Heavy menstrual bleeding (
HMB) is a common clinical problem; population‐based studies estimate that approximately 10–35% of women report this symptom during their lifetime, while about 5% of women consult a physician for evaluation of HMB. Patients with HMBaccount for 15% of all referrals to gynaecologists and are frequently seen by haematologists in bleeding disorder clinics as well. Heavy menstrual bleeding can be caused by a wide variety of local and systemic factors, so a careful clinical and laboratory evaluation is often necessary to determine the aetiology and guide appropriate management. This review discusses the definition, causes and clinical outcomes of HMB. It outlines a diagnostic approach and focuses on medical (as opposed to surgical) treatments. Throughout, areas of controversy and opportunities for further research are highlighted.