Blood loss that interferes with physical, social, emotional, or material aspect of a woman's life

Aetiology

Causes of heavy menstrual bleeding

• Fibroids (20-30%)
  • Benign smooth muscle tumours of the uterus
• Polyps (5-10%)
• Adenomyosis (5%)
  • Non-neoplastic endometrial glands and stroma in the myometrium
  • Associated with hyperplasia and hypertrophy of the surrounding myometrium
• Coagulopathy
  • Most common is von Willebrand disease
  • May be caused by medication
  • Referral to haematology required
• Malignancy

Risk factors

• The two main risk factors for heavy menstrual bleeding are age (more likely at menarche and approaching the menopause), and obesity
• There are also other risk factors that relate to the specific causes of HMB e.g. previous caesarean section as a risk factor for adenomyosis

Clinical features

Symptoms

• Bleeding during menstruation deemed to be excessive for the individual woman
• Fatigue
• Shortness of breath (if associated anaemia)

Signs

• Pallor (anaemia)
• Palpable uterus or pelvic mass
  • Try to ascertain if the uterus is smooth or irregular (fibroids)
  • A tender uterus or cervical excitation point toward adenomyosis/endometriosis
• Inflamed cervix/cervical polyp/cervical tumour