Why it’s time to stop ignoring the plight of women with heavy periods

In Australia, one in three women have had health concerns dismissed by their doctor. This number is likely much higher for women of colour, women with disabilities, women experiencing poverty, and LGBTQIA+ women and non-binary folk.

Pervasive gender bias creates serious barriers to accessing quality healthcare, especially for reproductive, menstrual and hormonal health issues. Persistent period stigma causes menstruation to be dismissed or minimised, even in healthcare settings.

Recent research suggests that the majority of Australian university students did not have confidence in managing their menstruation, with stigma and negative perceptions a key contributing factor.

This is especially concerning for the one in five Australians who live with heavy bleeding, also known as menorrhagia. Treating periods as a taboo topic is causing many women to suffer needlessly without appropriate diagnosis or treatment.

Menorrhagia: heavy periods are more than just an inconvenience

Menorrhagia is a condition where menstrual bleeding is abnormally heavy or prolonged. It can also cause extreme abdominal pain, making your usual activities painful, inconvenient, and in serious cases, impossible.

Up to 15 per cent of Australians who experience heavy menstruation have an underlying bleeding disorder, which too often goes undiagnosed and untreated.

Untreated menorrhagia impacts your ability to work, socialise, enjoy your hobbies and lead a healthy lifestyle. It is associated with higher risk of anaemia, and if severe enough can even lead to hemorrhages requiring blood transfusions or hysterectomies.

Women seeking medical help for their debilitating periods are sometimes shrugged off with generic suggestions to rest and consider taking the oral contraceptive pill. If the pill fails to alleviate the bleeding, or is otherwise unsuitable, they may be told to simply accept their situation and avoid making plans when their period is due.

The average woman spends a cumulative seven years of her life menstruating – that is a long time to miss out on the things you love because of a condition that may be treatable.

Fortunately, there are treatment options available, even if your doctor may not have presented them to you.

Medical and surgical treatment options for menorrhagia

If you have heavy or uncomfortable periods, your general practitioner or gynaecologist is the best place to start. They will provide you with information and options for a treatment plan.

In Australia, most women with menorrhagia are presented with two treatment pathways: medication or surgery.

Medication-centred treatment is usually explored first, as it is less invasive and may have fewer side effects than surgical options. Medications are usually also less likely to have implications for your fertility later in life.

Depending on your situation, your doctor may recommend medications including clotting agents to reduce your flow, anti-inflammatory drugs or contraception delivered via a pill or a hormonal-releasing intrauterine device (IUD).

All medications have potential side effects and pros and cons, so don’t hesitate to ask your doctor as many questions as you need to make an informed decision. The Royal Women’s Hospital have a useful overview of the medical treatment options for menorrhagia, including a summary of their pros and cons, on their website.

If medications do not alleviate your symptoms, or don’t work for you for other reasons, surgery may be offered. There are three main types of surgeries recommended for people with heavy periods.

A hysterectomy is the most invasive surgical procedure for menorrhagia and has the longest recovery time. It is usually the last resort, as it eliminates your ability to conceive in the future. It also has greater risks as a major surgery in which the uterus is removed entirely, sometimes along with your cervix, fallopian tubes and ovaries.

In some cases, it can trigger the onset of early menopause. On the plus side, it is the only guaranteed way to stop vaginal bleeding altogether, and it may even stop period pain and reduce the risk of uterine and ovarian cancers.

Myomectomy involves removing any fibroids from your uterus. It is typically effective at reducing heavy bleeding if fibroids are the underlying cause, and is a good option for people who want to have children in the future. However, risks include fibroids regrowing, blood loss and, in emergency situations, the need for a full hysterectomy.

Endometrial ablation is the least invasive and safest surgical option for heavy periods, with most patients spending only one day in hospital. Endometrial ablations involve removing or destroying the lining of the uterus using heat or microwaves. It can be done under general or local anaesthetic.

Endometrial ablation provides significant relief for about 85 per cent of patients who have the procedure, and can also be used to remove fibroids and polyps. The main downsides of this procedure are the risk that heavy bleeding can return, and the fact that future pregnancies will be risky and thus not recommended.

For women not wanting to have children, endometrial ablation is a fast, effective option that doesn’t require a lifetime of medication or invasive surgery. So why are they still relatively rare in Australia?

Why aren’t more women having endometrial ablations?

Despite their relative effectiveness and safety, endometrial ablation is a relatively uncommon solution for menorrhagia in Australia.

Women are actually more likely to have a full hysterectomy to alleviate heavy bleeding, despite clinical guidelines recommending uterine-sparing procedures (like ablations) over hysterectomy.

Even more strangely, hysterectomy rates are far higher in Australia compared with other developed countries such as the United Kingdom, where ablations are three times more common than hysterectomies.

What is the reason for this disparity? Why are women undergoing invasive, painful and complicated surgeries with a range of risks when an easier, less painful option is recommended by the latest clinical guidelines? Research into this is still limited, however access, awareness and training of medical practitioners may play a role.

Whether an endometrial ablation is the right answer for you depends on your preferences, plans to have children, your reaction to other options like the contraceptive pill, and your access to an experienced practitioner to perform the procedure.

If your doctor is unable or unwilling to explore a treatment option you think might work for you, you are entitled to seek a second opinion. The medical industry is full of amazing people doing incredible work, but they are still human beings with their own biases and limitations to their knowledge.

You are the expert in your lived experience, and you know your own body more intimately than anyone. Never be afraid to take a proactive role in managing your menstrual health, or allow shame or stigma convince you that you need to suffer in silence.

The lack of attention afforded to menorrhagia is just one manifestation of the gender bias that influences how women experience our world. It is a symptom of a larger issue that does not have a simple fix.

However, every time we speak up and advocate for our rights to control our lives and our bodies, we are creating change. Not only for ourselves, but for those who will come after us.