Factors affecting health-related quality of life in women with and without abnormal uterine bleeding: an unmatched case-control study.

The present study is an unmatched case-control study with a 1:2 ratio. This study was conducted among women attending the gynecology clinic of 29 Bahman Hospital in Tabriz, Iran, from April to September 2024. This hospital is one of the most important gynecology and obstetrics hospitals in the city and, due to its insurance coverage, is also considered a referral center for patients. The inclusion criteria for the case group were: 1- married women aged 18 to 49 years, 2- being literate, 3- experiencing abnormal bleeding problems for at least two months or more, 4- absence of sexual problems in the husband according to the woman’s self-report, and 5- not being pregnant. The control group was selected from individuals accompanying patients to the clinic. These individuals met all the inclusion criteria for the case group except for having abnormal uterine bleeding. The exclusion criterion for both groups was unwillingness to complete the questionnaire and not completing more than 10% of the questionnaire questions. In this study, 6 questionnaires from the control group were excluded because more than 10% of the questions, particularly key were not answered. In other cases, if there were incomplete answers to questions, the average score of the variable in question was substituted. Based on the report by Mariappen et al. 26 regarding the mean (standard deviation) of the emotional and psychological dimension of quality of life in two groups, those with menstrual problems (59.08, 20.61 and those without problems (healthy) (65.98, 20.79, the sample size was calculated using the following formula. Considering a confidence level of 95%, 80% statistical power, and a 5% margin of error, a sample size of 141 individuals was calculated for each group. Finally, considering a ratio of 1:2, the sample size for the control group was determined to be 282 individuals. Sampling was done using a convenience sampling method, and sampling continued until the calculated sample size for each group was reached. \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\:n=\frac{{\left({z}_{1-\raisebox{1ex}{$\alpha\:$}\!\left/\:\!\raisebox{-1ex}{$2$}\right.}+{z}_{1-\beta\:}\right)}^{2}\left({s}_{1}^{2}+{s}_{2}^{2}\right)}{{({\overline{x}}_{1}-{\overline{x}}_{2})}^{2}}$$\end{document} After obtaining the necessary ethical code and permissions, the researcher was present at the gynecology clinic for sampling. After ensuring that potential participants met the study’s inclusion criteria, the study’s objectives were explained to the women. With informed consent, questionnaires were provided for self-reporting. If any difficulties or questions arose during the completion of the questionnaires, the researcher provided the necessary guidance. Women in the control group were selected from among companions or those visiting the clinic for other reasons, and they also completed the questionnaires after giving informed consent. In this study, the following four questionnaires were used to collect data: This included information on age, education, occupation of the women, number of pregnancies, menstrual status, and the nature of bleeding complaints. Ware et al. designed the Short-Form Health Survey (SF-12) 27 . It is a shortened form of the SF-36 Health Survey (SF-36) 28 , which is a widely used instrument for assessing patient-reported general health conditions/ Health-Related Quality of Life. The instrument is categorized into eight health domains to evaluate physical and mental health, each including six items. Physical health scales include general health (1 item), physical functioning (2 items), role physical (2 items), and bodily pain (1 item). Mental health domains include vitality (1 item), social functioning (1 item), role emotional (2 items), and mental health (2 items). Scores for items range from 1 to 6. To enable comparison of the study results in different cultures, we used US population-derived SF-12 norms, which consider a mean value of 50 and a standard deviation value of 10 29 . Scores on this questionnaire range from 0 to 100, and higher scores indicate a better self-perceived health status. Montazeri et al. have evaluated the validity and reliability of this questionnaire in Iran 30 . Developed by Symonds et al. (2013) to evaluate the main dimensions of women’s sexual function 31 . It can distinguish women with sexual dysfunction from those with normal sexual function. This scale consists of 18 items and assesses sexual function over the past four weeks. The questionnaire is divided into four main sections: sexual psychosexual feelings (7 questions), satisfaction with sexual relationship and activity (5 questions with reverse scoring), feelings of worthlessness (3 questions), and sexual suppression (3 questions). Each item is scored on a 6-point Likert scale (strongly agree to strongly disagree), ranging from 1 to 6, with a total score between 18 and 108, where a higher score indicates a better quality of life. The reliability of the tool has been reported as acceptable in various samples (Cronbach’s alpha 0.82 and above, and a coefficient of 0.79 for the questionnaire dimensions). In the research by Ma’soumi et al. (2013), internal consistency for the total score and dimensions of the questionnaire in both healthy women and those with sexual dysfunction was reported above 0.7. The validity of this tool was confirmed by distinguishing normal women from those with sexual dysfunction, and confirmatory factor analysis results showed an appropriate fit (RMSEA = 0.07) for the five-factor model of the questionnaire 32 . The standardized Female Sexual Distress Scale, designed by Derogatis et al. for evaluating distress related to sexual issues, is a screening tool with 13 items that measure personal distress associated with sexual problems. It uses a five-point Likert scale format: “Never = 0,” “Rarely = 1,” “Occasionally = 2,” “Frequently = 3,” and “Always = 4.” In Iran, Qasemi reported Cronbach’s alpha coefficients of 0.94 and reliability coefficients of 0.89. This questionnaire has been validated in Iran by Qasemi and colleagues 33 . The research findings were analyzed statistically using SPSS version 24. For descriptive statistics, means and standard deviations were used for quantitative variables, and frequencies and percentages for qualitative variables. In inferential statistics, the test was used to check for normality. Although the data exhibited mild skewness (|skewness| < 1), they were deemed approximately normal, as |skewness| < 0.5 and |kurtosis − 3| < 1, supplemented by visual inspections and formal normality tests (Kolmogorov-Smirnov test). To compare demographic characteristics between the two groups, ANOVA, Fisher’s exact test, and Chi-square tests were used. Post hoc Tukey tests were used for pairwise comparisons between groups. The comparison of mean scores for the main study variables (sexual quality of life, sexual distress, and health-quality of life) between the two groups was performed using an independent t-test. Pearson’s correlation test was employed to report the correlation between. Finally, three regression models were developed to examine the predictors of health-related quality of life (the dependent variable). In Model 1, the independent variables (FSDS, Total Score of SQOL-F, and Group) were analyzed using univariate regression to assess their respective effects on health-related quality of life. In Model 2, all independent variables were entered simultaneously using the ENTER method to evaluate their collective impact. In Model 3, both the independent variables and demographic variables significantly associated with the health-related quality of life were included to identify key predictors. To evaluate multicollinearity among the independent variables in the multiple regression model, we employed the Variance Inflation Factor (VIF) and Tolerance indices. The results indicated that all VIF values were below 3, suggesting the absence of substantial multicollinearity. Statistical significance was defined as P-values less than 0.05, and a confidence interval was considered 95%, and all hypothesis tests were 2-sided.

A total of 423 women participated in this study (282 women without abnormal uterine bleeding and 141 women with abnormal uterine bleeding). The average age of the women was 34.58 (SD = 7.28), and the majority (77.7%) had a high school diploma or higher education, with 69.7% being homemakers. The age of women in the two groups, healthy and with abnormal bleeding, was significantly different (35.77 vs. 33.98, respectively, [ P  = 0.017]). The majority of women in both groups were in the 30–39 age group. Most participants in both the case and control groups were multiparous (70.2% vs. 65.7%), had a high school diploma or higher education (74.8% vs. 73.5% respectively), and were homemakers (66.3% vs. 76.9%). Significant differences were observed between the two groups for these variables (Table  1 ). The average health-related quality of life score differed significantly across different age groups, with scores decreasing with increasing age. Individuals with higher education had higher health-related quality of life scores; those with primary education scored lower than the other three groups. The score was higher in employed individuals compared to homemakers, but the difference was not statistically significant (65.57 vs. 64.55). No statistically significant difference in health-quality of life scores was observed between nulliparous and multiparous women. Individuals experiencing both irregular periods and heavy bleeding had a lower health-quality of life score (51.82) compared to other groups who experienced only one of these issues (irregular periods or heavy bleeding) or had no menstrual problems. Furthermore, the health-related quality of life score was higher in individuals with a normal menstrual cycle length (21–40 days) compared to the other two groups (68.43), and it decreased with increasing menstrual cycle length. Those with a menstrual cycle length of more than ten days had the lowest average score (44.30) (Table  1 ). Table 1 Demographic and obstetrics characteristics and their relationship with the health-related quality of life in two groups. Variable All n  = 423 Cases ( n  = 141) Controls ( n  = 282) P -value P -value Quality of life Women’s Age (years) n (%) 0.017 < 0.001  20–29 109 (25.8) 37 (26.2) 72 (25.5)  30–39 203 (48.0) 60 (42.6) 143 (50.7)  ≥ 40 111 (26.2) 44 (31.2) 67 (23.8) Women’s educational status n (%) < 0.001 < 0.001  Primary school 12 (2.8) 11 (7.8) 1 (0.4)  Secondary school 95 (22.5) 25 (17.7) 70 (24.8)  Diploma 115 (27.2) 53 (37.6) 62 (22.0)  University 201 (47.5) 52 (36.9) 149 (52.8) Women ’s employment status n (%) 0.029 0.607  Housewife 290 (69.7) 103 (76.9) 187 (66.3)  Employed 126 (30.3) 31 (23.1) 95 (33.7) Birth order n (%) 0.025 0.792  1 138 (32.6) 42 (29.8) 96 (34.0)  2 205 (48.5) 62 (44.0) 143 (50.7)  ≥ 3 80 (18.9) 37 (26.2) 43 (15.2) Compliant n (%) < 0.001 < 0.001  Heavy menstrual bleeding 41 (9.7) 41 (29.1) 0 (0) I rregular cycles 62 (14.7) 62 (44.0) 0 (0)  Booth of them 38 (9.0) 38 (27.0) 0 (0)  None 282 (66.7) 0(0) 282 (100.0) Duration of periods (days) n (%)  10 20 (4.7) 20 (14.2) 0 (0) Length of cycles (days) n (%) < 0.001 < 0.001   41 39 (9.2) 12 (8.5) 27 (9.6) a ANOVA, b chi-square, c Fisher exact test. Demographic and obstetrics characteristics and their relationship with the health-related quality of life in two groups. a ANOVA, b chi-square, c Fisher exact test. Data analysis showed that the mean total score for health-related quality of life was higher in healthy women compared to women with abnormal bleeding, and this difference was statistically significant [69.45 (SD = 17.75) vs. 56.26 (SD = 16.82), P  < 0.001]. Similarly, comparing the total sexual quality of life score in the two groups indicated that the total score for this variable was significantly higher in healthy women compared to women with irregular uterine bleeding [78.10 (SD = 15.02) vs. 65.14 (SD = 16.98), P  < 0.001]. Finally, comparing the mean sexual distress score between the two groups showed that sexual distress was significantly higher in women with irregular uterine bleeding compared to the control group [27.80 (SD = 10.31) vs. 25.20 (SD = 7.82), P  = 0.004] (Table  2 ). Table 2 Comparison of the total main variable scores in two groups. Variable All n  = 423 Min-Max Cases ( n  = 141) Mean (SD) Controls ( n  = 282) Mean (SD) P -Value a Effect size (Cohen’s d) Total score of health-related quality of life 65.04 (18.50) 22.22–100 56.26 (16.82) 69.45 (17.75) < 0.001 0.756 FSDS 26.07 (8.80) 13–60 27.80 (10.31) 25.20 (7.82) < 0.001 -0.298 Total Score of SQOL-F 76.43 (15.94) 38–108 73.18 (17.23) 78.10 (15.02) 0.004 0.312 a t-test, * statistically significant. Comparison of the total main variable scores in two groups. a t-test, * statistically significant. The results of the Pearson correlation test showed a statistically significant and inverse relationship between sexual distress and sexual quality of life ( r = -0.689, p  < 0.001, medium effect). An inverse and significant relationship was also observed between sexual distress and health-related quality of life ( r = -0.390, p  = 0.001, medium effect). Finally, a significant and positive relationship was found between sexual quality of life and health-related quality of life ( r  = 0.383, p  = 0.001, medium effect) (Table  3 ). Table 3 The relationship between the main variables in women with and without AUB. Variable FSDS Total Score of SQOL-F All Women with AUB Women without AUB All Women with AUB Women without AUB r P -Value r P -Value r P -Value r P -Value r P -Value r P -Value The total score quality of life -0.390 < 0.001 -0.200 0.018 -0.480 < 0.001 0.383 < 0.001 0.270 0.001 0.408 < 0.001 FSDS 1 - 1 - 1 - -0.689 < 0.001 -0.692 < 0.001 -0.679 < 0.001 Total Score of SQOL-F -0.689 < 0.001 -0.692 < 0.001 -0.679 < 0.001 1 - 1 - 1 - The relationship between the main variables in women with and without AUB. Table  4 presents the results of the univariate and multivariate regression analysis. According to Model 1, using univariate regression analysis, there was a statistically significant relationship between the independent variables (sexual distress, sexual quality of life, and having or not having irregular uterine bleeding) and quality of life. Each of these variables alone could predict 15%, 14.5%, and 11.1% of the variance in quality of life, respectively. Specifically, with an increase of one standard deviation in the scores of the mentioned independent variables, quality of life increased by 0.457 and 0.385 standard deviations, respectively. Multivariate regression analysis in Model 2 indicated that 25.6% of the variance in the quality-of-life variable could be explained by the three independent variables (sexual distress, sexual quality of life, and having or not having abnormal bleeding) (R²adj = 0.246, P  < 0.001). All three independent variables had a significant relationship with health-related quality of life, with the irregular uterine bleeding status variable having the greatest impact on quality of life (β = 0.278, P  < 0.001). Finally, in Model 3, after entering all variables into the regression model using the Enter method, the results showed that 29.7% of the variance in quality of life could be explained by the five variables entered into the model (R²adj = 0.297, P  < 0.001). All variables had a significant relationship with health-related quality of life, with group status and sexual distress having the greatest impact on quality of life. Not having irregular uterine bleeding increased quality of life (β = 0.275, P  < 0.001), and increased sexual distress decreased quality of life (β = -0.227, P  = 0.033). The health-related quality of life decreased with increasing age. Conversely, it significantly increased with higher levels of education and sexual quality of life (Table  4 ). Table 4 Predictors of health-related quality of life based on univariate and multiple linear regression. Predictors Model summary B S. E β 95%CI R R 2 R 2 adj P -Value F Model 1 FSDS 0.390 0.152 0.150 < 0.001 75.151 -0.818 0.094 -0.390 -1.003 to -0.632 Total score of SQOL-F 0.383 0.147 0.145 < 0.001 72.164 0.445 0.052 0.383 0.342 to 0.548 Group 0.337 0.113 0.111 < 0.001 53.642 13.190 1.801 0.337 9.650 to 16.729 Model 2 0.502 0.252 0.246 < 0.001 46.890 FSDS < 0.001 -0.461 0.123 -0.219 -0.703 to -0.219 Total Score of SQOL-F 0.001 0.221 0.068 0.190 0.087 to 0.355 Group < 0.001 10.891 1.679 0.278 7.591 to 14.191 Model 3 0.552 0.305 0.297 < 0.001 36.522 FSDS < 0.001 -0.477 0.119 -0.227 -0.711 to -0.243 Total Score of SQOL-F 0.002 0.211 0.067 0.181 0.080 to 0.342 Group < 0.001 10.791 1.640 0.275 7.568 to 14.015 woman’s age < 0.001 -0.457 0.105 -0.180 -0.664 to -0.250 Women’s educational status 0.001 -2.983 0.872 -0.142 -4.698 to -1.268 Predictors of health-related quality of life based on univariate and multiple linear regression.

Attention to quality of life and sexual issues and problems constitutes an important part of women’s care, as today the treatment of a disease cannot be limited solely to specific clinical dimensions. The treatment of diseases such as abnormal uterine bleeding has various dimensions, so it is natural and necessary that, alongside clinical issues, attention should also be paid to the sexual and general, and mental health aspects of such issues. Therapists should identify the personal threatening aspects that the patient has faced. Also, providing unconditional support will undoubtedly be one of the most important steps towards increasing the quality of life in such patients. Ultimately, these results highlight the importance of assessing health-related quality of life and sexual issues and problems when evaluating women with abnormal uterine bleeding, and improving the patient’s overall quality of life by considering its various aspects should be taken into account.

Abnormal and irregular uterine bleeding is a common symptom in women of reproductive age, and accurate diagnosis and provision of the most appropriate treatment, considering the impact of the condition on women’s health, well-being, and quality of life, is essential 34 , 35 . In this study, we evaluated the quality of life and its associated factors in two groups of women with and without uterine bleeding. Our study showed that health-related quality of life is affected by the presence of abnormal uterine bleeding, sexual quality of life, sexual distress, education, and age of the women. The results indicated that abnormal uterine bleeding, in addition to health-related quality of life, has a significant impact on sexual life and sexual distress in women. Firstly, our investigations showed that sexual distress and sexual quality of life scores differ in women with and without abnormal uterine bleeding, and a moderate inverse correlation was observed between these two variables. Researchers in a study conducted in Turkey reached similar results 22 , which indicated that women with menstrual irregularities had low sexual quality of life, and 64.5% of them were not satisfied with their marital adjustment. In a study by Dundon et al. (2010) 36 , it was reported that women with amenorrhea reported more sexual problems. Furthermore, another study by Ertunc et al. (2009) 37 , which examined the impact of fibroids and their effects on sexual function, reported that the level of sexual satisfaction in women with fibroids was lower than in women without fibroids. According to other researchers, menstrual status has a significant impact on women’s sexual function, such that women with regular menstruation have less sexual dysfunction compared to those with irregular menstruation 38 . Therefore, women may perceive changes in their menstrual function as a threat to their sexual identity 22 . In the study by Soylu and Nazik, when women’s menstrual characteristics were compared with the SQOL-F score, it was found that with a decrease in the duration and amount of menstrual bleeding, the average SQOL-F score increased. Similarly, in the study by Laughlin-Tommaso et al. (2015) 39 , by evaluating the sexual function of women with fibroids, it was found that women were not satisfied with their sexual experiences during periods of heavy and prolonged menstrual bleeding and experienced more problems (pain, decreased libido, etc.). Abnormal uterine bleeding can have negative effects on women’s sexual relationships. Women experiencing abnormal bleeding usually experience higher levels of anxiety and worry about sexual intercourse 40 . This can lead to a decrease in libido and relationship satisfaction, and ultimately can lead to limitations in sexual activity 41 . Women may avoid intercourse due to fear of bleeding during the act. It seems that hormonal and physical changes resulting from abnormal bleeding can negatively affect women’s body image and self-esteem 42 . Therefore, seeking necessary care, undergoing appropriate evaluations, and receiving treatment are essential. Early diagnosis and proper treatment can help improve sexual quality of life and reduce sexual distress 36 , 43 . In general, it can be said that paying attention to the sexual and mental health of women with abnormal uterine bleeding, alongside proper diagnosis and treatment, can significantly contribute to improving their overall sexual and health-related quality of life. Another important finding of our study indicates that the total health-related quality of life score differs significantly between women with and without abnormal uterine bleeding, with the score being lower in women with irregular uterine bleeding. Researchers also emphasize the significant reduction in quality-of-life scores in patients experiencing AUB 44 – 46 . In particular, other researchers have reported that women with bleeding related to uterine fibroids had significantly lower quality of life compared to women without fibroids 47 . In another study has been reported that over 80% of women had a constellation of physical and psychological sequelae, including pelvic pain, sleep disturbances, mood dysregulation, diarrhea, and nausea. These symptoms not only precipitated severe disruptions to academic performance and daily functioning but also precipitated a discernible decrement in overall quality of life (QoL), particularly among those afflicted with DM relative to unaffected peers 48 . Furthermore, it has been found that women with menorrhagia usually have mood changes/fatigue, general malaise 49 , and numerous physical complaints, and fear of cancer is also common among women with irregular bleeding 50 , 51 , which can negatively impact their quality of life. It has been reported that 100% of women presenting with bleeding wanted to make sure cancer was not the cause. In addition, although the risk of recurrent bleeding from benign conditions is over 25%, most women prefer immediate treatment for benign lesions 51 . In a report by researchers, women aged 40 to 45 years in their study experienced heavy menstrual bleeding at a rate of 32%, and these women had significantly worse quality of life 44 . AUB can affect overall health status and health-related quality of life (HRQOL), and its consequences, which can include iron deficiency anemia, chronic fatigue, or accompanying conditions such as pelvic pain, can further jeopardize women’s quality of life 20 , 44 , 52 . According to researchers, providing appropriate treatments for the underlying cause, such as endometriosis, fibroids, and polyps, which are commonly associated with irregular bleeding, can lead to improved HRQoL scores 5 , 53 . Ultimately, what was obtained from the results and based on the regression models presented in this study, the findings showed that irregular bleeding directly and significantly negatively affects women’s health-related quality of life. This effect is observable in all three models presented in the study and indicates that abnormal uterine bleeding is a significant factor in reducing women’s health-related quality of life. The roles of sexual distress and sexual quality of life also act as mediators that amplify the impact of irregular bleeding on health-related quality of life. That is, having irregular bleeding leads to increased sexual distress and decreased sexual quality of life, and ultimately, these factors affect the reduction of health-related quality of life. The impact of irregular and abnormal bleeding on sexual health has been less reported. However, it has been reported that in women in their late reproductive years who suffer from abnormal bleeding, their sexual function scores are significantly reduced [94], which is consistent with the results of our study. Another finding of the present study was that demographic variables, such as age and education level of women, also affect the quality of life. For example, increasing age or decreasing education level may be associated with a decrease in health-related quality of life. Women’s age affects health-related quality of life in both healthy women and those with abnormal uterine bleeding. This effect occurs for several reasons: abnormal uterine bleeding is more common at certain ages. It can be said that with increasing age, the likelihood of hormonal problems in women increases. However, in early reproductive years and near menopause, instability of the hypothalamic-pituitary-ovarian axis can lead to abnormal bleeding. In older women, the risk of endometrial cancer increases. Also, age-related hormonal changes with increasing age and decreased progesterone production, estrogen levels increase, which can lead to hormonal imbalance and bleeding. These factors indicate that women’s age can have a significant impact on health-related quality of life in both healthy women and those with abnormal uterine bleeding, but this effect may be more severe in the group with abnormal uterine bleeding. To improve the quality of life of women with abnormal menstrual bleeding, several different measures can be taken. For example, providing counseling, education, and awareness to women about the menstrual cycle, causes of abnormal bleeding, and how to manage the condition can help them. Furthermore, careful investigation and diagnosis of the causes of abnormal bleeding and providing appropriate treatments, including medication and lifestyle recommendations (proper nutrition and adequate physical activity), are of major importance. In addition, counseling on the use of stress management techniques such as yoga and meditation can help women relax and improve their quality of life. Also, creating support groups and communication with other women who have had similar experiences, and sharing and exchanging experiences can reduce problems and overall lead to improved perception of social support. Despite the substantive contributions of this study, certain limitations warrant acknowledgment. Principally, the unmatched case-control framework and convenience sampling may engender selection bias, thereby curtailing the applicability of results to diverse populations of women with abnormal uterine bleeding (AUB). To address this, forthcoming investigations should adopt matched designs and probabilistic sampling to augment external validity. Moreover, the quantitative methodology, although enabling systematic analysis of focal variables, circumvents intricate explorations of subjective experiences; accordingly, qualitative approaches are urged to delineate the psychosocial underpinnings of general health and sexual quality of life (QoL) in this cohort. Reliance on self-administered questionnaires, while expedient, invites vulnerabilities such as recall errors, social desirability distortions, and inter-respondent variability, which could erode estimate reliability. Finally, notwithstanding the exclusion of spousal sexual dysfunction based on self-reports, subclinical female sexual dysfunction spanning arousal, lubrication, or satisfaction persists as a potential unmeasured confounder that may distort the AUB-QoL linkages. This highlights the need for prospective studies integrating clinical evaluations or female-specific sexual function scales to validate these findings. To improve the quality of life of women with abnormal menstrual bleeding, several evidence-based clinical and practical measures can be implemented. Clinically, routine screening for sexual distress using validated tools like the SQOL-F should be integrated into AUB evaluations to enable timely interventions, such as hormonal therapies or cognitive-behavioral counseling, which can alleviate symptoms and restore sexual function. Practically, healthcare providers should prioritize patient education on menstrual management, lifestyle modifications (e.g., nutrition and exercise), and stress reduction techniques like yoga, while fostering support groups to bolster psychosocial resilience. These strategies not only address immediate AUB-related impairments but also promote long-term family health outcomes by enhancing women’s overall well-being.

Abnormal uterine bleeding (AUB) is one of the most common reasons for women of reproductive age to seek outpatient medical care 1 , 2 . Statistics indicate that nearly one-third of outpatient visits by women are due to this complaint 3 – 5 . Women’s issues can be categorized into two main types of menstrual abnormalities: heavy menstrual bleeding (HMB) and irregular menstrual bleeding, with many patients experiencing a combination of these symptoms 6 . A wide range of causes, including hormonal and systemic diseases, localized conditions, and unexplained reasons, can lead to abnormal uterine bleeding 5 , 7 . It is estimated that menstrual disorders, such as irregular menstrual cycles, affect 10 to 38% of women’s menstrual periods 8 , 9 . The prevalence of irregular uterine bleeding is highest around the menopausal years, with over 90% of women experiencing at least one episode of abnormal bleeding around menopause, and 78% reporting at least three episodes during this period 5 , 9 . Throughout a woman’s life, menstruation is a physiological phenomenon. Women often view menstruation as a significant aspect of their femininity, considering it a symbol of reproductive capability and sexual identity. Therefore, any changes might be perceived as a threat to their sexual identity, and these changes can have profound effects on their lives 1 , 10 . Uterine bleeding that is excessive in duration, frequency, or amount can hurt a woman’s psychological well-being as well as her physical, emotional, and social functioning 6 , 11 , 12 . Iron deficiency anemia is the most common consequence of this disorder 7 , 13 , 14 , which adversely affects the quality of life by interfering with physical health 15 – 17 . According to reports, women with heavy menstrual bleeding may experience widespread effects on their lives, including missed work or social activities (affecting up to 50% of those reporting HMB), educational disruptions, and reduced participation in daily routines 16 , 18 . Irregular menstrual bleeding is similarly linked to diminished quality of life 19 – 21 . Sexual function is a key domain influenced by physiological, psychological, and socio-cultural factors, often compromised, potentially straining marital relationships 9 , 22 , 23 . While existing research has established these broad impacts of AUB on health-related quality of life (QoL), significant uncertainties persist regarding its specific effects on sexual QoL and associated distress, particularly in women with irregular uterine bleeding, a subgroup where hormonal fluctuations may exacerbate intimacy-related challenges 24 , 25 . Few studies have isolated these outcomes in this population, leaving a critical gap in understanding how AUB disrupts sexual well-being beyond health QoL metrics. This omission matters clinically, as unaddressed sexual distress can perpetuate cycles of emotional isolation, relational discord, and delayed treatment-seeking, ultimately undermining holistic patient care. To address this unmet need, the present study innovatively evaluates general health QoL, sexual QoL, and sexual distress in women with irregular uterine bleeding using validated, multidimensional tools. We hypothesize that these women will report significantly lower sexual QoL and higher distress levels compared to controls without AUB, independent of anemia status. By filling this gap, our findings aim to inform targeted interventions that integrate sexual health into AUB management, enhancing patient-centered outcomes in reproductive medicine.