Total self-BAT scores associated with choice of heavy menstrual bleeding treatment

Background: Heavy menstrual bleeding (HMB) is frequently the indicating symptom of an underlying bleeding disorder. The self-administered bleeding assessment tool (self-BAT) provides an overview of the bleeding history and indication of a bleeding tendency. Research about the association between a bleeding tendency and choice of HMB treatment is scarce. Methods: The self-BAT was sent to all patients ≥ 18 and < 53 years old with systematic causes of HMB seeking care at a gynecological clinic. Closed questions on medical and surgical HMB management were provided, as well as a free-text question to reflect on personal experiences and opinions concerning HMB management. For clinical assessment of bleeding tendency, the cut-off for an abnormal self-BAT score was ≥ 5 in young women (18–30 years) or ≥ 6 for women of 31–52 years. Results: Overall, 36% (234/650) of eligible women completed the questionnaire. The median total self-BAT score was 6 (interquartile range: 0–17). An abnormal total self-BAT score was more prevalent in women who underwent a hysterectomy compared to those who had not for women age 31–52 years (OR 4.3; 95%CI,1.2; 15.3; p = 0.02). Medical therapy (hormonal, tranexamic acid or iron) was more prescribed in women with an abnormal total self-BAT score. The most frequently mentioned responses from patients were related to low awareness of the effects of HMB and the need for patient empowerment. Conclusions: Findings imply that there is a substantial group of patients with HMB who experience a bleeding tendency. This bleeding tendency may influence the choice of HMB treatment like a hysterectomy. Structured bleeding assessment tools could guide optimal diagnostics and treatment for women with HMB.