Clinicians' perspectives on managing and treating heavy menstrual bleeding in Australia: A qualitative study

Heavy menstrual bleeding (HMB) is a common gynaecological condition, yet management practices remain variable, and women report dissatisfaction with care and treatment decision-making. While previous research has explored women's experiences, less is known about how clinicians approach assessment, treatment decisions and shared decision-making in HMB care. This study explored Australian clinicians' perspectives on managing HMB.

Semi-structured interviews were conducted with Australian clinicians, including general practitioners and gynaecologists with experience in managing HMB. Participants were recruited through professional networks and snowball sampling. Interviews took place between March and July 2025 and explored patient assessment, how patients were involved in treatment discussions and the potential role of decision aids. Transcribed audio recordings were analysed thematically using Framework analysis.

15 participants (n = 9 general practitioners and n = 6 gynaecologists) were interviewed. Five main themes were identified. Clinicians varied in how they assessed HMB, commonly relying on proxy indicators rather than formal diagnostic tools. Treatment pathways were shaped by time constraints, clinical setting, and system-level factors, including access to specialist care. Views on hysterectomy differed, with most framing it as a last-line option, while some considered it a valid choice for well-informed women. Limited consultation time was frequently described as a barrier to shared decision-making.

The findings highlight the need for clearer diagnostic guidance, balanced patient information, and patient decision-support tools that enhance shared decision-making. Supporting patient-centred discussions that balance clinical caution with respect for preferences will be critical to improving the consistency and quality of HMB management.