Association of Non-Working Status and Low Socioeconomic Status with AUB
The available evidence does not demonstrate a direct association between non-working status or low socioeconomic status and the development or prevalence of abnormal uterine bleeding itself; however, these socioeconomic factors create significant barriers to accessing care and receiving appropriate treatment for AUB.
Impact on Treatment Access and Decisions
Key Finding on Socioeconomic Barriers
The most relevant study examining socioeconomic factors in AUB management found that insurance status was NOT independently associated with receiving surgical versus medical treatment or with receiving any treatment at all in a population serving mostly underinsured patients 1. This suggests that within safety-net healthcare systems, insurance type does not create disparities in treatment decisions 1.
However, this finding must be interpreted cautiously:
- The study population was already limited to underinsured patients in a residents' clinic, potentially masking broader socioeconomic disparities 1
- The analysis did not specifically examine employment status as a variable 1
Barriers to Seeking Care
Low socioeconomic status creates substantial barriers to women even seeking consultation for AUB symptoms, which is a more critical issue than treatment disparities once care is accessed 2. The barriers identified include:
- Health literacy deficits: Women from lower socioeconomic backgrounds have reduced understanding of normal menstrual patterns and lack access to appropriate health information 2
- Healthcare provider accessibility: Lack of accessible and trusted female general practitioners disproportionately affects women of lower socioeconomic status 2
- Prioritization patterns: Women in lower socioeconomic situations tend to prioritize others' needs over their own health concerns 2
Treatment Implications When Care Is Accessed
Once women with AUB access care, the evidence shows:
- Age and race/ethnicity—not insurance or BMI—were the primary determinants of treatment type received 1
- Women ages 41-60 were 4.8 times more likely to receive surgical treatment compared to younger women 1
- Women of "Other" race/ethnicity were 80.8% less likely than Black/African American patients to receive surgery 1
Clinical Approach for Patients with Low Socioeconomic Status
Prioritize First-Line Medical Management
For patients with limited resources or employment constraints, hormonal treatments should be the initial approach as they:
- Demonstrate significant effectiveness with improved outcomes (OR = 2.15, p < 0.001) 3
- Reduce anemia prevalence 3
- Require less time away from work compared to surgical interventions
- Are more cost-effective than surgical procedures
Specific Treatment Algorithm
Start with combined oral contraceptive pills as first-line therapy for most patients with AUB 3. For patients who cannot tolerate or have contraindications to oral contraceptives:
- Levonorgestrel-releasing intrauterine system (LNG-IUS) is highly effective and commonly leads to amenorrhea 4
- Follow with tranexamic acid or desmopressin as second-line options 4
- Consider combination therapy (tranexamic acid plus desmopressin) for refractory cases 4
Common Pitfalls to Avoid
- Do not assume that lack of insurance automatically predicts poor treatment access in safety-net settings, as the evidence shows treatment decisions may be equitable within these systems 1
- Recognize that the primary barrier is getting patients to seek care initially, not necessarily the treatment they receive once engaged 2
- Account for age and BMI as significant predictors of treatment response (age OR = 0.95, p = 0.015; BMI OR = 1.10, p = 0.005) when counseling patients about expected outcomes 3
Addressing Socioeconomic Barriers Proactively
- Improve health literacy through targeted education about normal versus abnormal menstrual patterns for women in lower socioeconomic groups 2
- Facilitate access to female healthcare providers when possible, as this improves care-seeking behavior 2
- Emphasize medical management options that minimize work disruption and out-of-pocket costs for non-working or economically disadvantaged patients 3, 4