Heavy menstrual bleeding (HMB) is a significant yet often overlooked issue affecting women at various stages of life. It can manifest during puberty due to ovulatory dysfunction (puberty menorrhagia), or later in life during reproductive years due to conditions like fibroids, adenomyosis, endometriosis, or polyps caused by estrogen dominance. Pregnancy complications may also contribute to heavy bleeding. 

Dr. Rashmi Shriya, HOD of Laparoscopic Gynaecology at MASSH (Minimal Access Smart Surgery Hospital), shares insights on this issue, stating: “Heavy bleeding may also occur in premenopausal women due to endometrial dysfunction or in postmenopausal women as postmenopausal bleeding, which can be alarming and possibly linked to uterine or cervical cancer.” 

To properly evaluate HMB, it’s important to gather a detailed history, perform clinical examinations, and run necessary blood tests and imaging.  

Key Indicators of Heavy Menstrual Bleeding (HMB) 

Heavy bleeding can be subjective, so doctors may ask these questions to determine if HMB is present: 

– Does the bleeding disrupt daily activities or significantly affect quality of life? 

– Are periods lasting more than seven days? 

– Is the menstrual flow heavy enough to require frequent changes of tampons or pads? 

– Are clots larger than a coin size present? 

– Is there a need to use two forms of sanitary protection simultaneously? 

– Does heavy bleeding cause waking up at night? 

– Is it necessary to change tampons or pads every hour? 

– Does the individual feel constantly exhausted or fatigued? 

If the answer to any of these questions is yes, the person may be experiencing HMB. On average, women lose 30–40 milliliters of blood during menstruation, but those with HMB can lose up to 80 milliliters or more per month. 

Understanding the Causes and Diagnosis 

To treat HMB effectively, identifying the root cause is crucial. Whether the bleeding is acute or chronic, the patient’s history is vital. Factors such as pregnancy, medication use (like anticoagulants), or bleeding disorders (such as von Willebrand disease or Hemophilia) can contribute to HMB. Associated symptoms may include gum bleeding or bruising.  

Diagnosing HMB may involve running blood tests, ultrasounds, MRIs, or performing a hysteroscopy to determine the underlying cause and establish a treatment plan. 

Heavy Menstrual Bleeding: Treatment Options 

Once the cause is identified, treatment can range from conservative or medical management to surgical procedures. A hysterectomy is the most common gynecological procedure for managing HMB caused by fibroids, endometriosis, endometrial hyperplasia, or preinvasive cancer. However, alternatives to hysterectomy (HALT—Hysterectomy Alternatives Less Talked About) exist, and treatment is often tailored based on age, reproductive history, and patient preferences. Options include myomectomy, endometrial resection, polypectomy, Mirena (a medicated IUD), or laparoscopic hysterectomy (minimally invasive surgery). 

Breaking the Silence Around HMB 

By raising awareness, sharing information, and encouraging open discussions, we can reduce the stigma surrounding heavy menstrual bleeding and ensure that women receive the necessary support and treatment to manage this condition effectively.