India, Feb. 28 -- Heavy menstrual bleeding (HMB), medically termed abnormal uterine bleeding (AUB), is a common concern among women above 40 years, particularly during the perimenopausal transition. Nearly 25-30% of women in this age group experience clinically significant heavy or irregular bleeding. HMB is defined as menstrual blood loss exceeding normal limits - soaking a pad every 1-2 hours, passing large clots, bleeding beyond seven days, or developing symptoms of anaemia such as fatigue, breathlessness, or dizziness. Common causes fall under the PALM-COEIN classification system. Structural causes (PALM) include polyps, adenomyosis, leiomyoma (fibroids), and malignancy or endometrial hyperplasia. Non-structural causes (COEIN) include coagulopathy, ovulatory dysfunction (common in perimenopause), endometrial disorders, iatrogenic causes (medications), and conditions that are not yet classified. Thyroid dysfunction and metabolic disorders may also contribute. In my clinical practice, I often see women seeking help only after severe anaemia develops. A simple ultrasound, blood tests, and sometimes a minor outpatient procedure such as endometrial sampling can provide clarity. Treatment depends on the underlying cause. Many women improve with medication and hormonal regulation. Others may benefit from minimally invasive procedures such as hysteroscopy and endometrial sampling. Advanced laparoscopic and robotic surgery techniques today allow safer procedures and faster recovery when surgery is required. These are keyhole procedures that are minimally invasive, and patients are able to walk within eight hours of surgery. The goal is always to treat the problem while preserving overall health and quality of life. Women over 40 should consult an experienced gynaecologist for systematic evaluation. Early diagnosis, evidence-based treatment, and appropriate follow-up ensure safety during this transitional phase. Regular health checks are mandatory, even if no symptoms are felt. Menopause is natural - excessive bleeding is not. Timely medical care protects both health and quality of life. All women can navigate this phase confidently and safely. The author of this article is director, gynaecology, and a specialist in robotic surgery, advanced laparoscopy, infertility and high-risk pregnancy care at Max Super Speciality Hospital, Mohali. She is also available at her gynae clinic in Sector 27, Chandigarh. She can be reached at 985-582-4455; Instagram: @drseemawadhwagynae; or www.drseemawadhwa.com...