Heavy menstrual bleeding

Abstract

Heavy menstrual bleeding (HMB) is one of the most common reasons for primary care consultations by women of reproductive age. The condition is associated with a reduction in health-related quality of life and substantial utilisation of health service resources. There are several underlying causes of HMB, which are generally benign in nature and can exist in isolation or in combination. The majority of women presenting with HMB can be managed in primary care, either expectantly or using effective medical treatments. Referral to secondary care should be restricted to refractory cases, where surgical or radiological interventions may be indicated and where pre-malignant or malignant uterine disease is suspected. This article will explore the nature of HMB, the terminology that should be used to describe menstrual disorders and the aetiology of HMB. Diagnostic work-up and clinical management, encompassing treatment in primary care and indications for referral to secondary care based on national clinical guidance, will also be discussed.