Navigating treatment options: a qualitative study exploring Australian women's decision-making experiences and satisfaction with treatment of heavy menstrual bleeding.

Background: A wide range of management options exist for heavy menstrual bleeding (HMB). Australian clinical standards emphasise the need for shared decision-making to ensure women receive comprehensive, reliable information about their options. However, the high variation in the usage of treatments, such as hysterectomy and endometrial ablation, across Australia suggests inconsistent access to quality care. This study aims to gain insights into Australian women's perceptions of current practices, their experiences of HMB care and treatment decision-making.

Methods: A qualitative study using semi-structured interviews with Australian women who sought treatment for HMB within the past two years. Women were recruited via social media advertising. The interviews took place online between July and September 2024. Women were asked about (1) their experiences with HMB, (2) their interactions with clinicians (3) experiences of shared decision making and (4) what other resources they consulted in their treatment decision-making. Transcribed audio recordings were analysed thematically using Framework analysis.

Results: Twenty-four participants between the ages of 35 and 55 were interviewed. Five main themes emerged: "Why Women Seek Treatment", "Efforts and Obstacles in Securing Quality Care", "Women's Perceptions of Their Treatment Options", "The Role of Clinicians in Treatment Decision-making" and "Women consult various sources of information to make treatment decisions".

Conclusions: Australian women face significant barriers in accessing quality care and appropriate effective treatment for HMB. Women are often uncertain about what is considered a normal menstrual experience and receive inadequate information from clinicians. Women seek balanced, comprehensive information on all available treatment options and clear guidance on how treatment success is monitored. Tools that support shared decision-making have been identified as a potential method to improve HMB treatment journeys.