Understanding Acute Heavy Menstrual Bleeding: Insights From an Interdisciplinary Panel

Whereas the symptoms that make up chronic abnormal uterine bleeding (AUB) in the reproductive years have been well described and the subject of extensive clinical investigation, acute heavy menstrual bleeding has received relatively little attention. Acute heavy menstrual bleeding has been defined by the International Federation of Gynecology and Obstetrics as an episode of heavy bleeding in the reproductive years, unrelated to pregnancy, that, in the opinion of the clinician, is of sufficient quantity to require immediate intervention. These women often present with a background of chronic heavy menstrual bleeding, often with iron deficiency, which makes them particularly vulnerable to the consequences of an acute episode. Only a few studies have evaluated acute heavy menstrual bleeding; relatively little guidance is available for clinicians worldwide. Management of acute heavy menstrual bleeding requires the expertise of several medical specialties, including primary care, pediatrics, gynecology, hematology, and emergency medicine. This article is the result of a virtual multidisciplinary panel meeting designed to raise awareness of the problem of acute heavy menstrual bleeding, including its pathogenesis, clinical manifestations, and management, and to examine the evidence gaps and barriers that continue to impair basic and clinical research in the development of effective interventions. Although there are challenges to performing clinically relevant and well-designed research, it is necessary from both policy and clinical perspectives. Such investigation must be coupled with initiatives designed to inform clinicians in a fashion that provides effective guidance in the management of this vexing clinical problem.