Menstruation is a woman’s monthly bleeding from her reproductive tract induced by hormonal changes of the menstrual cycle. The length of a menstrual cycle is the time from the start of a period to the start or the next.
Beliefs derived from personal experience and cultural, social and educational inﬂuences determine whether she perceives the menstrual blood loss to be ‘normal’ for her. However. a ‘normal’ quantity of monthly blood loss (MBL) can be defined objectiver for the whole population.
Due to difﬁculties in determining when a menstrual period begins (e.g. spotting, brown/pink discharge, continuous prolonged bleed). it is often difﬁcult to differentiate between a menstrual period and an intermenstrual bleed (IMB). In the main, the aetiopathology and treatment of IMB differs from heavy menstrual bleeding (HMB).
Heavy menstrual bleeding (HMB) is clinically defined as menstrual blood loss (MBL) that is subjectively considered to be excessive by the woman and interferes with her physical, emotional, social and material quality of life.
Subjective assessment of MBL combines information of sanitary protection usage, ﬂooding, clots, duration of menstruation and the woman’s personal opinion of her menstrual loss. Although this tends to be inaccurate, it is easy to undertake in clinical practice and is the preferred method of assessing HMB.
Between 40—60% of women with HMB have no uterine, endocrine, haematological or infective pathology on investigation. These women were formerly termed to have dysfunctional uterine bleeding (DUB) of ovulatory (regular cycle) or anovulatory (irregular cycle) type.
Pathological causes of HMB include uterine ﬁbroids (20—30%), uterine polyps (5—10%), adenomyosis (5%): endometriosis rarely presents as AUB, but is identified in < 5% of cases of AUB.
Gynaecological malignancy rarely presents as HMB, but can present as prolonged intermenstrual bleeding (IMB), postcoital bleeding (PCB), postmenopausal bleeding (PMB) and as a pelvic mass.