Women shouldn’t suffer in silence
with heavy menstrual bleeding, writes Dr Akmal Zulayla Mohd Zahid
DO you have prolonged heavy periods? Do you dread that time of the month? Do you feel dizzy or lethargic all the time? If you answer yes to any of these questions, you probably have heavy menstrual bleeding, which can lead to anaemia (reduced red blood cells in your body).
Heavy menstrual bleeding, commonly referred to as menorrhagia, is a common gynaecological problem for many women. Many just put up with the problem, thinking nothing much can be done, and suffer in silence. However, there are many treatment options — from medical to surgical — to relieve the problem.
CAUSES OF MENORRHAGIA
There are several causes of menorrhagia that are related to a woman’s age. For those at the beginning of their reproductive age i.e. girls just starting their period, the common cause is hormonal imbalance. However, there is a small group who may have an inherited bleeding disorder and this could be excluded through a blood test.
For other women and those nearing menopause, hormonal imbalance can be the cause. However it is very important to exclude other common problems such as uterine fibroids (overgrowth of the muscle of the uterus) and also abnormalities in the lining of the womb such as polyps, or worse, cancer of the lining of the womb.
If you also experience painful periods, you may have adenomyosis, a condition where the inner lining of your womb is within the muscles of your womb, or endometriosis (inner lining of the womb grows outside of it). Other less common causes for menorrhagia include thyroid hormone problems, infections and cervical cancer.
MAKING THE DIAGNOSIS
Diagnosis of the underlying cause of menorrhagia begins with the doctor taking all the details of your problem as well as other relevant information such as your history of previous deliveries, surgeries, use of any contraceptive method and also your ferti-lity wish.
The latter information is important as most hormonal treatments will prevent pregnancies (for the duration of the treatment) and some surgical treatments will make future pregnancies either unsafe or impossible, for example, a hysterectomy.
Doctors will perform an abdominal examination and an intimate examination, as well as an ultrasound scan to assess your womb and ovaries. They may take a small sample from the lining of your womb using a small plastic tube called “pipelle” to exclude cancer.
Once the diagnosis has been made and cancer excluded, your doctor will discuss various treatment options available to suit your personal circumstances.
GETTING TREATED
Treatment of menorrhagia depends a lot on age, past medical history, the cause of the condition and whether you are planning for a pregnancy.
For young women who are not planning for a child, they can undergo hormonal treatments to relieve heavy periods. These include the combined oral contraceptive pill or the pill and the progesterone only pill also known as the mini pill.
One of the highly recommended treatments for this condition is the insertion of an intrauterine system better known as the Mirena coil. It is essentially an intrauterine coil device with the progesterone hormone which thins the lining of your womb and will eventually lead to reduced menses and sometimes, none at all.
Although the Mirena coil treatment is a bit costly, it lasts five years so it works out to be quite cost-effective.
For women planning for pregnancy, the only possible treatment option are the non-hormonal tablets: Tranexamic acid, which will reduce the flow of the period and mefenamic acid, which reduces the period flow as well as relieves period pain.
SURGICAL OPTIONS
For women who have completed their fami-ly, surgery is definitely on the cards. Minimally invasive surgery such as endometrial ablation and hysteroscopic surgery results in a quicker recovery period and allows the uterus to be preserved.
Endometrial ablation is a procedure that destroys (ablate) the lining of your womb using a hysteroscope, a telescope placed through your cervix into the uterus. Seve-ral techniques have been used for this, including using electrical currents, radiofrequency waves or heated water.
Hysteroscopic myomectomy can be done if you have been diagnosed with a submucous fibroid, a type of fibroid that bulges into the cavity of your womb. Not all gynaecologists are trained to perform endometrial ablation or hysteroscopic myomectomy, so it can only be done in certain hospitals or medical centres.
If all the above treatments fail, you can still opt for hysterectomy.
In conclusion, heavy periods can be stopped with the treatment alternatives available. All you need to do is to consult your gynaecologist to get the right diagnosis and tailor your treatment options according to your personal situation and wishes.
Dr Akmal Zulayla Mohd Zahid is a consultant obstetrician and gynaecologist at UiTM Private Specialist Centre as well as a senior lecturer at the Faculty of Medicine, Universiti Teknologi Mara.