Heavy menstrual bleeding

Heavy menstrual bleeding is defined as excessive menstrual blood loss which interferes with the woman's physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms. In the majority of cases, an accurate history may indicate the cause of the bleeding. Common investigations include haematological blood tests, ultrasound scan and endometrial biopsy. Management may be medical or surgical, depending on the patient's age, pathology identified and fertility wishes. All interventions should aim to improve quality of life rather than focussing on menstrual blood loss alone. This review considers the intricacies involved when managing women with heavy menstrual bleeding.