title: How I manage heavy menstrual bleeding.
abstract: Heavy menstrual bleeding (HMB) is a common clinical problem; population-based studies estimate that approximately 10-35% of women report this symptom during their lifetime, while about 5% of women consult a physician for evaluation of HMB. Patients with HMB account for 15% of all referrals to gynaecologists and are frequently seen by haematologists in bleeding disorder clinics as well. Heavy menstrual bleeding can be caused by a wide variety of local and systemic factors, so a careful clinical and laboratory evaluation is often necessary to determine the aetiology and guide appropriate management. This review discusses the definition, causes and clinical outcomes of HMB. It outlines a diagnostic approach and focuses on medical (as opposed to surgical) treatments. Throughout, areas of controversy and opportunities for further research are highlighted.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Canada.
authors.forename: Menaka
authors.initials: M
authors.lastname: Pai
authors.forename: Anthony
authors.initials: A
authors.lastname: Chan
authors.forename: Ronald
authors.initials: R
authors.lastname: Barr
mesh_terms: D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D008796:Metrorrhagia / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*
keywords: bleeding disorders; consultative haematology; heavy menstrual bleeding; iron deficiency; women's health