Heavy menstrual bleeding (HMB), also called menorrhagia, is a common condition that can significantly affect your quality of life. This guide explains the condition, its causes, symptoms, treatments, and how to manage living with it.

What is Heavy Menstrual Bleeding?

Heavy menstrual bleeding refers to periods that are abnormally heavy or prolonged. While the amount of blood loss varies between individuals, HMB is generally defined as:

• Losing 80 millilitres or more of blood per period (equivalent to soaking through a pad or tampon every 1–2 hours).
• Bleeding that lasts longer than 7 days.
• Experiencing symptoms that interfere with daily activities, such as fatigue or difficulty concentrating.

HMB is not a disease itself but can be a symptom of an underlying health condition.

Key Facts About Heavy Menstrual Bleeding

Background

• HMB is one of the most common menstrual disorders, affecting millions of women worldwide.
• It can occur on its own or alongside other symptoms like painful periods (dysmenorrhoea) or irregular cycles.

Causes

HMB can have several causes, including:

• Structural Problems in the Uterus:
  • Fibroids: Non-cancerous growths in the uterus.
  • Polyps: Small growths on the lining of the uterus.

• Hormonal Imbalances:
  • Conditions like polycystic ovary syndrome (PCOS) or thyroid disorders can disrupt hormone levels and cause heavy bleeding.

• Bleeding Disorders:
  • Conditions like von Willebrand disease (a genetic bleeding disorder) can make blood clotting less effective.

• Endometrial Issues:
  • Endometriosis or adenomyosis can lead to abnormal uterine bleeding.

• Medications:
  • Certain medications, such as anticoagulants (blood thinners), may contribute to heavier periods.

In some cases, no clear cause is identified.

Incidence and Prevalence

1. HMB affects approximately 20–30% of women of reproductive age globally 1.
2. It is more common in women approaching menopause due to hormonal changes.

Who is Affected?

• Age of Onset: HMB can occur at any age after menstruation begins but is more common in women aged 30–50 years.
• Gender: Only females are affected by this condition due to its link with menstruation.
• Ethnicity: HMB occurs across all ethnic groups without significant differences in prevalence.

Geographic Distribution

• HMB occurs worldwide and does not show higher prevalence in specific regions.

How Does Heavy Menstrual Bleeding Impact You?

Symptoms and Effects on Daily Life

HMB can cause physical, emotional, and social challenges, including:

• Fatigue or low energy due to blood loss (anaemia).
• Pain during periods or between periods.
• Difficulty participating in work, school, or social activities due to heavy flow or discomfort.

Living With Heavy Menstrual Bleeding

Living with HMB often involves managing symptoms through lifestyle adjustments and medical care.

Expected Life Expectancy

HMB does not directly affect life expectancy but may lead to complications like anaemia if untreated.

Managing and Treating Heavy Menstrual Bleeding

Available Treatments

Treatment for HMB depends on its cause and severity but may include:

1. Medications:
   1. Non-steroidal anti-inflammatory drugs (NSAIDs): Reduce bleeding and relieve pain (e.g., ibuprofen).
   2. Hormonal Therapies: Regulate menstrual cycles and reduce bleeding:
      1. Combined oral contraceptives (birth control pills).
      2. Progestin-only options like oral tablets or intrauterine devices (IUDs). The levonorgestrel-releasing IUD is particularly effective for HMB.
   3. Tranexamic Acid: A medication that reduces blood loss by helping blood clot more effectively.
   4. Iron Supplements: For treating or preventing anaemia caused by heavy blood loss.
2. Surgical Options:
   1. Endometrial Ablation: A procedure to remove the lining of the uterus to reduce bleeding.
   2. Myomectomy: Removal of fibroids while preserving the uterus.
   3. Hysterectomy: Removal of the uterus; this is a permanent solution for severe cases where other treatments fail.
3. Lifestyle Adjustments:
   1. Keeping track of your menstrual cycle using a diary or app can help you identify patterns and discuss symptoms with your doctor.
   2. Using high-absorbency pads or tampons during heavy flow days may help manage bleeding.

Ongoing Clinical Research

Research into HMB continues to explore new treatments and better diagnostic tools :

1. Studies are investigating non-invasive therapies for fibroids and polyps that contribute to HMB.
2. Research into personalised hormonal therapies aims to improve symptom control while reducing side effects.
3. Advances in imaging techniques are helping doctors identify underlying causes more accurately.

For information on clinical trials related to HMB, visit clinicaltrials.gov.

Support Groups and Resources

If you have been diagnosed with heavy menstrual bleeding, connecting with support groups can provide valuable information and emotional support:

1. The Eve Appeal (eveappeal.org.uk) – Offers resources for gynaecological health issues, including heavy periods.
2. NHS Inform – Period Problems (nhsinform.scot) – Provides guidance on managing heavy menstrual bleeding.
3. Women’s Health Concern UK (womens-health-concern.org) – Offers advice on menstrual health issues.
4. Endometriosis UK (endometriosis-uk.org) – Provides support for women experiencing related conditions like endometriosis.

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Remember:

This information is intended for general knowledge and educational purposes only and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.

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