{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T08:50:14Z","timestamp":1791881414159,"version":"4.3.4"},"reference-count":23,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T00:00:00Z","timestamp":1782000000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T00:00:00Z","timestamp":1782000000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the physical, psychological, social, and functional impact of heavy menstrual bleeding (HMB) using a mixed\u2010methods approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Mixed\u2010methods online survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>A UK\u2010wide sample of adults assigned female at birth with lived experience of HMB. Participants were recruited between June and July 2024 via social media, menstrual\u2010health charities and the Katie's Team and Co\u2010Production Collective networks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants completed an online questionnaire comprising multiple\u2010choice and open\u2010ended items. Qualitative data were analysed inductively using thematic analysis and quantitative data were summarised descriptively. Findings were integrated to understand the multi\u2010dimensional impact of HMB. Patient and public involvement informed survey development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Menstrual cycle characteristics; self\u2010reported physical, psychological, social, and functional impacts of HMB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>105 participants were included. Most reported bleeding lasting \u2265\u20096\u2009days and long\u2010standing HMB beginning early in their reproductive lives. Severe or very severe impact was reported across physical health (83%), mental health (73%), social participation (83%), and sexual relationships (59%). Qualitative findings highlighted profound fatigue, symptoms consistent with anaemia, pain, cognitive difficulties, and night\u2010time disruption. Participants described pervasive anxiety regarding leakage, altered career or study trajectories, and adverse effects on intimacy and relationships. Many structured daily routines around access to toilets and sanitary protection. Experiences of stigma and unmet healthcare needs were common.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among participants, HMB was associated with quality of life impairment across multiple domains, extending far beyond bleeding volume. These findings underscore the importance of holistic, patient\u2010centred management, including timely investigation, appropriate medical therapy, and psychosocial support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.70290","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T02:44:20Z","timestamp":1782096260000},"page":"2170-2177","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Impact of Heavy Menstrual Bleeding on Quality of Life: A Mixed\u2010Methods Survey Study"],"prefix":"10.1111","volume":"133","author":[{"given":"Michalina","family":"Drejza","sequence":"first","affiliation":[{"name":"Cambridge University Hospitals NHS Foundation Trust  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7862-8750","authenticated-orcid":false,"given":"Lily S.","family":"Nicholson","sequence":"additional","affiliation":[{"name":"UCL Innovative Clinical Trials Unit UCL  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Paquette","sequence":"additional","affiliation":[{"name":"EGA Institute for Women's Health UCL  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehar","family":"Chawla","sequence":"additional","affiliation":[{"name":"EGA Institute for Women's Health UCL  London UK"},{"name":"Imperial College Healthcare NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire L.","family":"Vale","sequence":"additional","affiliation":[{"name":"UCL Innovative Clinical Trials Unit UCL  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewelina","family":"Rogozi\u0144ska","sequence":"additional","affiliation":[{"name":"UCL Innovative Clinical Trials Unit UCL  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngawai","family":"Moss","sequence":"additional","affiliation":[{"name":"Patient and Public Contributor, Katie's Team  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niccola","family":"Hutchinson\u2010Pascal","sequence":"additional","affiliation":[{"name":"Co\u2010Production Collective University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bassel H.","family":"Al Wattar","sequence":"additional","affiliation":[{"name":"Clinical Trials Unit, Faculty of Health Medicine and Social Care Anglia Ruskin University  Chelmsford UK"},{"name":"Beginnings Assisted Conception Unit Epsom and St Helier University Hospitals  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,21]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2014.09.027"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(23)00416-3"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-019-0726-1"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.12669\/pjms.35.2.644"},{"key":"e_1_2_12_6_1","unstructured":"National Institute for Health and Care Excellence (NICE) \u201cHeavy Menstrual Bleeding: Assessment and Management\u201d2018 (updated 2021) https:\/\/www.nice.org.uk\/guidance\/ng88."},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12394"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1008978114650"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14943"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2007.00168.x"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13273"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2022.0460"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2007.08.018"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41539-025-00338-x"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.18109"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.70178"},{"key":"e_1_2_12_17_1","volume-title":"Women's Health Economics: Investing in the 51 per Cent","author":"Gorham B.","year":"2024"},{"key":"e_1_2_12_18_1","volume-title":"Designing and Conducting Mixed Methods Research","author":"Creswell J. 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