An exploration of women's concerns about heavy menstrual blood loss and their expectations regarding treatment

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Abstract
‘Heavy periods’ (menorrhagia) constitute a high number of referrals to outpatient gynaecology departments, with surgery as a frequent outcome, despite the symptoms frequently presenting no risk to health. Concerns about high rates for hysterectomy has led to a turn to less invasive surgical techniques, which remove the lining of the womb rather than the whole organ. However, the offer of surgery of whatever sort should still be a cause for concern where it is performed in the absence of abnormality. Research in this area has attempted to distinguish between objective (real) menorrhagia and subjective (imagined) menorrhagia and explored the psychopathology of women who are subjectively menorrhagia Some researchers have called for routine objective measurement of blood loss, while others have argued for a greater emphasis on exploring women's concerns and expectations. The present study uses qualitative methods to examine what prompts women's presentation and referral, the nature of women's concerns and anxieties, and the desired outcome following gynaecological consultation. Themes from 23 transcripts of interviews conducted with women who presented to an outpatient gynaecology department, indicate the importance of considering women's concerns and perspectives around heavy menstrual blood loss. The likely effects of these concerns and perspectives on outcome are explored and the implications for the management of menorrhagia are discussed.