Conditions · Heavy menstrual bleeding

The most common reason women see a gynecologist.

Heavy menstrual bleeding (HMB) affects up to a third of reproductive-age women at some point in life. Workup is largely symptom-based; molecular characterization of the bleed itself opens a faster, less invasive path to subtype.

Heavy menstrual bleeding — symptom illustration

The condition

A syndrome with many causes.

Heavy menstrual bleeding (HMB) — defined as menstrual blood loss that interferes with physical, emotional, social, or material quality of life — affects up to a third of reproductive-age women at some point in life [1]. The FIGO PALM-COEIN classification organizes the underlying causes into structural (polyps, adenomyosis, leiomyoma, malignancy) and non-structural (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified) categories [2].

Standard of care

Symptom-based, slow.

Workup is largely symptom-based: history, ultrasound, and a CBC for iron-deficiency anaemia. There is little molecular characterization of the bleed itself. Patients with persistent HMB often go through multiple empiric treatments before receiving a specific diagnosis, and a substantial fraction are referred for endometrial sampling or hysterectomy without a clear molecular reason [1].

Why menstrual blood

Sampling the bleed itself.

HMB is a syndrome of menstrual physiology. Direct sampling of the bleed itself opens a window onto coagulation factors, endometrial inflammation markers, structural disease–derived signals (e.g., from leiomyomas or adenomyosis lesions), and the systemic consequences of chronic blood loss (iron status, inflammation). Molecular characterization of the bleed has the potential to subtype HMB along the PALM-COEIN axes faster and less invasively than current workup.

Qvin's role

Population-scale discovery.

HMB is on the discovery-track menu, run through institutional partnerships investigating the menstrual proteome, methylome, and microbiome at population scale. Read more on Science.

References

Sources

  1. National Institute for Health and Care Excellence (NICE). Heavy menstrual bleeding: assessment and management (NG88). NICE guideline, 2018 (updated). nice.org.uk/guidance/ng88.
  2. Munro MG, Critchley HOD, Broder MS, Fraser IS; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International Journal of Gynecology & Obstetrics 113(1):3–13, 2011. doi.org/10.1016/j.ijgo.2010.11.011.

Other conditions

Continue exploring.