Heavy menstrual blood loss (HMB) is a medically recognized condition. But heavy is of course a subjective concept. Therefore: in this article we describe 7 symptoms by which you can recognize HMB. Plus we give you an overview of possible treatment options.

Heavy menstrual blood loss

Heavy menstrual blood loss (HMB) is a common gynecological problem. Changes in the hormonal balance are often the cause. This explains why many women experience it during premenopause. As many as 1 in 5 women between the ages of 35 and 55 have symptoms so severe that medical treatment would be justified. Yet it often takes years before women go to their family doctor; if they do so at all. The corona crisis may further encourage procrastination. This results in unnecessary health risks. HMB (also called menorrhagia) can be caused by other conditions such as endometriosis, adenomyosis, PCOS, gynecological cancer, infection or a coagulation disorder. What do you recognize HMB from?

What are the symptoms of HMB?

1. Abnormal blood loss.

The most important symptom of HMB is of course abnormal blood loss. On average, you lose about 5 tablespoons of blood per menstruation; slightly more than a shot glass. If HMB is involved, this is easily three quarters of a long drink glass or more. Officially, gynecologists maintain a threshold value of 120 ml.

2. Blood clots

Menstrual blood contains plasmin, an enzyme that breaks down blood clots. Sometimes, however, clots form along with the menstrual blood. This happens to almost every woman at some time. If large blood clots or clots the size of a bottle cap or five-cent coin are standard with every menstruation, HMB may be involved.

3. Severe menstrual discomfort

Heavy menstrual blood loss is often accompanied by painful menstruation or severe menstrual cramps caused by the contraction of the uterus. PMS symptoms are also common. The term PMS stands for premenstrual syndrome and is the collective name for a wide range of physical and psychological symptoms that occur just before menstruation, such as heart palpitations, headaches, abdominal pain, swollen breasts, fluid retention, feelings of anxiety, irritability, crying spells and nervousness.

4. Short cycle & prolonged menstruation

Almost no one has a menstrual cycle of exactly 28 days. Anything between 21 and 35 days is considered normal. Of these, between 3 and 7 days are associated with blood loss. Characteristic of HMB is a cycle duration shorter than 21 days and menstrual duration longer than 7 days.

5. Frequent leaks

With a normal menstruation, one menstrual product (sanitary towel/tampon) that is changed every 4-5 hours is enough. Women with HMB often need double protection and may need to go to the bathroom every hour and/or get out of bed at night to prevent leakage. Sudden heavy menstrual periods and spotting (light blood loss between periods) due to hormonal changes are also characteristic of HMB. Women with HMB are therefore always apprehensive about leakage.

6. Fatigue due to iron deficiency

Heavy blood loss during menstruation often causes iron deficiency (anemia). As a result, complaints may arise such as lethargy, dizziness, blotches, mood swings and fatigue. If the hemoglobin level is too low, the resistance is reduced. This in turn can lead to sickness absence, for example.

7. Planning the agenda around menstruation

Heavy menstrual blood loss has a negative impact on quality of life: physically (fatigue due to iron deficiency), psychologically (fear of leaking, embarrassment) and socially (have to cancel sports classes and social appointments or work absences). As soon as menstrual problems start to determine the agenda, it is “code red”. In other words: time to discuss possible treatment options with the family doctor and/or ask for a referral to a gynecologist.

Tip: In preparation for the consultation, keep a menstrual diary for a while – or use a special app for this – so you can see how menstrual complaints affect daily functioning.

What are the treatment options for HMB?

1. Hormone therapy

In case of heavy blood loss, hormone therapy, such as the contraceptive pill, the Mirena IUD, or Keleena IUD, is often prescribed in the first instance. Hormonal drugs containing estrogen and/or progesterone (progestin) can thin the endometrium and thus reduce heavy blood loss. Hormone therapy is a temporary solution; once you stop it, the heavy periods return. Hormone therapy is not a solution for all women.

2. Removal of fibroids or polyps

Myomas and polyps can cause heavy menstrual bleeding. These benign growths in the uterus can be removed using a minimally invasive procedure (for example, MyoSure); outpatient and under local anesthesia. Myomas or polyps can be removed if there is no pregnancy or underlying problem, such as a pelvic infection and/or abnormalities of the cervix or uterine (neck) cancer. The treatment does not interfere with a future pregnancy.

3. Endometrial ablation

For premenopausal women without underlying medical problems causing HMB symptoms, endometrial ablation (e.g., NovaSure) is an option. In this treatment, the functional layer of the endometrium (uterine lining) is scorched with electrical energy. The endometrium is then unable to rebuild thickly resulting in little or no blood loss.Endometrial (endometrium) ablation (removal) can be performed on an outpatient basis and under local anesthesia. With an endometrial ablation, the hormonal system continues to function normally. Thus, you do not enter the menopause early. Although the uterus is preserved, becoming pregnant after endometrial ablation carries significant risks. Therefore, this treatment can only be performed if there is no longer a desire to have children. Contraception remains necessary until menopause.

4. Uterine removal

In some cases, a uterine removal (hysterectomy) is the only solution to cope with gynecological problems. A uterus removal is a major surgery that – if the ovaries are also removed – will put you immediately into menopause. Hospitalization is required and the recovery period is several weeks. After a uterus removal, of course, you cannot become pregnant again.

More information or an appointment?

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Sources: SHE. Health Clinics, Period! Magazine, Paula Kragten