How should menorrhagia be managed in people with bleeding disorders: A systematic review of the literature and thematic synthesis

ObjectivesTo determine how menorrhagia is managed in people with bleeding disorders. DesignA systematic review and thematic synthesis. Data sourcesPubMed, Medline, Scopus, Cochrane library, google scholar and CINAHL complete (via EBSCO). MethodsSearches were conducted on articles published from 1st January 2000 until 6th May 2024. Following deduplication, the titles and abstracts were screened for relevance. 244 primary studies were then assessed for eligibility based on inclusion and exclusion criteria. Studies were included if they were based on primary articles and focussed on people with inherited bleeding disorders and heavy menstrual bleeding. Included studies were appraised for risk of bias and quality assurance using the Newcastle Ottawa Scale, following which data was systematically coded to generate descriptive and analytical themes. ResultsWe identified 16 eligible articles of which 13 were included in a thematic synthesis. These included prospective and retrospective clinical studies, cross-sectional studies and randomised control trials encompassing over 893 participants. Thematic synthesis identified hormonal treatments, such as the levonorgestrel-releasing intrauterine system (LNG-IUS), to be largely effective in the symptom management of HMB in IBD and associated with improved quality of patient life. Treatment of HMB patients with LNG-IUS, followed by tranexamic acid (TA) or 1-deamino-8-d-arginine vasopressin (DDAVP), the trade name for desmopressin, commonly led to amenorrhea. Technological approaches to the management of HMB in IBD included the use of mobile technology to encourage treatment compliance. These management strategies led to an improvement in reported QoL by patients with IBD. This review had limitations including the exclusion of some articles that may have limited generalisability. The Medical Subject Heading (MeSH) terms used focussed on HMB as opposed to abnormal menstrual bleeding, potentially directing the identified recommendations for clinical practice. Based on the findings of this thematic review, the use of LNG-IUS as first line therapy for those with HMB, followed by the use of combination therapy such as TA and desmopressin, would be recommended. These measures should be adopted in both primary and secondary care settings. We identified the need to strengthen counselling and communication between specialists involved in the care of those with HMB and IBD, and the need to increase awareness of HMB in IBD through public and patient education. Data availability statementAll data presented is secondary to published studies and available within the public domain. RegistrationPROSPERO registration number: CRD42023452533 Key MessagesO_LIWhat is already known on this topic - Heavy menstrual bleeding (HMB) is often a symptom of inherited bleeding disorders (IBD) in females and can have a significant impact on the quality of life of an individual. C_LIO_LIWhat this study adds - A systematic review and thematic analysis of the currently available literature allowed the identification of best practise management options for patients with IBD and HMB. A thematic synthesis was used to identify best practice for IBD patient treatment and management of HMB, which will improve patient quality of life. C_LIO_LIHow this study might affect research, practice or policy - This study of existing literature and thematic synthesis has been used to provide recommendations to haematologists and gynaecologists to support evidence based best practise recommendations on how to treat patients with HMB consequent to IBDs. C_LI