Comment on: “‘I Feel Chained Right Now’: A Qualitative Study Exploring Treatment Decision-Making Among Individuals With Abnormal Uterine Bleeding”

Abnormalities in uterine bleeding can include differences in volume, regularity and timing, and can be caused by multiple etiologies. Significant impacts are evident in individuals with abnormal uterine bleeding (AUB) in social, professional, and family aspects of quality of life, and up to 30% of women of reproductive age are affected by AUB. Advances in treatment options have increased access to treatment for many women affected by AUB as well as reduced the incidence of benign hysterectomy. Studies focusing on clinical decision-making for patients with AUB have not been updated to include new technologies and techniques for management, and this study was designed to capture the complex beliefs, perceptions, and concerns surrounding current treatment for AUB. This was a qualitative study that used an interview process for data collection, either in-person or over the phone. Inclusion criteria were women with a self-reported diagnosis of chronic AUB who were premenopausal, above the age of 40, and offered a variety of treatment options. Exclusion criteria were a gynecologic malignancy. Interviews were conducted in either English (19 people) or Spanish (6) according to participant preference. Study materials were created in English and translated into Spanish and subsequently verified by a certified translator. The interviews focused on experiences while seeking care, treatment expectations, interactions with providers, community beliefs, the value of the uterus, views of the medical community, and side effects and safety concerns surrounding treatment. A total of 25 interviews were included in this study, conducted between January 2023 and March 2024. Of the 25 participants, 28% identified as black and 24% identified as Hispanic. The treatment choices they had chosen included hysterectomy (11 patients), medical management (8 patients), endometrial ablation (1 patient), and undecided treatment (5 patients). There were 4 main themes identified: long delays to getting diagnosis and treatment, hormones as unnatural and dangerous, fears and misconceptions about surgery, and reconciling personal priorities with available treatments. Many felt dismissed by providers and were thus discouraged from returning or seeking other care. Other barriers reported by patients included lack of insurance coverage, limited finances, and inability to find a specialist provider. Several also reported being offered limited options, with more than one stating that they were not offered hysterectomy at all. Some patients experienced relief with hormonal treatments, though beliefs and success surrounding them varied widely; several had strong negative feelings about putting something in their bodies or taking medications. Many had negative associations with surgery, which presented a barrier to pursuing hysterectomy for patients who would prefer it to hormonal treatment. Others appreciated the option for minimally invasive surgical options and anticipated relief. Overall, decision-making for many patients was a blend of personal experience, community values, culture, and individual beliefs. (Summarized from Wentzel KE, Rubin SC, Coots C, et al. “I feel chained right now”: A qualitative study exploring treatment decision-making among individuals with abnormal uterine bleeding. J Minim Invasive Gynecol . 2026;33:196-204.e2. doi: 10.1016/j.jmig.2025.10.002).