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Menstrual

Heavy menstrual bleeding (HMB)

Excessive menstrual blood loss interfering with quality of life.

1. Clinical overview & diagnosis

HMB is excessive menstrual blood loss interfering with quality of life. It is a clinical diagnosis based on the woman's own assessment (RANZCOG).

Red flags for urgent referral

  • • Postcoital or intermenstrual bleeding — investigate for pathology
  • • Rapidly enlarging uterus
  • • Anaemia with haemodynamic compromise

2. Patient diagnostic pathway

  1. 1History — Cycle length/regularity, flooding/clots, impact on life, associated pain, pressure symptoms.
  2. 2Examination — Abdominal and pelvic exam, speculum, assess for fibroids/masses.
  3. 3Investigations — Full blood count and ferritin (all patients); cervical screening if due; transvaginal ultrasound to assess for structural causes; consider endometrial sampling if risk factors for endometrial pathology (age >45, persistent IMB, failed treatment).

3. Treatment & management plan

First-line — Levonorgestrel IUD (Mirena) is most effective medical therapy; alternatives include tranexamic acid, NSAIDs, or combined OCP.

Second-line — Consider endometrial ablation or surgical management for structural causes or failed medical therapy.

  • • Treat iron deficiency.

4. Patient pathway & referral

When & where to refer

  • • Structural pathology
  • • Failed medical management
  • • Where surgical options are considered
  • • Provide patient education on treatment options and iron replacement

Clinical decision support only. Not a substitute for independent clinical judgement. HerPath informs, it does not replace the treating practitioner.