{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:50:17Z","timestamp":1787500217439,"version":"build-2736575974"},"reference-count":39,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["NIHR153187"],"award-info":[{"award-number":["NIHR153187"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]},{"name":"MRC unit grants","award":["MC_UU_00004\/06"],"award-info":[{"award-number":["MC_UU_00004\/06"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,3,13]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>A quarter of women experience heavy periods in their lifetime, often significantly impairing their well-being, productivity and quality of life.<\/jats:p>\n                    <jats:p>Several treatment options are offered for heavy menstrual bleeding; however, there is limited evidence on the effectiveness, safety and cost of available treatments. We aim to conduct a comprehensive systematic review, network meta-analyses and health economic evaluation to compare all available treatment options while considering the views and treatment preferences of women with heavy menstrual bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will systematically search electronic databases (MEDLINE, EMBASE, CENTRAL) as well as the grey literature, conference proceedings and trial registries to identify all relevant randomised trials that evaluated any medical or surgical treatment for women with heavy menstrual bleeding regardless of their cause compared with placebo or other active treatments.<\/jats:p>\n                    <jats:p>We will perform pairwise and network meta-analyses using standard methods. We will report primarily on changes in menstrual blood loss (using Pictorial blood loss assessment chart scores or the Alkaline-Haematin method), quality-of-life measures, safety in addition to other important clinical outcomes.<\/jats:p>\n                    <jats:p>We will develop a health economic model to evaluate the cost-effectiveness of available treatments within a healthcare perspective using data inputs from the planned meta-analyses. We will calculate the incremental cost per change in alternative outcomes and present the net monetary benefit for a range of cost-effectiveness thresholds for quality-adjusted life-year gained. We will conduct consultations and a discrete choice experiment involving patient representatives to capture the factors influencing women\u2019s decision-making and treatment preferences in real life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The project was approved by the UCL Institute for Women\u2019s Health Low-Risk Research Ethics Committee (reference: 004_2023_24) and UCL Research Ethics Committee (ID 16351\/003) for the planned patient involvement and qualitative research. We will produce an evidence-based decision aid toolkit and will publish the findings in peer-reviewed journals, as well as lay media outputs to inform health professionals, policymakers and the patient community.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration numbers<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.17605\/OSF.IO\/4MUSF\">https:\/\/doi.org\/10.17605\/OSF.IO\/4MUSF<\/jats:ext-link>\n                      , CRD42023468055, CRD42024519622, CRD42024520558 and CRD42024520634.\n                    <\/jats:p>\n                  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UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niccola","family":"Hutchinson-Pascal","sequence":"additional","affiliation":[{"name":"Co-Production and Public Engagement, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngawai","family":"Moss","sequence":"additional","affiliation":[{"name":"Patient and Public Representative, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7447-8934","authenticated-orcid":false,"given":"Rachael M","family":"Hunter","sequence":"additional","affiliation":[{"name":"Research Department of Primary Care and Population Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5084-7312","authenticated-orcid":false,"given":"Khalid Saeed","family":"Khan","sequence":"additional","affiliation":[{"name":"Public Health, 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National heavy menstrual bleeding audit: first annual report. 2011."},{"key":"2025120600011352000_15.4.e085292.4","doi-asserted-by":"crossref","first-page":"S70","DOI":"10.1016\/S0049-3848(17)30072-5","article-title":"Heavy menstrual bleeding: An update on management","volume":"151 Suppl 1","author":"Davies","year":"2017","journal-title":"Thromb Res"},{"key":"2025120600011352000_15.4.e085292.5","article-title":"Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis","volume":"5","author":"Bofill Rodriguez","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"2025120600011352000_15.4.e085292.6","unstructured":"The National Institute for Health and Care Excellence . 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