"I Feel Chained Right Now": A Qualitative Study Exploring Treatment Decision-Making Among Individuals With Abnormal Uterine Bleeding.

OBJECTIVE

This study investigates how individuals approach treatment decisions when offered both medical and surgical interventions for abnormal uterine bleeding (AUB).

DESIGN

This is a qualitative study based on in-depth interviews conducted via telephone or in-person. We tape-recorded and transcribed all interviews, then used Atlas TI Cloud to code and analyze data according to the principles of grounded theory.

SETTING

We recruited English and Spanish-speaking participants from outpatient gynecology offices at a large suburban academic medical center.

PARTICIPANTS

Premenopausal individuals aged 40 years and above diagnosed with AUB due to any benign etiology who had been offered medical and surgical treatments, including hysterectomy.

INTERVENTIONS: Not applicable

RESULTS

We completed 25 interviews between January 2023 and March 2024. Treatment choices among participants included hormonal and nonhormonal medical management, endometrial ablation, minimally invasive hysterectomy, and undecided. For many participants, AUB interfered with work, sexual intercourse, and relationships. Delays in diagnosis and treatment were common, with participants seeing multiple clinicians before obtaining treatment. Hormonal therapies were described as unnatural and potentially dangerous, causing physical and mental side effects. Barriers to surgery included fears of complications and menopause as well as hesitancy to lose an organ with cultural and emotional value (the uterus). Participants weighed multiple outside influences into their decision, and many prioritized efficacy in their final treatment choice.

CONCLUSION

Early counseling incorporating a range of medical and surgical treatment options including hysterectomy is important for patients with AUB. Identifying patients' priorities and clarifying misconceptions may reduce delays in obtaining their ideal treatment thus improving quality of life.