It’s one of those days. You are on your period, and it is heavy and painful. You are not feeling one hundred percent and you don’t want to go into work. But you have an important meeting and cannot possibly miss it! So, you drag yourself out of bed, down a few pain killers, and rush into work. Minutes before the meeting you discover that you have stained your dress. The day couldn’t get any worse! No wonder they call periods, a curse…
Sounds familiar? Welcome to the world of over 355 million menstruating women in India.
Why do women have periods?
Imagine a life without periods—no bleeding, no pain, no sanitary napkins, and no tampons… just plain freedom. Before you get too carried away with that Utopian thought, have you ever wondered why the female species has menses? Well, because we are special of course!
Every month the womb prepares for a possible pregnancy and when this does not happen it sheds the lining of the womb which results in a period or menses. This usually happens once a month and a woman bleeds on an average for five days. The normal cycle varies from 21 to 35 days and the bleeding can last from two to seven days.
So, having a regular period most often indicates that a woman is ovulating every month. So ladies the next time you moan about your periods remember it is your monthly reminder that you are capable of having a baby!
But menstrual abnormalities are also a reality
Some women may experience variations in their cycles. About 60% of women who consult me do so, because they have a menstrual problem.
Bleeding may be heavy (changing five, six, or more fully soaked pads every day), painful, or irregular. These variations may be a result of a hormone imbalance, growths (non-cancerous) in the uterus called fibroids or polyps, adenomyosis, or occasionally in an older woman a sign of cancer. A lot of times no specific cause is found.
Heavy menstrual bleeding most commonly causes a low blood count otherwise known as anaemia, in about 40% of women. This can cause tiredness, weakness and an inability to perform day-to-day activities optimally. So, if you have problems with your periods don’t just “put up with them”; rather, go and see your gynaecologist. You owe it to yourself!
So how can you manage heavy menstrual bleeding?
Well, seek help from a doctor of course, who will diagnose the underlying cause of the problem and then suggest a treatment—which might include:
Your doctor may prescribe non-hormonal drugs with tranexamic acid and mefenamic acid; a combined oral contraceptive pill; or progesterones to ease your flow.
Alternatively, s/he may also suggest the use of an intrauterine device or system (IUS). A relatively new device, it is inserted like a copper T into the uterus and releases progesterone locally. It thins the lining of the womb, thus reducing the amount of blood lost during menstruation. Research has shown that this is the most effective form of medical treatment in suitable women.
*Surgical & non-surgical procedures
Depending on the underlying cause, your doctor might also suggest the following:
- Hysteroscopy and/or laparoscopy if your heavy menstrual bleeding is caused due to fibroids or polyps and need to be removed.
- Endometrial ablation, which involves destroying the lining of the womb. After endometrial ablation, most women have much lighter periods, though pregnancy after endometrial ablation has many associated complications.
- Endometrial resection, in which an electrosurgical wire loop is used to remove the lining of the womb. However, in women considering a pregnancy this procedure is not recommended.
- Uterine artery embolization, for when heavy menstrual bleeding is caused by large fibroids (more than 3 cm). This procedure helps shrink the fibroids (in selected cases) by blocking the uterine arteries and cutting off the blood supply to the fibroids.
- High-intensity focused ultrasound is a non-invasive way to treat uterine fibroids. Using this treatment method in conjunction with image guidance, the physician directs a focused beam of energy through the patient’s skin, superficial fat layer, and abdominal muscles to heat and destroy the fibroid tissue without damaging nearby tissue or the tissues that the beam passes through on its way to the target.
Heavy menstrual bleeding affects women across all cultures and socio-economic backgrounds. It leads to anaemia, ill health, and loss of work days. Women must seek medical help early in order to prevent its debilitating side effects. For many women medical treatment is adequate, however for a proportion of women surgical management may be required.