Heavy Menstrual Bleeding (HMB)


Heavy Menstrual Bleeding, also known as menorrhagia, is a common condition affecting many women during their reproductive years. It is characterized by abnormally heavy or prolonged menstrual bleeding that can interfere with daily activities and overall quality of life.

What is Heavy Menstrual Bleeding?

Heavy menstrual bleeding is defined as losing 80 milliliters or more of blood during each menstrual cycle, or having a period that lasts longer than seven days. It’s important to distinguish HMB from normal variations in menstrual cycles, as it can be a sign of underlying health issues.

Causes of Heavy Menstrual Bleeding

Heavy menstrual bleeding can result from a variety of causes:

  • Hormonal Imbalance: Particularly imbalances in estrogen and progesterone, which regulate the menstrual cycle.
  • Uterine Fibroids and Polyps: Benign growths in or on the uterine wall can cause increased bleeding.
  • Endometriosis: Endometrial tissue grows outside the uterus, leading to painful periods and excessive bleeding.
  • Adenomyosis: The inner lining of the uterus breaks through the muscle wall of the uterus.
  • Inherited Bleeding Disorders: Such as von Willebrand disease which affects blood clotting.
  • Medication: Certain medications, including anti-inflammatory drugs and anticoagulants, can contribute to heavy bleeding.
  • Pelvic Inflammatory Disease (PID): An infection of the reproductive organs can cause irregular bleeding.
  • Other Medical Conditions: Including thyroid problems, endometrial cancer, and certain systemic disorders.


  • Soaking through one or more sanitary pads or tampons every hour for several consecutive hours.
  • Needing to use double sanitary protection to manage menstrual flow.
  • Needing to wake up to change sanitary protection during the night.
  • Bleeding for longer than a week.
  • Passing large blood clots.
  • Symptoms of anemia, such as tiredness, fatigue, or shortness of breath.

Diagnosing Heavy Menstrual Bleeding

Accurate diagnosis is essential for effective treatment. Diagnosis may involve:

  • Medical History: Discussing symptoms, menstrual cycles, and medical history.
  • Physical Examination: Including a pelvic exam.
  • Blood Tests: To check for anemia and other potential underlying conditions.
  • Ultrasound: To visualize the uterus, ovaries, and pelvis.
  • Endometrial Biopsy: Taking a sample of the uterine lining to rule out cancerous conditions.
  • Hysteroscopy: Using a camera to examine the inside of the uterus.

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Treatment Options for Heavy Menstrual Bleeding


Endometrial Abalation

If you have persistent heavy periods, your Gynaecologist may recommend Endometrial ablation.


This procedure involves the removal of the uterus and provides a permanent solution to menstrual issues.
Mirena Coil Insertion

Mirena Coil

It effectively reduces bleeding and offers reliable contraception for up to five years.

Frequently Asked Questions

What is considered heavy menstrual bleeding?

Heavy menstrual bleeding, or menorrhagia, is defined as losing 80 milliliters or more of blood during each menstrual cycle, or menstruating for longer than seven days. Common indicators include soaking through pads or tampons every hour for several consecutive hours and needing to change menstrual products during the night.

What causes heavy menstrual bleeding?

HMB can be caused by a variety of factors including hormonal imbalances, uterine fibroids, polyps, adenomyosis, inherited bleeding disorders, and certain medications. Underlying health conditions like thyroid problems or clotting disorders can also contribute to excessive bleeding.

When should I see a doctor about heavy menstrual bleeding?

You should consult a healthcare provider if your menstrual bleeding is heavy enough to interfere with your daily life, if you feel fatigued or show signs of anemia (such as shortness of breath or severe tiredness), or if you suddenly begin experiencing heavy menstrual bleeding after regular cycles.

How is heavy menstrual bleeding diagnosed?

Diagnosis typically involves a review of your medical history, a physical examination, and may include blood tests to check for anemia and other possible conditions. Additional tests such as a pelvic ultrasound, pap test, or biopsy may be recommended depending on your individual symptoms.

What are the treatment options for heavy menstrual bleeding?

Treatment varies based on the underlying cause and includes medications such as hormonal therapies like birth control pills or IUDs (e.g., Mirena), and non-hormonal medications like tranexamic acid to reduce bleeding. Surgical procedures such as endometrial ablation or removal of fibroids and polyps may be necessary for severe cases. Lifestyle changes like dietary adjustments and regular physical activity can also help manage symptoms.

Can heavy menstrual bleeding be prevented?

While not all causes of heavy menstrual bleeding can be prevented, managing underlying conditions and maintaining a healthy lifestyle can help reduce the risk. Regular check-ups with your gynaecologist are also important for early detection and treatment of any abnormalities.

Is heavy menstrual bleeding a sign of cancer?

In most cases, heavy menstrual bleeding is not due to cancer. However, postmenopausal bleeding can be a warning sign of endometrial cancer. Any sudden changes in menstrual patterns, especially with additional symptoms like pelvic pain or unintended weight loss, should be evaluated by a doctor.

Can lifestyle changes help manage heavy menstrual bleeding?

Yes, certain lifestyle changes can help manage symptoms of HMB. These include maintaining a balanced diet rich in iron to help prevent anemia, regular exercise to improve overall health, and managing stress which can sometimes exacerbate menstrual symptoms.

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