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Heavy menstrual bleeding (HMB) is one of the commonest and most controversial of gynaecological complaints presenting both at primary care and specialist levels. There is controversy over terminologies and definitions,1 classification of underlying causes2 and over symptom assessment in clinical practice.3 For clinical purposes, HMB is best defined as excessive menstrual blood loss leading to interference with the physical, emotional, social and material quality of life of a woman, and which can occur alone or in combination with other symptoms.3 There is a general lack of clinical and research awareness that HMB is actually a symptom complex, lack of awareness of what aspects are important for women, and of the impact on quality of life and modern lifestyle.4 5 These are often incompletely taken into account in the design of clinical management trials, as exemplified in many of the trials …
Competing interests ISF has received consultancy fees, lecture fees and research funding from Bayer Schering Pharma, Schering Plough (now Merck), Daiichi Sankyo, NIH and NHMRC. He is a member of the International Committee for Contraception Research of the Population Council, New York (which developed the levonorgestrel intrauterine system, LNG IUS) and of the current Bayer Global Advisory Board for the LNG IUS.