The female human reproductive system comprises the hypothalamic–pituitary–ovarian axis and the reproductive tract (fallopian tubes, uterus, cervix, and vagina). The principal functions of this system are to produce an ovum, enable its fertilization and implantation, and allow growth and safe expulsion of the fetus into the external world. The menstrual cycle is critical for facilitation of the initial steps of this raison d’etre of the female reproductive system. As a greater understanding of the menstrual cycle biology is garnered, therapies that directly target pathways underpinning the regulation of normal and heavy menstrual bleeding are likely to emerge. Such future targeted therapies have the potential to offer a more personalized approach to management with minimization of undesirable side effects.