Barriers to seeking consultation for abnormal uterine bleeding: systematic review of qualitative research

Abstract

Background: Although Abnormal Uterine Bleeding (AUB) can have serious medical consequences and significantly impacts daily life, the overall trend is that most women do not seek care for these symptoms. The objective of this review was to synthesise factors impeding women's access care for AUB. Methods: Systematic literature review of qualitative studies (interview and focus group) regarding the lived in experiences of women with abnormal menstrual symptoms, followed by a thematic analysis of these studies. We screened CINAHL, SCOPUS, ProQuest, OVID and Pubmed for qualitative studies. Studies were assessed using the Clinical Appraisal Skills Programme checklist and thematic synthesis was used to develop themes from the findings of the studies. Results: The review yielded 12 studies that satisfied the inclusion criteria. Three themes were developed that described barriers for women seeking care for AUB: health literacy (understanding of normal periods, role of cervical Pap smears and lack of access to appropriate information), taboo/normalisation (fear and embarrassment of symptoms, prioritising others) and health care provider (lack of accessible and trusted female GPs and poor experiences with GPs). Conclusions: For 20 years women have consistently reported poor experiences in accessing care for AUB. The findings from our review indicate that drivers to impeding access are multiple; therefore any approaches to improve access will need to be multi-levelfrom comprising local sociocultural considerations to improved GP training.

Body image concerns in individuals diagnosed with benign gynaecological conditions: scoping review and meta-synthesis

“…Additionally, coping improved when individuals sought and received support (e.g. family, or a trusted doctor), reinforcing research indicating that discussion of disease, in general, can reduce loneliness and anxiety (Henry, Ekeroma, & Filoche, 2020). These supportive communications helped normalise the body-related concerns of affected individuals, resulting in the alleviation of body-related shame.…”

Experiences of menstrual inequity and menstrual health among women and people who menstruate in the Barcelona area (Spain): a qualitative study

“…Hormonal contraception (HC), which generally stops a natural menstrual cycle and menstruation, is a common strategy to manage menstruation-related issues such as menstrual pain or even acne [ 20 , 26 ]. Women and PWM experiencing menstrual problems rarely attend healthcare services, partly as some menstrual health problems tend to be normalized and dismissed [ 22 , 27 , 28 ]. Delayed diagnoses (e.g., of endometriosis) and negative experiences are expected when seeking institutionalized healthcare for menstrual-related issues [ 27 ].…”

“…Women and PWM experiencing menstrual problems rarely attend healthcare services, partly as some menstrual health problems tend to be normalized and dismissed [ 22 , 27 , 28 ]. Delayed diagnoses (e.g., of endometriosis) and negative experiences are expected when seeking institutionalized healthcare for menstrual-related issues [ 27 ].…”

Questions and answers on iron deficiency treatment selection and the use of intravenous iron in routine clinical practice

“…Heavy menstrual bleeding (HMB) is a symptom that should be defined by patients themselves as " … excessive menstrual blood loss which interferes with physical, social, emotional and/or material quality of life" [51,52]. Women can be unaware that their menstrual bleeding is abnormal [53][54][55], while others suppress symptoms [56] or present to providers who seem to normalize the symptoms, which remain untreated [57,58]. Iron deficiency and anaemia is common in this population [1] Management of women with the symptom of HMB and associated iron deficiency, with or without anaemia, requires dual therapyinterventions directed at the cause of the HMB and treatment designed to correct the iron deficiency and anaemia.…”

“…Heavy menstrual bleeding (HMB) is a symptom that should be defined by patients themselves as “…excessive menstrual blood loss which interferes with physical, social, emotional and/or material quality of life” [ 51 , 52 ]. Women can be unaware that their menstrual bleeding is abnormal [ 53–55 ], while others suppress symptoms [ 56 ] or present to providers who seem to normalize the symptoms, which remain untreated [ 57 , 58 ]. Iron deficiency and anaemia is common in this population [ 1 ]…”