In this case-based module, Dr Toni Hazell discusses how to manage consultations about heavy menstrual bleeding
Learning objectives
This module will support your knowledge and understanding of:
- How to take a history from a patient with heavy menstrual bleeding (HMB).
- The risk factors for endometrial pathology.
- Which patients need examination and investigating.
- How to treat idiopathic HMB.
Author: Dr Toni Hazell is a GP in North London
Date published: 28.11.2025
Log in to access the full CPD module and track your progress toward certification.
Already registered?
New user?
Reviews
Heavy menstrual bleeding (HMB) is a common presentation, and effective assessment relies on a structured history that explores menstrual pattern, associated symptoms, medical and gynaecological background, medications, and the impact on quality of life. This approach helps distinguish idiopathic HMB from bleeding caused by structural or systemic pathology.\nUnderstanding risk factors for endometrial disease is essential, as conditions such as obesity, chronic anovulation, increasing age, tamoxifen use, and hereditary cancer syndromes significantly raise the likelihood of hyperplasia or malignancy. These factors guide decisions about who requires further examination and investigation.\nClinical examination and investigations are not mandatory for all patients but are indicated when red?flag symptoms are present, when risk factors for endometrial pathology exist, or when symptoms persist despite treatment. Transvaginal ultrasound and endometrial biopsy are the key diagnostic tools, supported by basic blood tests.\nFor idiopathic HMB—where no underlying cause is identified—management focuses on improving quality of life. The levonorgestrel intrauterine system is the most effective first?line treatment, with alternatives such as tranexamic acid, NSAIDs, and hormonal therapies available depending on patient preference and suitability. Surgical options are reserved for refractory cases or when fertility is no longer desired.
very useful, very precise and to the point