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Terminology

These terms are used interchangeably and there is no consensus on one “correct term.”

Heavy Menstrual Bleeding
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Heavy Uterine Bleeding
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Excessive Vaginal Blood Loss
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Abnormal Uterine Bleeding

Other historical terms include “Dysfunctional Uterine Bleeding” and “Menorrhagia”, but these are no longer commonly used.

How did these terms evolve?

DID YOU KNOW?

The word “taboo” comes from the Polynesian word “tabu,” which means menstruation. 

Let that sink in.

Early Historical Accounts:

Hippocrates briefly addresses the subject of heavy menstrual bleeding in his text Aphorisms:
“To stop excessive evacuations of the menses, a large cupping glass may be applied to the breast” (section v, L) 

“Menstruation if too abundant produces disease” (section v, LVII) 

Aristotle wrote: 
“In quantity, bleeding is excessive, saith Hippocrates, when they flow about eighteen ounces, in time when they flow about three days … but it is inordinate flowing when the faculties of the body are thereby weakened.”

We see here the evolution of definitions of heavy menstrual bleeding based on amount, duration, or impact on overall bodily health. These concepts remain in our definitions today.

Twentieth Century:

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Barer and Fowler were the first to formally quantify vaginal blood loss in 1936. They studied 50 females and found that average menstrual blood loss was ~37 mL per cycle, and that loss of ~80 mL or greater per cycle would lead to iron deficiency. This 80mL is still part of the definition of HMB to this day.

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Hallberg et al expanded on Barer and Fowler’s work in 1966 and measured menstrual blood loss in ~500 females. They found a mean blood loss of 43 mL per cycle, with upper limit of normal determined to be between 60-80 mL per cycle. Risk of iron deficiency increased significantly when blood loss was 80 mL or more per cycle.

For further reading on the fascinating history of abnormal uterine bleeding, see: Woolcock et al “Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding” (2008) in Fertility and Sterility.

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