Heavy menstrual bleeding (HMB) is a common and distressing condition that affects women of reproductive age and can lead to significant impairment of quality of life.

The diagnosis is made when a woman experiences excessive menstrual bleeding, which interferes with her physical, social, emotional, and/or material quality of life. The management of HMB involves the identification and treatment of an underlying cause, if present, and the use of medical or surgical interventions to reduce menstrual bleeding.

In this article, we discuss the prevention and management of HMB, with a focus on evidence-based strategies.

Causes of Heavy Menstrual Bleeding

Various factors contribute to the development of HMB in women. The most common causes include:.

Fibroids
Adenomyosis
Endometrial polyps
Endometriosis
Coagulation disorders
Thyroid disorders
Pregnancy complications

It is important to identify the underlying cause of HMB in order to direct appropriate treatment. In some cases, no underlying cause can be identified, and the management is focused on reducing the severity of bleeding.

Prevention of Heavy Menstrual Bleeding

There are several measures that women can take to prevent the development or aggravation of HMB:.

1. Maintain a Healthy Lifestyle

Eating a balanced diet, exercising regularly, and avoiding smoking and excessive alcohol consumption can help to maintain good health and reduce the risk of developing conditions that can lead to HMB, such as obesity and hypertension.

2. Use Hormonal Contraceptives

Hormonal contraceptives, such as the combined oral contraceptive pill, the progestogen-only pill, the contraceptive injection, or the hormonal intrauterine device (IUD), are effective in reducing menstrual bleeding.

They work by suppressing ovulation and thinning the endometrium, thereby reducing the amount of blood loss during menstruation.

3. Consider Tranexamic Acid

Tranexamic acid is an antifibrinolytic agent that reduces menstrual bleeding by inhibiting the breakdown of blood clots in the uterus.

It can be taken orally or applied topically to the vagina and has been shown to be effective in reducing the amount of blood loss during menstruation. It is, however, contraindicated in women with a history of thromboembolic disease.

4. Manage Underlying Medical Conditions

Medical conditions, such as thyroid disorders, coagulation disorders, and adenomyosis, can contribute to the development of HMB. The appropriate management of these conditions can help to reduce menstrual bleeding.

Management of Heavy Menstrual Bleeding

The management of HMB depends on various factors, including the severity of bleeding, the underlying cause, and the woman’s preferences and medical history. Some of the interventions that may be used to manage HMB include:.

1. Medications

Medical interventions, such as antifibrinolytic agents, nonsteroidal anti-inflammatory drugs (NSAIDs), and hormonal therapies (including combined oral contraceptive pills, progestogen-only pills, hormonal IUDs, and gonadotropin-releasing hormone analogues), can be used to manage HMB in women who do not have any contraindications to these treatments. The choice of medication depends on several factors, including the severity of bleeding, the underlying cause, and the woman’s medical history and preferences.

2. Surgery

Surgical interventions, such as endometrial ablation and hysterectomy, may be recommended for women with severe or persistent HMB who do not respond to medical treatments or for women who have completed their childbearing.

The appropriateness of surgery as a treatment option should be discussed with the woman, taking into account the potential risks and benefits of the procedure.

3. Management of Anemia

Women with HMB are at risk of developing iron-deficiency anemia due to the chronic blood loss. The management of anemia in these women includes oral or intravenous iron supplementation and, in severe cases, blood transfusions.

4. Lifestyle Modifications

Lifestyle modifications, such as increasing physical activity and maintaining a healthy diet, can help to reduce menstrual bleeding and improve overall health and well-being.

Conclusion

Heavy menstrual bleeding is a common condition that can have a significant impact on a woman’s quality of life.

The prevention and management of HMB requires a thorough evaluation of the underlying cause and the use of evidence-based interventions. Women with HMB should be encouraged to maintain a healthy lifestyle and consider the use of hormonal contraceptives, tranexamic acid, or other medical interventions as appropriate. Surgical interventions may be recommended in severe or persistent cases.

The management of anemia and lifestyle modifications should also be considered as part of the overall management plan.