69 Total Self-BAT scores associated with choice of heavy menstrual bleeding treatment INTRODUCTION Heavy menstrual bleeding (HMB) defined as menstruation at regular intervals, but with excessive flow and duration can be the first symptom of a bleeding tendency and various bleeding disorders [1, 2, 3]. Von Willebrand disease (VWD) type 1 is one of the most common inherited bleeding disorders with a prevalence ranging from 5%-24% in patients with HMB [4]. A bleeding tendency can also contribute to excessive or prolonged bleeding during childbirth, trauma or surgery and a higher chance that these women need blood transfusions compared to those without a bleeding tendency or bleeding disorder [2, 5]. Women with a bleeding tendency or underlying bleeding disorder may experience various bleeding symptoms in addition to HMB, with which women may present at the outpatient clinic [6]. The etiology of HMB can be diverse and the cause of HMB (e.g. bleeding tendency, hormonal dysregulation and/or uterine pathology) should be investigated first. An overall bleeding history besides a obstetrical-gynecological history is an important factor in reducing diagnostic delay in bleeding disorders and could be crucial in optimizing HMB management [7, 8, 9, 10, 11]. A possible strategy to aid gynecologists in consistent bleeding history assessment could be the self-administered bleeding assessment tool (self-BAT) [12]. Since its introduction in 2015, the self-BAT is gaining interest as a screening tool during the diagnostic work-up of patients to distinguish between normal and abnormal bleeding [13]. The aim of our study was to investigate the prevalence of the total and domain-specific self-BAT scores among patients with HMB, and to describe if there is an association with the total self-BAT scores and choice of HMB treatment. Furthermore, we explored the patients’ perspectives on HMB management in free-text responses. METHODS Study population and procedures We performed a cross-sectional survey study. The local institutional review board of Gelre Hospitals confirmed that the Medical Research involving Human Subjects does not apply to this anonymous, observational study. (Reference number: TCO 13.26). Included were all premenopausal women ≥18 years and <53 years of age, who were referred to the peripheral gynecological center of Gelre Hospitals for HMB, The Netherlands between January 2020 and January 2022. Excluded were patients with uterine pathology (e.g. carcinoma, myoma, or endometriosis). The HMB patients were identified through the hospital’s patient administrative system (Dutch diagnosis-and-treatment code G11 R11 N92.0 or N92.6; menstrual cycle disorders, first appointment, menorrhagia or HMB). The selected patients were informed about our study and were asked to participate voluntary in a one-time self-BAT survey through an invitation letter. All participants provided written informed consent by handing back the questionnaires. A formal sample size calculation was not done, since this was a convenience sample of all eligible patients. The paper-based survey was sent to all 650 patients during the first half of 5
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