Heavy menstrual bleeding (HMB)
Definition and clinical approach
HMB (menorrhagia) is menstrual blood loss that interferes with a person’s physical, social, emotional or material quality of life. Management is patient‑centred: decisions are guided by clinical impact, haemodynamic status and the likelihood of underlying pathology rather than measured blood loss (NICE NG88, QS47).
This section focuses on emergency/acute‑care priorities, investigation triage and evidence‑based initial management relevant to the emergency department (ED) and acute gynaecology pathways.
Immediate priorities and red flags
Recognise when urgent resuscitation and gynaecology involvement are required. Call senior/ gynaecology early if any of the following are present:
- Haemodynamic instability (hypotension, tachycardia, signs of shock).
- Ongoing heavy bleeding despite basic measures (for example saturating sanitary products or towels at a high rate, recurrent syncope).
- Severe symptomatic anaemia with cardiorespiratory compromise.
- Suspected retained products of conception, septic abortion or pelvic sepsis.
- Bleeding in early pregnancy or any positive pregnancy test with haemorrhage.
- Clinical suspicion of endometrial malignancy (prompt investigation).
Treat the unstable patient with standard major haemorrhage/massive transfusion protocols as required (local policy) and involve the blood bank early (RCEM, NG88).