15 General introduction haemostasis defects or hyperfibrinolysis (2). This thesis employs a trans- and interdisciplinary approach which will strengthen our insight into the pathways to diagnosis as related to social and environmental factors contributing to under- or misdiagnosis bleeding disorders among women with HMB. To better understand how to raise awareness for bleeding disorders and develop strategies to reduce delays in diagnosing bleeding disorders in women within a gynecological setting, we conducted several studies on this issue, focusing on women with HMB, both with and without underlying bleeding disorders. The following questions were considered essential: 1. Concerning strategies: What are intraoperative strategies to reduce intraoperative bleeding and what are patient preferences regarding surgical interventions for HMB in women with bleeding disorders? 2. Concerning prediction: How do diagnostic BAT scores associate with treatment choices and outcomes after endometrial ablation in women with HMB? 3. Concerning communication: What impact does a narrative medicine approach using site-specific arts have on healthcare providers’ awareness of stigmatization, and how do women benefit from these initiatives? To address these questions, we conducted the following studies: • Chapter 2 gives an overview of prophylactic and therapeutic strategies for managing intraoperative bleeding in women with von Willebrand disease and heavy menstrual bleeding. • Chapter 3 discusses the high prevalence of reduced thrombin generation and/or decreased platelet response in women with unexplained heavy menstrual bleeding. • Chapter 4 evaluates the results of ISTH-BAT scores and outcomes after endometrium ablation in women with heavy menstrual bleeding. • Chapter 5 evaluates the total Self-BAT scores compared to choice of heavy menstrual bleeding treatment. • Chapter 6 investigates women’s’ preferences toward the type of support from providers for the treatment of heavy menstrual bleeding. • Chapter 7 discusses a narrative medicine intervention on the obstetric-gynecological workfloor using co-created site-specific poetry. • Chapter 8 provides a general discussion on the clinical implications of this thesis and suggestions for further research. • Chapter 9 and 10 summarize the results of the thesis in English and Dutch. • Chapter 11 contains the impact paragraph. 1
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