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Heavy Menstrual Bleeding

Definition of heavy menstrual bleeding:

  • Volume (equates to saturating a heavy absorbance pad/tampon more frequently than every two hours) OR excessive menstrual flow in its duration (>7 days)

  • Bleeding causing symptomatic anemia or lifestyle disturbance

  • Bleeding unlikely to be due to ongoing contraception


  • Congenital or acquired bleeding disorders

  • Sexually transmitted infections (STIs)

  • Thyroid dysfunction

  • Anovulatory cycle/Polycystic ovary syndrome (PCOS)

Off guideline if:

  • Hormonal bleeding with contraception

  • Pregnancy

  • Known trauma

  • Sexual assault

  • Genital injury

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.