Quantifying menorrhagia and overview of nonsurgical management of heavy menstrual bleeding

Abstract Heavy menstrual bleeding (HMB) is a common problem, presenting in 1 in 5 females. The quantification of menstrual blood loss and the subsequent treatment of HMB are both nuanced tasks that require the physician to consider the patient perspective. The individualization of care and transition to methods that fit each individual patient are critical to building a successful relationship with the patient to facilitate follow-up care and evaluation of response to treatment. In this review we outline various methods of quantification of menstrual blood loss, including considerations of accuracy and practicality. These methods, all of which have the potential for clinical benefit, vary from pictorial assessment charts to the gold standard alkaline hematin method to asking the patient about their average amount of blood loss and how it affects their quality of life. Next, we outline nonsurgical treatments for HMB, including hormonal and nonhormonal options, and consider the potential for success, as well as treatment considerations and contraindications. Overall, options for the evaluation and nonsurgical management of menstrual blood loss and HMB are presented along with quality-of-life considerations.