Heavy menstrual bleeding is prolonged (>7 days) or excessive (>10 mL) uterine bleeding occurring at regular intervals over several menstrual cycles.
It is menstrual blood loss that is excessive and interferes with patient's physical, emotional, social and quality of life.
It is also referred to as menorrhagia or hypermenorrhea.
It is a common problem in women of reproductive age that usually causes anemia.
Uterine fibroids and polyps are the most common pathology identified.


  • Common problem in women of reproductive age (increases with age) which usually causes anemia
    • Most common symptom experienced by women with bleeding disorder


  • Prolonged (>7 days) or excessive (>80 mL) uterine bleeding occurring at regular intervals over several menstrual cycles
    • Menstrual blood loss that is excessive and interferes with patient’s physical, emotional, social and quality of life


  • Causes of abnormal uterine bleeding (AUB) are categorized into the following groups:
    • Discrete structural abnormalities that can be examined with imaging techniques and/or histopathology
      • PALM: polyp, adenomyosis, leiomyoma1, malignancy and hyperplasia
    • Non-structural abnormalities that cannot be defined by imaging or histopathology
      • COEIN: coagulopathy (eg von Willebrand’s disease), ovulatory dysfunction, endometrial, iatrogenic, not yet classified
      • Iatrogenic includes AUB associated with use of hormonal or non-hormonal medications (eg anticoagulation therapy), intrauterine systems or devices, or other local or systemic agents
      •  Not yet classified includes conditions that are rare or ill-defined
    • Other causes include chronic endometrial infection, arteriovenous malformation, hypothyroidism, obesity  
    • 1Please see Leiomyomas Disease Management Chart for details
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Human papillomavirus (HPV) infection is a prevalent disease worldwide. Consequences of HPV infection vary, depending on the infected individuals and the HPV genotype involved. Life-threatening consequences are not uncommon, and cervical cancer is a clear demonstration of the virus’s potency. While the incidence of cervical cancer is heavily concentrated on developing countries,1 the impact of HPV-related diseases on developed countries has not ceased. In the United States alone, HPV infections are the most common sexually transmitted disease with an estimated 5 million new cases being diagnosed in 2000 among young adults, incurring nearly US$3 billion in terms of direct medical costs.2 A multinational study involving 18,498 women showed that cervical HPV prevalence varied greatly geographically, ranging from the low of 1.6% in North Vietnam to the high of 27% in Nigeria. In general, HPV prevalence peaked among young, sexually active women and declined with age. In selected countries, however, a second peak was noted in women older than 55 years.3 The high prevalence of HPV-related diseases incurs a heavy burden on the healthcare systems of developed and developing countries alike, which renders HPV research and prevention a global public health imperative. On an individual level, the afflictions caused by HPV-related diseases go beyond that of physical suffering to affecting the psychological well-being of the infected. This is the focus of our paper.

27 Nov 2017
Chronic hepatitis B virus (HBV) infection is a global problem. Chronic HBV infection is probably the most common maternal infection encountered in Hong Kong, China, and Southeast Asia. In Hong Kong, which is one of the endemic areas, immunisation against HBV was first provided in 1983 to infants born to mothers who were screened positive for hepatitis B surface antigen (HBsAg). Immunisation became widespread since November 1988, but HBsAg-positive mothers are still encountered frequently.1