As women, we are often too busy taking care of everyone around us that we forget about ourselves. Oftentimes, when it concerns gynaecological issues, such as hormonal changes or our reproductive health, we attribute any discomfort to age and childbirth. But it is important to understand what exactly is going on within us, so that we can take the best care of ourselves. After all, it’s only when we take good care of ourselves that we can take better care of our families!
To shed light on some of the possible conditions women experience, we conducted a webinar, “Women’s Health – Common Gynaecological Conditions” with mumpreneur and certified Yoga instructor Dawn Sim and Dr. Clara Ong, consultant Obstetrician & Gynaecologist at Gleneagles Hospital, Singapore.
The webinar touched on common gynaecological conditions such as heavy menstrual bleeding, the symptoms and causes, how to diagnose it, and treatment options. Here are some of the key takeaways:
Common Gynaecological Problems – Heavy Menstrual Bleeding
Dr. Ong started off by explaining the difference between a normal and heavy period. Normal periods typically see a woman lose an average of 2 – 3 tablespoons of blood (35 to 40 ml) over 4 to 8 days. On the other hand, heavy menstrual bleeding will see a woman lose more than 5 tablespoons (above 80ml) of blood during her cycle.
Dr. Ong explained that unusually heavy bleeding warrants a visit to the doctor. Some red flags to look out for are:
- Bleeding beyond the 7 day window
- Having to double up on pads, wear adult diapers or experiencing your pads or tampons getting soaked through within an hour for two hours straight
- Blood clots larger than the size of a 20-cent coin
Dr. Ong cautioned not to ignore these red flags as continuous heavy bleeding can cause you to be anaemic (low red blood cell count) or to have low iron levels!
Causes of Heavy Menstrual Bleeding
Dr. Ong listed some of the most common causes of heavy menstrual bleeding. These include:
1. Changes within the uterus
She explained that any abnormalities in the uterine muscle wall prevents the uterus from ‘squeezing’ well and hence blood vessels continue to bleed. This in turn causes heavy menstrual bleeding. These abnormalities can be caused by conditions such as uterine polyps, fibroids, uterine adenomyosis (a condition where the lining of the uterus grows into the muscle wall of the uterus, thus making it bulkier and lead to heavy menstrual bleeding) or endometrial cancer.
Of the above mentioned conditions, fibroids are one of the commonest causes of heavy menstrual bleeding. These are growths in the muscles of the wall of the womb and it happens to about 20% of all women. They are usually non-cancerous and may continue to grow until a woman hits menopause.
2. Hormonal Causes
Dr. Ong added that if women don’t ovulate regularly, meaning that the ovary does not release an egg every month, the lining of the womb will build up and become very thick. Eventually it sheds in an uncontrolled way, causing heavy menstrual bleeding. This condition can happen around puberty and perimenopause or in medical conditions such as Polycystic Ovary Syndrome (PCOS) and thyroid disorders.
Dawn shared about her experience with PCOS and how it did not actually cause her heavy menstrual bleeding. Dr. Ong clarified that women who suffer from PCOS generally have periods that are spaced out and may not necessarily experience heavy menstrual bleeding.
3. Blood Disorders
Women with medical conditions such as low platelet count usually experience symptoms such as easy bruising, bleeding while brushing their teeth or heavy menstrual bleeding. In addition, women who take medication to prevent blood clotting (e.g. Warfarin) may also experience heavy menstrual bleeding.
How Doctors Diagnose Gynaecological Problems like Heavy Menstrual Bleeding
Doctors will typically do a physical examination to feel the abdomen and see if the uterus feels enlarged, or if the cervix is the source of bleeding. Blood tests are also done to look out for anaemia, low iron levels, thyroid or any blood disorders. A pelvic ultrasound may also be done to examine the womb and ovaries.
Diagnostic procedures such as pipelle sampling can also be done to collect samples of the uterine cavity.
Alternatively, a diagnostic hysteroscopy can be done to take samples or even remove fibroids and polyps. During this procedure, a hysteroscope is then carefully inserted through the cervix into the uterine cavity. Sterile saline is then injected through the hysteroscope to inflate the uterine cavity. On a TV monitor, you can then see images of the uterine cavity. The test usually takes 30 minutes.
Treatment for Heavy Menstrual Bleeding
Treatment options are considered based on factors such as the cause of bleeding, desire for birth control or planning for children, as well as any other medical concerns you may have. Treatments can be medical or surgical.
Medical Treatment:
This can be hormonal or non-hormonal with the aim of decreasing the blood flow and pain. Non-hormonal treatments reduce the menstrual flow by allowing blood to clot more effectively and are only taken when the flow is too heavy.
Hormonal treatments include options such the progestogen containing IUCD, intramuscular injections and oral contraceptive pills. All of these contraceptive options are efficient at reducing bleeding and are reversible.
Surgical Treatment for Heavy Menstrual Bleeding
When medical treatments either don’t work or are not suitable, you might have to go for surgical treatments. Some surgeries may be major, similar to a c-section, depending on the condition or the size of the growth. The permanent cure for heavy menstrual bleeding would be a hysterectomy – a major operation to remove the uterus. This is only considered when all other options have not worked or are unsuitable. This is irreversible and should be considered as a last resort as you will no longer be able to have children after this is done.
Dawn shared how she knows many people who have experienced disruption to their daily lives and avoided going out due to heavy menstrual bleeding. She emphasised that there are many options and all you have to do is to speak to your doctor to seek the best option for you. Not all options are invasive. There’s no reason to allow heavy menstrual bleeding to affect your quality of life.
Dr. Ong reinforced this by saying that the first treatment option is usually medication or hormonal options depending on whether you are planning for children. Surgery is usually only considered when you have an underlying cause that cannot be resolved by medication.
Question & Answer
Dr. Ong concluded her presentation with a question and answer session. These were some of the questions:
1. If heavy menstrual bleeding and cramps cause you to have to take a medical certificate and miss work, is it considered normal?
Dr. Ong responded that if it is affecting your quality of life and it is persistent, it is not considered normal and you should make an appointment to see your doctor.
2. Is there anything you can eat or drink to avoid heavy menstrual bleeding?
Heat therapy has proven to help the cramps. But there is no dietary or lifestyle change that can reduce heavy menstrual flow. However, increasing your red blood cell count helps so it would be good to eat food that is rich in iron. Vitamin C also aids in iron absorption so you can increase your intake of it.
3. Is it normal to have a very light flow every 31 – 35 days?
This can be an indication that you are not ovulating every month so it’s important to see your doctor to find out what is going on. However, if it has always been the case then it should not be a cause for concern.
4. Is it common for teenage girls to have irregular periods?
It is normal for the cycle to take a few years to become regular but by the age of 18 if it is still very erratic, it is a good idea to get it checked to see if there are any underlying concerns.
In conclusion, Dr. Ong’s message to all women was that heavy menstrual bleeding should not persistently affect their quality of life. If it does, you should seek medical advice. We hope that you found the answers to your pressing questions about common gynaecological conditions. Remember, never suffer in silence. When in doubt, consult a specialist and get the treatment you need!