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Identify patients with HMB

What are the challenges in identifying when a patient has heavy menstrual bleeding?

Heavy menstrual bleeding (HMB) affects up to 30% of women and has a significant negative impact on quality of life.1,2


The diagnosis of HMB is difficult. This is mainly due to a lack of practical, objective methods to measure blood-loss and the discordance between self-reported and healthcare provider-assessed severity of bleeding symptoms.3

In fact, many gynecologists (up to 96% in one study) base their diagnosis of HMB on women’s self-reported bleeding symptoms.3,4


It is recommended that there should be a specific work-up whenever a woman believes that her menstrual bleeding affects her quality of life.5 There is therefore a need to develop tools that help identify patients with HMB easily and efficiently. Accordingly, the HELP Group has developed a set of questions that may be useful.

HELP questions to identify HMB

Watch Dr Singh presenting the HELP questions approach to allow you to easily identify when a patient has HMB.

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HELP questions to identify HMB

You can use this leaflet containing the 7 HELP questions in clinical practice to help you easily identify patients who may have HMB.

Track period blood loss with FlowCyclo™ App


A certified app for your patients to assess their menstrual volume

Based on two methods, the pictogram-based or menstrual diary entry-based method, FlowCycloTM is the first app available to quantify menstrual blood loss and inform about the 80 ml threshold. The apps methodology is the only one validated against the alkaline hematin method and allows the assessment of menstrual blood loss. The app provides a report of the users bleeding patterns after just one cycle helps you as physician to determine if further diagnostic tests are needed.


To ease the identification of women with HMB we recommend encouraging your patients with problematic bleeding to search for “FlowCyclo” in Google Play and iOS App Store and use it for one cycle before the next appointment in your practice.


The method of estimating menstrual blood loss has been developed by the British Keele University and Bayer AG, validated in clinical trials performed by Bayer. FlowCycloTM is distributed by Bayoocare GmbH as legal manufacturer and was developed for and is sponsored by Bayer.


PALM-COEIN Classification: Causes and treatment of HMB

Learn more about the structural and non-structural causes of HMB as well as suitable treatment approaches.

General diagnosis of HMB

Use the HELP algorithm to assist with the diagnosis of HMB in your patients


  1. Singh S, et al. J Obstet Gynaecol Can 2013;35(5_eSuppl):S1–S28.
  2. Bahamondes L & Ali M. F1000Prime Rep 2015;7:33–7.
  3. Liu Z et al. Value Health 2007;10:183–94.
  4. Dilley A et al. J Womens Health Gend Based Med 2002;11:39–44.
  5. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. 2018. https://www.nice.org.uk/guidance/ng88.

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