Heavy Menstrual Bleeding

Definition

Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with a woman's physical, social, emotional, and/or material quality of life, typically exceeding 80 mL per cycle or lasting more than 7 days.

Epidemiology

• Affects 10–30% of women of reproductive age globally.
• More common in women aged 30–49 years.
• Prevalence may be underreported due to subjective perception of blood loss.
• HMB is a leading cause of iron deficiency anemia in women.
• Risk factors: fibroids, adenomyosis, coagulopathies, hormonal disorders, and anticoagulant use.

Etiology

• Structural causes: uterine fibroids, polyps, adenomyosis, malignancy.
• Non-structural causes: ovulatory dysfunction, coagulopathies (e.g., von Willebrand disease), endometrial disorders, iatrogenic (anticoagulants, IUD).
• Hormonal imbalance leading to anovulatory cycles.
• Inflammatory or systemic conditions affecting endometrial hemostasis.
• Idiopathic in some cases (primary endometrial disorder).

Pathophysiology

• Excessive endometrial proliferation and impaired hemostasis lead to increased menstrual blood loss.
• Hormonal dysregulation (estrogen-progesterone imbalance) affects endometrial shedding.
• Structural lesions (fibroids, polyps) disrupt normal endometrial architecture and vasculature.
• Coagulopathies reduce clotting efficiency during menses.
• Inflammatory mediators and angiogenic factors contribute to abnormal bleeding.