Heavy menstrual bleeding: Understanding the options

Amanda Lyons

11/12/2017 11:42:22 AM

Hayley Harrison served as a consumer advocate for the Australian Commission of Safety and Quality in Health Care on the ‘Heavy menstrual bleeding clinical standard’, bringing her lived experience of the condition to the working group.

Hayley Harrison found practitioners’ more detailed questions helpful in identifying her own issues with heavy menstrual bleeding.
Hayley Harrison found practitioners’ more detailed questions helpful in identifying her own issues with heavy menstrual bleeding.

newsGP sat down with Hayley to discuss her personal experiences with heavy menstrual bleeding.
What was your experience of heavy menstrual bleeding?
You read that the average is five to seven days, but some women have longer, so you think it’s normal that you’ve been bleeding 10 days a month, every month.
It’s not until you speak to a health professional who tells you, this is not normal and you should get some help, that you feel, ‘Okay, it’s not just me being a bit of a wuss’, it is something that’s valid.
What often made me go to GPs was the pain. It has caused me to have time off work, or work from home – I just couldn’t sit at a computer for seven hours – and the normal anti-inflammatories don’t touch the surface.
[The condition] affects even my social decisions. Whenever I go out on the first five days of my period, I have to change my tampon once an hour. So even going out for a couple of drinks, I just wouldn’t do it, because it was too much of a risk.
At work, I would try to make sure I didn’t have long meetings. Or if I had a conference, where I couldn’t control being able to leave the room as often as I want, I’d really have to consider and think, ‘I have to get the maternity sanitary towels in case I can’t get to a bathroom in time’.
I remember watching the Jason Bourne movies: ‘When I walk into a room, I know where all the exits are’. I’m like that – I know where all the toilets are, that’s the first thing that I check when I’m on my period. It impacts every decision you make: what you choose to wear, what you choose to do, where you choose to go.
It can be a difficult subject for women to discuss. Do you think that is a barrier to accessing appropriate care?
I think part of it is that. Women do talk; I’ve talked to my sisters, I’ve talked to my girlfriends, so I know that my periods are heavier than theirs. But you don’t really talk to the detail, ‘How often do you change your sanitary pad?’
When you go to GPs for the pain, obviously they try and give you stuff to manage it. But it wasn’t until my GP in Australia [Harrison is originally from the UK], when referring me to a gynaecologist, that I was asked detailed questions like, how often do you change your tampon? That was the first time I’d ever been asked those sorts of questions so someone could objectively have an understanding of how heavy my periods were.
Up to then, [practitioners] asked, how are your periods? When they’re asked that question, no one ever says, ‘Well, I’m going to the bathroom every hour to change my tampon, I’m getting up in the middle of the night because I will leak through my sanitary towel otherwise’. You don’t think to talk to that detail.
So that level of detail in questioning was key to identifying the condition for you?
Yes. I’m quite a frank woman, so I’m happy to talk about my periods. But there’s a lot of women out there who would be very embarrassed about having that sort of conversation. So when it’s a GP asking those specific questions, it helps guide that conversation so women can get the information they need.
Once you discussed the issue with your GP and were referred to a gynaecologist, what was the specific diagnosis and what treatment options were provided?
Well, for me, there was no underlying cause like fibroids or endometriosis, so there wasn’t any urgent treatment needed. It was more about management options.
The gynaecologist wanted to do a laparoscopy, but I was actively trying for a baby so I didn’t feel it was worth the risk for me at that time. That’s something I might do in the future, when I’m finished having children.
What the gynaecologist did provide for me, though, was tranexamic acid. I could wait until I started bleeding, so I knew I didn’t have a pregnancy, and then use it. You can’t use it for more than three to four days, but it reduces the amount of bleeding. That was fantastic.
What have you learnt from working as a consumer advocate on the Heavy menstrual clinical care standard?
Being part of this clinical care standard has been fantastic because I’m hearing all the evidence.
I know in the past my GPs have asked questions like, are you planning on having children? Listening to the team talk while we were working on the clinical care standard, I realised why my doctor was asking me that, but there was no shared decision-making in it. Rather, it was, ‘I’m asking these questions because that’s going to control what options I give you’.
But having that honest discussion about – ‘This is what could and what couldn’t help you, and this is the pros and cons of that’ – helps you to make those decisions. It doesn’t need to be a detailed conversation, it just needs to be explained as to why a treatment is being suggested.
For example, a prior GP did actually suggest the Mirena [intra-uterine device], but it was always talked about as just a contraceptive, never that it has been proven to reduce the bleeding.
What is the main thing you would like GPs to know regarding heavy menstrual bleeding?
It’s about giving patients an option that might not work right now, but gives them a pathway to come back to. For example, I’ve chosen not to have the Mirena at the moment because I’m hoping to continue my family. So for me it’s a case of carry on the way I am for now and, once I’ve finished having my family, I will have Mirena, because I know that that’s an option.
For other patients it may be, ‘Let’s go on to the ablation techniques’, or ‘I’ve had enough, let’s go for the hysterectomy’. But unless you know what that pathway is, you don’t know what stops might work for you, along the way.
Is that the difference the clinical care standard might help to make for women like you?
Definitely. I’m a very practical person, I work in the area of advocacy for consumers, and I do understand that GPs have 10 minutes – there’s not a lot of time to try and go through everything. So having the clinical standard there as a leaflet is a fantastic tool for GPs to be able to say, ‘You can see the pathway here, I’m going to talk a little bit about this, have a read of it and then let’s have a discussion about it’.
You’re never going to solve someone’s problems in that first meeting, not with heavy menstrual bleeding – I know that from my own experience. And what works for one person might not work for the next. But to give people that understanding of, ‘This is the pathway I can take, these are the options I have’, gives them hope and the willingness to try other options instead of just saying, ‘I’ve had enough, I’m going straight for the hysterectomy’.
The Heavy menstrual clinical care standard is available on the Australian Commission of Safety and Quality in Health Care website.

This interview has been edited and truncated for clarity.

Australian-Commission-of-Safety-and-Quality-in-Health-Care heavy-menstrual-bleeding Heavy-menstrual-clinical-care-standard

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Eisen Liang   10/03/2019 12:25:43 PM

Can anyone explain to me why uterine fibroid embolisation (UFE) was not even mentioned in the HMB clinical care standard? There have been 7 randomised control trials and a Cochrane review (2014) stating no difference in outcome between UFE and hysterectomy in terms of patient satisfaction, symptom relief and QoL improvement. One would assume the Commission is neutral, impartial and evidence based, with women's interest in mind. Why was this effective non-surgical option omitted in the recommendation?