From menarche to menopause, heavy menstrual bleeding is the underrated compass in reproductive health.

Hilary O.D. Critchley, Silvia Vannuccini, Varsha Jain, Felice Petraglia

Research output: Contribution to journalReview articlepeer-review

Abstract / Description of output

Menstruation is defined as monthly uterine bleeding, regarded as a sign of reproductive health. When characterized by excessive
bleeding (heavy menstrual bleeding [HMB]), it may act as a useful clinical marker for diagnosis of reproductive diseases. Endometrial
and myometrial mechanisms underlying abnormal uterine bleeding (AUB), which includes HMB, have hormonal, cellular, and molecular
aspects. Structural and nonstructural causes of AUB, presenting with HMB as the major symptom, result in iron depletion and
consequent anemia. Heavy menstrual bleeding can be considered as a single entity to identify the possible underlying causes, which
may be different to some extent to those of AUB, as a whole. Furthermore, the difficulties in defining HMB through objective methods
do not allow the current epidemiological scenario on the prevalence of the symptom among reproductive-age women to be outlined.
Moreover, the introduction of new diagnostic methods, including imaging technologies, entails a revision of the available figures on
HMB in different age groups from menarche to menopause. In addition, a proper diagnostic algorithm for HMB should be implemented
to adapt recommendations for clinical investigation when HMB is present.
Original languageEnglish
Article number33782
Pages (from-to)625-636
Number of pages12
JournalFertility and Sterility
Issue number4
Early online date6 Sept 2022
Publication statusPublished - Oct 2022

Keywords / Materials (for Non-textual outputs)

  • Abnormal uterine bleeding
  • endometrium
  • heavy menstrual bleeding
  • menstruation-related symptoms
  • myometrium


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