The bigger picture

Heavy menstrual bleeding, defined as excessive menstrual blood loss which interferes with a woman’s quality of life, is one of the most common reasons for gynaecological consultations in both primary and secondary care settings. 

The impact of the condition is now much more widely recognised, and the focus of management should be on improving quality of life rather than focusing solely on blood loss.

An underlying cause of heavy menstrual bleeding is identified in around half of women seeking help.

Some of the more common causes include fibroids (non-cancerous growths in or around the womb), endometriosis (womb lining found outside the uterus, such as in the ovaries and fallopian tubes), adenomyosis (womb lining tissue becoming embedded in the uterine wall), pelvic inflammatory disease (an infection in the upper genital tract), polyps (non-cancerous growths in the lining of the womb or cervix) and polycystic ovary syndrome. 

Blood clotting disorders, an underactive thyroid gland, diabetes and cancer can also cause heavy menstrual bleeding, as can having an intrauterine device, taking anticoagulant medication, some chemotherapy agents, and some herbal supplements such as ginseng and ginkgo.