HMB, previously termed ‘Menorrhagia’ is heavy menstrual bleeding, defined as greater than 80ml of blood loss during menstruations and/or blood loss occurring over seven days or more. It can greatly interfere with quality of life and everyday activities.  

As it is hard to measure 80ml of blood loss, HMB may also be diagnosed if two or more of the following criteria are met:

·   Changing tampons/towels every two hours or less

·   Passing blood clots during your period (menses)

·   Using double protection (tampons and towels)

·   Flooding into clothes or bedding

Causes of HMB:

Heavy menstrual bleeding may be a genetic dysfunction and in lots of cases, the cause is unknown. However, HMB may be as a results of an underlying pathologies and so it is important to get it checked out by a medical professional.

Some causes include:

·      Endometriosis or adenomyosis due to the increased amount of uterine tissue that bleeds each month

·      Fibroids

·      It can be a symptom of other diseases such as diabetes, liver/kidney disease, cancer, coagulation disorders, STIs or hypothyroidism

·     It can happen as a result of chemotherapy treatment or anticoagulant treatment (which thin the blood so can cause more profuse bleeding)

·     It may be a side-effect of using the copper IUD

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A doctor should ask questions about the symptoms, your medical history and also ask you to keep a record of your period duration and symptoms. This can help them assess the impact it is having on every day life and identify anything that may be causing the HMB (50% of cases there is no underlying cause).

A doctor should also order a full blood count to screen for anaemia as around ⅔ of women suffering from menorrhagia have iron deficiency anaemia.

 If the symptoms described suggest an underlying cause for the HMB, a doctor is likely to suggest a more thorough physical examination. This may include a hysteroscopy, ultrasound or vaginal/cervical swabs.

They may also test for thyroid function and coagulation disorders using blood tests to identify the causes. 

They should not need to assess blood loss to diagnose heavy menstrual bleeding.
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How can you manage it (lifestyle factors)?

Make sure your diet includes lots of iron-rich food to decrease the likelihood of developing anaemia.

 Ensure to drink enough fluid before and during menstruation to minimise the likelihood of dehydration.

It is suggested using a cold compression on the abdomen can restrict the blood flow to the uterus during menstruation and potentially reduce the amount of blood loss. It can also help with pain and swelling.
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*How can you treat it? (Pharmacological)

Depending on the cause and the impact it is having on everyday life there are many different potential treatments.

Non-hormonal treatments include tranexamic acid to reduce the bleeding or non-steroidal anti-inflammatories to relieve stomach cramps and pains associated with the prolonged menstruation.

Hormonal contraception can also be used to stop periods completely or reduce the length of bleeding. An intrauterine system (IUS) can be inserted into the womb, this releases progestogen which prevents the lining of the womb growing so quickly and can completely stop or significantly lighten periods.

Endometrial ablation, which can use heat or ultrasound, may be used to destroy or thin the lining of the womb to prevent such heavy bleeding each month.

In some extreme cases when other treatment has failed a hysterectomy may be recommended to remove the uterus completely. Although of course this causes irreversible infertility. 

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*Disclaimer: Information and content from FitrWoman are intended as general information only and should not be substituted for medical advice, diagnosis or treatment.