For most women, periods are a natural part of life and femininity. However, some women experience a heavier menstrual flow monthly, which can greatly impact their lifestyles. Medically, this is known as Heavy Menstrual Bleeding. In fact, about one-third of women are affected by Heavy Menstrual Bleeding (HMB) at some point in their lives. 

What is HMB?
Clinically, HMB is defined as excessive menstrual blood loss, which interferes with a woman’s physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms.

The classic definition of HMB is regular menstrual blood loss exceeding 80 ml per month during a menstruation of normal length (5 to 7 days). That is equivalent to more than 5 tablespoons of blood loss! If you need more than five pads or tampons per day, or need to change your pad or tampon more frequently than every two hours, you might be suffering from HMB.

Take the following survey to find out if you have symptoms of HMB. If you find yourself answering “yes” to many of the questions, you might be suffering from HMB. However, it is strongly recommended that you consult your doctor for an accurate diagnosis.

What causes HMB?

Hormonal imbalance
During a normal menstrual cycle, there is a balance between two hormones, estrogen and progesterone. Part of this process is to regulate the development of the endometrium, the lining of the womb that is shed each month during menstruation. An imbalance between these two natural hormones can result in heavy menstrual bleeding. Young women and women nearing menopause are at higher risk of hormonal imbalance.

Infections of the womb or cervix can cause abnormally heavy menstrual bleeding.

Organic abnormalities of the womb
Endometriosis: A benign but sometimes very painful, chronic disease where endometrial tissue is found outside of the womb in the abdomen
– Uterine fibroids: Non-cancerous tumours that grow in the womb
– Polyps: Soft, small growths on the lining of the womb

Some types of medication such as anticoagulants (that inhibit blood clotting) and anti-inflammatory medication can lead to heavy or prolonged menstrual bleeding.

Other diseases
There are some other fairly rare causes for heavy menstrual bleeding, which include:
– High blood pressure
– Diseases of the heart or the kidneys
– Adnexitis (infection of the Fallopian tubes or the ovaries)
– Thyroid disease

Some women have no obvious organic findings, so it is important to talk to your doctor about your signs and symptoms.

How can you treat HMB?

Hormonal preparations
You can opt for an intrauterine system (IUS) to be placed in the uterus. This releases a small amount of hormone, which helps to suppress the lining of the uterus and hence the heavy bleeding. It also offers contraception protection and is effective for up to five years.

Alternatively, oral contraceptive pills also suppress the lining of the uterus. Bleeding is therefore shorter, lighter and less painful during periods. It, too, offers protection from pregnancy when taken correctly.

You can take non-steroidal anti-inflammatory drugs that prevent inflammation and relieve pain. There is some evidence to show that they are effective in reducing heavy periods. Antifibrinolytics also help blood to clot and reduce bleeding. 

Surgical options include endometrial ablation, in which the lining of the uterine cavity is removed. However, this may adversely affect future fertility. You can also opt for a hysterectomy, in which the uterus and sometimes ovaries are removed. This will also result in permanent sterility.

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