Around one in five women have trouble with their periods, sometimes leading to significant health issues including anaemia, tiredness, lethargy, weakness, dizziness, and possibly even the need for blood transfusion. Dr Anil explores some potential issues and solutions.
Causes
For most women it’s down to hormonal changes, but it can also be due to growth in the muscle layer of the womb known as fibroids, as well as thickening and polyps of the lining of the uterus. Occasionally, it can be due to uterine cancer. Bleeding disorders and the old-fashioned copper IUCD can cause it, also.
Investigation
Your GP may undertake some blood tests to check for anaemia and iron levels and possibly an ultrasound scan to check the uterus. You may be referred to a gynaecologist, and later may need a biopsy of the lining (like a hysteroscopy), where a thin telescope is used to look inside the uterus, under an anaesthetic.
Treatment
Options vary and might include relatively simple things like the combined pill or certain anti-inflammatory medication. It may also involve tablets such as tranexamic acid – which can reduce flow – and, additionally, sometimes hormone medications.
A big advance around 25 years ago was Mirena, which is a type of IUD that releases progesterone – which can last for up to five years or longer – and has around an 80% success rate for period problems. Iron tablets or syrup or infusions may be needed to replace iron.
Surgical treatments
Various operations, include endometrial ablation – the use of heat energy to try and permanently disrupt the lining of the womb, under an anaesthetic. Sometimes an operation to remove fibroids is needed while retaining the uterus and therefore retaining fertility.
Finally, a hysterectomy involves removing the uterus and therefore offers 100% success with the periods. This needs careful discussion and is mostly done via laparoscopically or with assistance from the Da Vinci robot – both are keyhole surgeries with massively improved recovery.
If you’re having heavy and painful periods, you need to see your family doctor or a gynaecologist to discuss investigation and management options. Only a careful assessment can help exclude anything serious and encourage a return to good health.
When women have post-menopausal bleeding or irregular ongoing bleeding after being on hormone replacement therapy (also known as menopausal hormone treatment), this needs timely investigation. This might require a pelvic ultrasound scan and possibly a biopsy of the lining to exclude uterine tumours.
Whilst most of the time episodes of bleeding are harmless and not due to sinister causes, it’s important that you see your GP or a gynaecologist (or both) to manage these safely. If picked up fairly early, uterine cancer is almost always effectively and permanently treated.
Based at Ascot Central in Greenlane/Remuera, Dr Anil Sharma also holds visiting clinics in Hobsonville, Takapuna and Ponsonby. He operates out of Ascot and Brightside hospitals, providing accessible, top-tier care to his patients.
