Heavy menstrual bleeding

Heavy menstrual bleeding (HMB) is a common presentation in primary care that affects the quality of life of the patient. The definition of HMB, or ‘menorrhagia’, has changed in order to consider people’s self-assessment of blood loss rather than the amount of blood loss. HMB is very common and can affect 20–50% of people who menstruate at some stage during their reproductive years. The World Health Organization reports that 18 million people aged 30–55 years perceive their menstrual bleeding to be excessive. Most patients can be managed in primary care by having a logical approach to the causes and management, but some require referral to secondary care. This article will discuss the causes and management in primary care.