For the same reason, it’s never been easier to reach patients with the education they need that will boost their confidence in seeking your help. I encourage physicians to utilize social and digital media to equip patients with broader knowledge, prompt their patients with questions to better understand how their period may be impacting all elements of daily life, and inform patients of all treatment options.  
Disclosure: Dr. Weiss reports being a paid consultant for Hologic, Inc. for the NovaSure® endometrial ablation system.

References
1) Centers for Disease Control and Prevention. Heavy menstrual bleeding. https://www.cdc.gov/ncbddd/blooddisorders/ women/menorrhagia.html. Accessed April 07, 2017.
2) Hologic, Inc. Data on File; Custom Women's Health Subscriber Study. January - February 2019. Survey of 884 women who subscribe to Women's Health print publication.
3) NovaSure Instructions for Use.

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