Abnormal uterine bleeding

Overview

Heavy menstrual bleeding is no longer defined by a volume threshold. FIGO's current definition is impact-based: excessive menstrual blood loss that interferes with the woman's quality of life, whatever the measured loss. This reframing matters — the woman's account drives diagnosis, and treatment success is judged by her life, not by a collection chart.^[4]

The condition is common and under-treated: prevalence estimates range from 5% to 58% across studies depending on definitions, and the burden includes impaired quality of life, mental health impact, economic cost and iron-deficiency anaemia. In one UK haemophilia-centre cohort of women with inherited bleeding disorders — a population at particular risk — four of every five experienced heavy menstrual bleeding.^[17][20]

Management follows a simple architecture: exclude pregnancy and cervical pathology always; classify the cause using PALM-COEIN; treat medically first unless structural disease dictates surgery; co-manage iron deficiency throughout.^[21]

References21ShowHide

1. [1]Munro MG, Critchley HOD, Fraser IS et al. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2018.PMID 30198563
2. [2]Munro MG, Critchley HO, Fraser IS et al. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertility and sterility, 2011.PMID 21496802
3. [3]Bofill Rodriguez M, Dias S, Jordan V et al. Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis. The Cochrane database of systematic reviews, 2022.PMID 35638592
4. [4]Bofill Rodriguez M, Lethaby A, Jordan V Progestogen-releasing intrauterine systems for heavy menstrual bleeding. The Cochrane database of systematic reviews, 2020.PMID 32529637
5. [5]Bofill Rodriguez M, Lethaby A, Farquhar C Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. The Cochrane database of systematic reviews, 2019.PMID 31535715
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8. [8]Bofill Rodriguez M, Lethaby A, Fergusson RJ Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. The Cochrane database of systematic reviews, 2021.PMID 33619722
9. [9]Bofill Rodriguez M, Lethaby A, Grigore M et al. Endometrial resection and ablation techniques for heavy menstrual bleeding. The Cochrane database of systematic reviews, 2019.PMID 30667064
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11. [11]Whitaker LHR, Middleton LJ, Daniels JP et al. Ulipristal acetate versus levonorgestrel-releasing intrauterine system for heavy menstrual bleeding (UCON): a randomised controlled phase III trial. EClinicalMedicine, 2023.PMID 37251622
12. [12]Oliveira JA, Eskandar K, Chagas J et al. Heavy menstrual bleeding in women with inherited bleeding disorders in use of LNG-IUS: A systematic review and single-arm meta-analysis. Contraception, 2024.PMID 38614274
13. [13]Gupta S, Castaman G, Funkhouser K et al. Call to action: identifying an underlying bleeding disorder in adolescents with heavy menstrual bleeding. Research and practice in thrombosis and haemostasis, 2026.PMID 42598146
14. [14]Dason ES, Maxim M, Sanders A et al. Guideline No. 437: Diagnosis and Management of Adenomyosis. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2023.PMID 37244746
15. [15]Christelle K, Norhayati MN, Jaafar SH Interventions to prevent or treat heavy menstrual bleeding or pain associated with intrauterine-device use. The Cochrane database of systematic reviews, 2022.PMID 36017945
16. [16]Al Wattar BH, Schofield S, Minns V et al. Quality of life measurement tools for heavy menstrual bleeding: A systematic review and critical appraisal. Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, 2025.PMID 40318577
17. [17]Ammerdorffer A, Ferrillo O, Mills K et al. The prevalence and burden of heavy menstrual bleeding, and market access barriers of medical interventions with a focus on low- and middle-income countries: a scoping review. BMC women's health, 2025.PMID 41318534
18. [18]Jaya-Bodestyne SL, Goh MS, Gwan MCH et al. To do or not to do? - Endometrial biopsy in younger women with abnormal uterine bleeding. European journal of obstetrics & gynecology and reproductive biology: X, 2025.PMID 39981415
19. [19]Taree NA, Lee A, Sivak A et al. Rate of abnormal uterine bleeding in women on anticoagulation for venous thromboembolism: systematic review and meta-analysis. Journal of thrombosis and haemostasis : JTH, 2026.PMID 41791665
20. [20]Knox L, Swart-Rimmer I, Rahimi N et al. Current gynaecological management of women and girls with bleeding disorders in the United Kingdom: A UKHCDO haemophilia treatment centre survey and evaluation of real-world clinical practice for the British Journal of Haematology. British journal of haematology, 2026.PMID 41420070
21. [21]Munro MG, Critchley HOD, Fraser IS et al. Contemporary evaluation of women and girls with abnormal uterine bleeding: FIGO Systems 1 and 2. International journal of gynaecology and obstetrics, 2023.PMID 37538019