How do you define HMB?
Technical definition for heavy menstrual bleeding is anything that exceeds 80ml. Given that most women don’t measure their periods, Dr Uppal says a more practical rule is to look how it affects their quality of life – physically, emotionally, socially or materially.
Another major sign is if you have to change your sanitary products more often. For some women this could be every hour or more.
“Women will often tell me they’re using a tampon and a pad, or they’re using Modibodi and a tampon,” Dr Uppal adds.
Other symptoms include getting up during the night, passing clots (especially if they’re bigger than a 50 cent coin) or if you’re feeling dizzy or tired.
“All of these things can be factors that could point toward heavy menstrual bleeding,” she says.
Who does it affect?
We know that HMB affects at least a quarter of all women, but it’s possible that number could be higher. In a recent survey by Bayer, 32 per cent of women believed that they had signs of undiagnosed heavy menstrual bleeding.
Despite this, many women don’t seek treatment.
“The woman herself might trivialise it or might feel, ‘Oh this is normal,’” Dr Uppal says.
Some women dismiss HMB as a normal part of menopause, or they may have had a negative experience when they did seek medical advice. While Dr Uppal says there are many excellent doctors, they can also be pressed for time or they might need additional support in treating some conditions.
“General practitioners are often quite time-poor,” she explains. “Studies show that if we don’t ask about women’s health issues we may not uncover what they’re suffering with.”
What causes HMB?
Some women will only experience HMB as they head toward the change of life. However, there are a number of conditions that can cause this too, such as endometriosis, fibroids or polyps. Dr Uppal says the first step towards effective treatment is to get the right diagnosis.
“It’s really a problem with many solutions,” she explains.
A good starting point could be to visit a GP who specialises in women’s issues, or to ask for a referral to a gynaecologist.
Dr Uppal also recommends visiting the website mybodymyway.com.au, which includes a questionnaire that you can save and show to your doctor.
Your doctor can also measure your iron levels, and rule out any potentially serious causes such as uterine cancer. “Uterine cancer is rare, but it still could be an underlying cause in a number of cases,” Dr Uppal says.
Postmenopausal bleeding is any kind of bleeding that occurs 12 months after your last period, and it should always be investigated by your doctor.
“Postmenopausal bleeding should be taken very seriously,” Dr Uppal says.
Depending on what’s causing these symptoms, Dr Uppal says a number of treatments are available.
A popular option for women undergoing perimenopause is hormone replacement therapy (or HRT).
Dr Uppal says it’s common for women to start HRT when they first begin having symptoms, and their periods haven’t yet stopped. “If they are struggling, I would encourage women to at least have the conversation so they can make an informed choice,” she advises.
While HRT isn’t suitable for everyone, Dr Uppal says there are also a range of natural therapies and lifestyle changes that can make a difference, from diet and exercise to stress management, and mindful practices like meditation and yoga. “You should familiarise yourself with what is available for you, because there is so much support,” she adds.