Heavy menstrual bleeding (HMB) is one of the most common gynaecological problems the world over, and up to 3 out of 10 visits to the gynaecologist are due to this condition.¹ The National Institute for Health and Care Excellence in the United Kingdom defines HMB as excessive menstrual blood loss that interferes with a woman’s physical, emotional, social and material quality of life. This can occur alone or in combination with other symptoms and with a menstrual blood loss of >80 ml per cycle.^1,2

One of the most common causes of HMB is the inability of the uterus to contract properly. The muscles of the uterus do not contract well when large benign growths such as fibroids or polyps get in the way. Adhesions in the uterus and inflammations in the uterus or in the fallopian tubes are also common causes of HMB.³ Moreover, HMB may be indicative of underlying uterine pathology, and it is also known to increase susceptibility to iron deficiency. A full gynaecological evaluation, including pelvic examination, transvaginal ultrasound and/or histological sampling of the endometrium, is recommended.² 

HMB can be identified by a need to change tampons or pads every one to two hours; weakness, tiredness and sluggishness during the period; and large clumps of blood in the menstrual flow.³ It is common for women with HMB to feel exhausted while coping with the demands of everyday life and work. Even social activities and hobbies that are usually enjoyable can become a burden.³ Having to change tampons or pads several times during the night can affect sleep.³ It has a significant impact on the physical, psychosocial, professional and familial aspects of a woman’s life and results in decreased work productivity, which contributes to the overall economic burden.^1,2

The treatment options to help reduce bleeding vary from medications to surgery. Hormonal contraceptives such as birth control pills and intrauterine devices (IUDs) can also help in the management of HMB.²

References:

1. Sriprasert I, Pakrashi T, Kimble T, Archer DF. Heavy menstrual bleeding diagnosis and medical management. Contracept Reprod Med. 2017;2:20.
2. Davies J, Kadir RA. Heavy menstrual bleeding: an update on management. Thromb Res. 2017;151 Suppl 1:S70–
3. Heavy periods: overview. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG). 2006.