What is HMB?
According to NICE, HMB is2:
“Excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life. It can occur alone or in combination with other symptoms".
Please be aware that HMB may also affect patients assigned female at birth (AFAB).
“You think, oh it can’t be that bad, I’m sure it will get better, you know. Oh really, do I want to bother them with this?”5
How common is HMB?
HMB affects between 5–30% of women1 and is the underlying reason for 12% of all gynaecology referrals.2 It also exerts a significant burden on primary care with 1 in 20 sufferers aged 30–49 years seeking GP advice annually for HMB or menstrual problems.2 Yet many of these women may have been living with the impact of HMB for several years before seeking help.5
The burden in younger patients may be even higher, as HMB is estimated to affect up to 37% of adolescents,9 who may not be consulting any healthcare professional for advice.
“I just thought this is normal … I have just got to stick with it until the menopause [laughing]. It never really occurred to me to try and seek help” 5
How is HMB defined?
Women lose, on average, 30–40ml of menstrual blood each cycle.10 For those with HMB this rises to 80ml or more of blood loss per cycle.9, 10
However, from a practical perspective, this is not particularly helpful when talking to patients as it may not reflect their experience or the impact of HMB on their quality of life.10 In addition, HMB can be subjective, with one person’s perception of normal bleeding being another person’s perception of heavy bleeding.9
Given this, an HMB diagnosis is usually based on the patient’s personal perception of blood loss and the effect of this on their daily life.8
“It was probably four or five years before I kind of did anything, you know, about it” 5