Heavy periods can be a nightmare. But new treatment options have led to a better quality of life for many women and a dramatic drop in the numbers of hysterectomies being carried out. Angie Mezzetti reports.
With labels stamped "Super Plus" and "Ultra", you might be forgiven for thinking that the description applies to a petrol or car product. But these are the names used by manufacturers to describe heavy-duty absorbency pads for women who experience periods with significant and debilitating blood loss.
"Often women go through hell before they resolve to see a gynaecologist and by that time they are resigned to having a hysterectomy. So they're pleasantly surprised to learn that there are lots of options available to them depending on the cause of their individual problem," says Dr Bridgette Byrne, Royal College of Surgeons in Ireland (RCSI) senior lecturer and consultant obstetrician and gynaecologist at the Coombe Women's Hospital.
Rita from Dublin said she held out for two years before getting anything done. "I was so bad, bleeding for three weeks at a time. I couldn't go out at night and wore three pads together. I was afraid to go to other people's houses in case I would ruin their couches," she says.
"One night I ran to the loo and passed a clot the size of my fist and my husband wanted to call an ambulance."
Rita had a hysterectomy seven years ago, aged 43, but the number of women having this surgery has dropped dramatically.
"We now carry out about 100 a year, whereas before we could have done up to 400 a year," says the Master of the Rotunda Hospital in Dublin, Dr Michael Geary.
The National Maternity Hospital in Holles Street has had a similar experience, with abdominal hysterectomies down to one-third of what they were 10 years ago.
"Dysfunctional Uterine Bleeding is often caused by hormonal imbalance, which tends to happen in the 35-plus age group and into the 40s," says Dr Shirley McQuade, medical director of the Dublin Well Woman Centre.
"There are lots of things that can be done and typically a contraceptive pill is prescribed, particularly in younger age groups where the woman has normal weight and normal blood pressure."
Women up to age 50 will often use lower dose pills such as Microlite or Mercilon. "If this is not appropriate, Progesterone-only pills can be used on a cyclical basis, two weeks out of four. However, there may be side effects, which can include headaches, bloating and mood swings, so it is not for everyone."
Dr Geary says: "It is relatively common for periods to act up for women from the mid-30s upwards." There are several possible reasons for this: hormonal imbalance, fibroids, endometriosis and anovulation.
One of the most common and early treatments he recommends is to take Ponstan on the first few days of the period.
"For women with regular but heavy bleeding, it is very useful because it is non-steroidal, anti-inflammatory, anti-spasmodic and anti-prostaglandin. For women over 40, it is probably a good idea to be referred to a gynaecologist for investigation," Dr Geary says.
Ultrasound scanning of the pelvis can detect the presence of fibroids and they can also be diagnosed through hysteroscopy and D&C.
"A common misconception is that a D&C is done as a treatment, but this is not so. It is done as a diagnostic tool," Dr Geary says. A hysteroscopy allows a look at the inside of the womb with a camera.
"Fibroids are a benign swelling in the lining of the womb. Around 20 per cent of women over 35 will have fibroids, but at least half of them are oblivious to the fact. The other half will suffer through very heavy menstrual bleeding," says Dr Geary.
Another possible cause is endometriosis, where a small amount of the lining of the womb can be found in other places in the pelvis, such as the ovaries or fallopian tubes.
For women in their fifth decade, who don't ovulate as much, sometimes there is a build-up in the womb and this is called anovulation.
One of the most "exciting developments" in recent years has been the licensing of the Mirena IUD for the treatment of heavy periods, according to Dr Geary.
"It was introduced here in 1998 and between 90 and 95 per cent of women who use it see a dramatic improvement."
Developed in Scandinavia in the 1970s initially as a contraceptive, Dr Declan Keane says it is one of the biggest reasons for the reduction in hysterectomies.
"It is an IUS [intrauterine system\] which releases low doses of progesterone directly into the lining of the womb where the problem is happening," says Dr McQuade. "So the lining becomes smaller and periods become lighter and lighter, and some women end up with no periods at all, and yet the normal cycle continues." The Mirena usually lasts for five years and can then be replaced with another.
Mary in Blackrock had her first one inserted at the age of 42. She says it gave her a new lease of life. "My friends were all dying [with cramps and bleeding\] and complaining, but I was flying," she says. "I was able to go off for weekends with my husband and enjoy myself and the responsibility [for contraception\] was off him. It should be up in lights." After some initial discomfort and spotting in the first three months, she had no periods at all.
Dr Byrne says: "The best thing about the Mirena is that it is reversible, so if you don't like it, you can have it removed. The risks are minimal as the progesterone capsule is released locally and very little gets released into the bloodstream."
The added advantage is that it is also a contraceptive. "It's more effective than getting your tubes tied, which has a failure rate of one in 200, whereas the Mirena is less than that."
The device is fitted without anaesthetic a few days after the period starts and "feels about as uncomfortable as having a smear done, but slightly more pinching," says Dr Byrne.
"Some women experience period-like cramps for the first few days. A nylony thread protrudes through the neck of the womb into the vagina to allow its position to be checked and for removal of the device. Approximately three months, and possibly more, is the settling-in time for most women and some of the side effects can include breast tenderness and bloating, but this soon passes," she says. In a few cases, there is a constant lighter discharge in the first three to six months.
The Mirena is free of charge on the GMS medical card. It is also available on the drug payment scheme card for around €200 and the patient will also have to pay the doctor to have it inserted.
Since it was first launched in Ireland in 1998, over 70,000 women have used it.
Another treatment available in Ireland is "endometrium ablation" - a day procedure involving a "burning-off" of the lining of the womb. "The woman has no cuts, no scars and she goes home that day," says Dr Keane. "She often ends up either with no periods or significantly lighter ones," he adds.
For women who think heavy periods are simply their lot in life, Dr Geary has the following advice: "Don't suffer in silence, go and see your doctor, as there is plenty that can be done."
A little Web help
www.2womenshealth.co.uk: Advice on all aspects of women's health.
www.gynalternatives.com/: US doctors' site with practical information.
pslgroup.com/dg/3a84a.htm US study on women seeking alternatives to hysterectomy for bleeding problems.
www.rotunda.ie. Telephone: 01 8730700 or 01 8171700.
www.coombe.ie. Telephone: 01 4085287.
www.nmh.ie: National Maternity Hospital Holles Street Telephone: 01 6373100.
www.wellwomancentre.ie