title: The experience of heavy menstrual bleeding: a systematic review and meta-ethnography of qualitative studies.
abstract: OBJECTIVE
  This paper is a report of a systematic review and meta-ethnography of the experience of heavy menstrual bleeding.
  
  
  BACKGROUND
  Heavy menstrual bleeding is common. Not all women seeking help have heavy menstrual bleeding as measured objectively and, conversely, some who do have this problem do not seek help.
  
  
  METHODS
  Seven electronic databases were searched in 2004 and updated in 2008, and supplemented with hand-searching.
  
  
  METHODS
  We identified four papers describing qualitative research among women with heavy menstrual bleeding. Key themes and concepts were extracted and synthesised using meta-ethnography, the key process of which is translation, identifying similar or contradictory findings in primary research. In the updated search three papers were identified.
  
  
  RESULTS
  Three papers were largely descriptive. These provided support for the fourth paper's conceptual framework of a lay model of heavy menstrual bleeding which shows little overlap with the traditional clinical definition. Details of physical, practical and emotional elements of this model were identified. A matrix of uncertainties were identified suggesting reasons why women may or may not seek medical help for heavy menstrual bleeding. Women and healthcare professionals may conspire to privilege blood loss over other symptoms and the disease model of heavy menstrual bleeding is little help to either. Two papers from the updated search were also largely descriptive. The third interpreted key elements of the lay model as relating to the need for concealment demanded by 'menstrual etiquette'.
  
  
  CONCLUSIONS
  A lay model of heavy menstrual bleeding is proposed, detailing key physical, social and emotional impacts that women find problematic.
authors.affiliation: PenTAG, Peninsula Medical School, Exeter, UK. R.Garside@exeter.ac.uk
authors.forename: Ruth
authors.initials: R
authors.lastname: Garside
authors.forename: Nicky
authors.initials: N
authors.lastname: Britten
authors.forename: Ken
authors.initials: K
authors.lastname: Stein
mesh_terms: D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000523:psychology*; D008598:Menstruation / Q000502:physiology / Q000523:psychology*; D036301:Qualitative Research; D011788:Quality of Life