The prevalence and burden of heavy menstrual bleeding, and market access barriers of medical interventions with a focus on low- and middle-income countries: a scoping review

Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that negatively affects physical, emotional, social, and quality of life (QoL) of women at reproductive age. The aim of this systematic scoping review was to map and summarize the available evidence on the prevalence, burden, treatment, and barriers to accessing treatment for HMB in low- and middle-income countries (LMICs). We conducted a review of published data in nine databases and included studies published from 1 January 2000 to 28 October 2024. Covidence was used for screening and data extraction. We identified 376 eligible studies conducted in 46 countries. Most of the studies (300, 80%) reported on the treatment of HMB (including 9 studies on treatment and burden), 55 reported on prevalence, 19 reported on burden (including 12 studies on burden and prevalence) and two studies reported on barriers to providing treatment. A total of 55 systematic reviews were included. Prevalence of HMB ranged from 5% to 58%, using a variety of diagnostic and reporting methods. Burdens of HMB included impaired QoL, mental health issues, economic burdens, and health concerns such as anemia. The use of a hormonal intrauterine device was the most commonly reported treatment for HMB (n = 120), followed by progestin (n = 41), combined oral contraceptives (n = 36), gonadotrophin-releasing hormone (n = 31), and tranexamic acid (n = 23). Thirty studies focused on herbal treatment. Lack of knowledge and misunderstanding of treatment options for HMB were mentioned as barriers for HMB treatment. The prevalence of HMB and the variety of treatment options available indicate that HMB is a condition that should not be underestimated and has a large impact on women’s health and well-being. There is a need for reliable, good-quality studies on the prevalence, burden, and treatment access barriers of HMB, especially in LMICs where HMB more often leads to iron deficiency anaemia.