ABSTRACT
Heavy menstrual bleeding (HMB) is a subjective symptom which hampers a woman’s physical, emotional, social, and material quality of life. HMB is an important symptom of many well-defined conditions, which may or may not be associated with irregular cycles. An excess of menstrual loss in women without evidence of pathology is sometimes called abnormal uterine bleeding, or unexplained HMB. During puberty, HMB can occur as a result of hypo-function of the anterior pituitary body, with consequent failure of ovulation, and therefore no corpus luteum is formed. HMB can be associated with fibroids, adenomyosis, pelvic infection, endometrial polyps, endometriosis, and the presence of an intrauterine contraceptive device. Chronic pelvic infection and ovarian endometriosis both give rise to HMB as a result of inflammation, but dysmenorrhoea, pelvic pain, dyspareunia, and backache are usually more prominent symptoms. Leiomyomas may cause a mixture of HMB and intermenstrual spotting. The irregular bleeding tends to occur when they are submucous.
