By Dr Prathima Reddy
Director, Senior Obstetrician and Gynaecologist – Fortis La Femme Hospital, Richmond Road Bangalore
It’s one of those days. You are on a 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. 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 worse. No wonder the periods or menstrual bleeding are called “the 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 notampons …….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 5 days. The normal cycle varies from 21 to 35 days and the bleeding can last from 2 to 7 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!
Some women may experience variations in their cycles. About 60% of the women who consult me, do so because they have a menstrual problem.
Bleeding may be heavy (changing 5 – 6 or more fully soaked pads/day), painful or irregular. These variations may be a result of a hormone imbalance, growths (non-cancerous) in the uterus called fibroid or polyps, adenomyosis or occasionally in an older woman a sign of cancer. A lot of times no specific cause is found.
HMB (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” but go and see your gynecologist. You owe it to yourself to be healthy.
Heavy Menstrual Bleeding – Treatment options in the 21st Century
Treatment depends on the under lying cause of HMB can be divided into Medical, Surgical and Non-Surgical Procedures.
Drugs: The most commonly usednon-hormonal drugs are Tranexamic Acid and Mefenamic Acid.
The Combined oral Contraceptive pill and Progesterones are hormonal drugs.
An Intra uterine device or system (IUS) like the “Copper T or Loop” is a relatively new device, which has a small amount of progesterone hormone impregnated into it and releases it locally. It is inserted into the uterus and acts by thinning 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 and Non-Surgical Procedures
Hysteroscopy and/or Laparoscopy: If the HMB is due to fibroids or polyps these can be surgically removed by Hysteroscopy and/or Laparoscopy or by the traditional “open method”.
Endometrial Ablation: This procedure involves destroying (ablating) the lining of the womb (endometrium). The procedure uses a laser, radiofrequency or heat applied to the endometrium to destroy the tissue.
After endometrial ablation, most women have much lighter periods. Pregnancy after endometrial ablation has many associated complications. If you have endometrial ablation, the use of reliable or permanent contraception until menopause is recommended.
Endometrial resection: In this procedure an electrosurgical wire loop is used to remove the lining of the womb.This results in lighter bleeding. However, in women considering a pregnancy this procedure is not recommended.
Uterine artery embolization: When HMB 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. During this procedure, the doctor passes a catheter through the large artery in the thigh (femoral artery) and guides it to the uterine arteries, where the blood vessel is injected with materials that decrease blood flow to the fibroid.
HIFU: 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.The treatment is conducted with the patient awake and uses either magnetic resonance (MR) or ultrasound (US) guidance.
In all the above procedures except the “open method” patients can go home the same day or the next day.
Hysterectomy: This is the final solution when all other treatments have failed. This involves removal of the uterus and cures HMB permanently.
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.