How serious is Heavy Menstrual Bleeding (HMB)?

How serious is Heavy Menstrual Bleeding (HMB)?
HMB is one of the most common reasons for women seeking a gynecological consultation. Many times it is a sign of a more serious health problem that needs urgent treatment. This huge amount of blood loss can further lead to anemia, fatigue, breathing difficulties and heart problems.

What amount of bleeding is considered as “heavy”?

• Bleeding that lasts for more than 7 days or
• Bleeding that soaks through one or more tampons or pads every hour for several hours in a row or
• Needing to wear more than one pad at a time to control menstrual flow.
• Needing to change pads or tampons during the night or
• Menstrual flow with blood clots.

What are the causes of HMB?

• Fibroids and polyps
• Adenomyosis
• Irregular ovulation—polycystic ovary syndrome (PCOS) and hypothyroidism.
• Blood clotting disorders
• Drugs—Blood thinners, aspirin, copper intrauterine device (IUD)
• Cancer—endometrial cancer, cervical cancer.
• Other causes—Endometriosis, ectopic pregnancy, miscarriage, Pelvic inflammatory disease.

What tests and exams may be used to evaluate heavy menstrual bleeding?

• Physical exam
• Ultrasound exam
• Hysteroscopy
• Endometrial biopsy
• Sonohysterography
• Magnetic resonance imaging

What are the management options for heavy menstrual bleeding?

Medications often are tried first to treat heavy menstrual bleeding:

• Tranexamic acid.
• Nonsteroidal antiinflammatory drugs, such as ibuprofen.
• Hormonal birth control methods are useful in heavy bleeding caused by problems with ovulation, endometriosis, polycystic ovary syndrome, and fibroids.
• Hormone therapy can be helpful for heavy menstrual bleeding that occurs during perimenopause.
• Gonadotropin-releasing hormone (GnRH) agonists – they stop the bleeding and reduce the size of fibroids but their effect on fibroids is temporary. After stopping the drug, fibroids usually return to their original size.

If medication does not work, a surgical procedure may be needed:

• Hysteroscopy.
• Endometrial ablation that destroys the lining of the uterus.
• Uterine artery embolization (UAE) is used to treat fibroids.
• Myomectomy to remove fibroids without removing the uterus.
• Hysterectomy.