High costs and transfusions linked to acute heavy menstrual bleeding

Red blood cell transfusion and treatment cost are significantly increased by acute heavy menstrual bleeding, according to a recent study published in The Lancet Obstetrics, Gynecology, & Women’s Health.¹

One in 4 reproductive-aged women are impacted by heavy menstrual bleeding, significantly affecting patient productivity, wellbeing, and quality of life.² Cases requiring emergency treatment unrelated to pregnancy, trauma, malignancy, or postpartum hemorrhage are considered acute.¹

“Furthermore, the true incidence of this common health issue is poorly reported due to variation in diagnostic criteria and reporting codes across different health-care settings,” wrote investigators.

Transfusion and cost assessment

The multi-center, retrospective, observational study was conducted to evaluate costs and rates of red blood cell transfusion among women admitted to the National Health Service (NHS) for acute heavy menstrual bleeding. Women aged 18 to 51 years with menstrual period and no amenorrhea for more than 12 months were included in the analyses.

Participants were admitted for heavy menstrual bleeding and received at least 1 unit of red blood cell transmission across 6 months between January 1, 2024, and June 30, 2024. Those receiving blood transfusions for other causes such as elective or emergency surgery were excluded from the analysis.

Published data on teaching hospitals was assessed to identify acute gynecology units in the NHS. Virtual training and onboarding were provided to all unit investigators to ensure familiarity.

Admission characteristics

Weekly admission logs and blood bank transfusion records were screened for heavy menstrual bleeding cases, with electronic and paper-based notes screened for relevant data. The number of red blood cell units transferred per women was reported as the primary outcome.

Covariates included ethnicity, year of birth, transfusion of other blood products, number of admission days, changes in hemoglobin concentrations, initial management plan, known heavy menstrual bleeding causes, proposed management plan at discharge, cost of care per admission, and cost of proposed management at discharge.

There were 1332 patients with 1386 admission episodes included in the analysis, 4% of which were readmission episodes for the same patient. An average of 14.3 admissions per emergency gynecology unit were reported across 6 months, with a median patient age of 42 years at admission. Of patients, 38% were White, 26% Asian, and 21% Black.

Transfusion patterns and hemoglobin trends

A mean 2.2 red blood cell units were transferred per admission episode, with 3025 transferred overall. Additional blood products were given to 1% of patients, and a negative correlation was reported between hemoglobin on admission and the number of red blood cell units transferred. Post-transfusion hemoglobin was not linked to the number of units transferred.

Tranexamic acid was the most common treatment used, administered in 62% of cases, while gonadotropin-releasing hormone analogues were used in 11% and surgical procedures in 6%. A ferrous sulphate prescription was given to 76% of patients at discharge.

A mean cost of £2972 was reported for admission, with a cost of £1735 per admission for the proposed management at discharge. When only evaluating initial admissions, the mean costs were £2930 and £1722, respectively. Factors associated with increased costs included age over 35 years and White ethnicity.

Implications

with acute heavy menstrual bleeding in the NHS. Investigators recommended additional research to assess management of irregular and heavy menstrual bleeding patients.

“Robust, community-based early interventions could reduce the health burden and costassociated with acute heavy menstrual bleeding,” wrote investigators.

References

1. Jiat The J, Hunjan T, Bordea E, Wattar BHA. Blood transfusion and management of acute heavy menstrual bleeding (BROWNIE): a retrospective and observational cost analysis service evaluation. The Lancet Obstetrics, Gynecology, & Women’s Health. 2025. doi:10.1016/j.lanogw.2025.09.017
2. Cox SM, Cromwell D, Mahmood T, et al. The delivery of heavy menstrual bleeding services in England and Wales after publication of national guidelines: a survey of hospitals. BMC Health Serv Res. 2013;13:491.