"It started about three years ago, when my periods suddenly became quite heavy."
- 25 per cent of Australian women experience heavy menstrual bleeding
- Many women wait years before seeking treatment
- New medical guidelines are available to ensure women have options of treatment
Jenny, 37, was at the beach and didn't know she had just got her period.
"I went to the toilet and suddenly realised that there was blood everywhere — I'd just completely flooded.
"It was horrible."
Jenny is among the 25 per cent of Australian women who experience heavy menstrual bleeding.
Many of those women suffer severe pain, with the condition significantly impacting their social, emotional and physical wellbeing.
"At any moment in time, I might get this gush of blood just come through and flood through the tampon and pad into my clothes.
"That did happen on a number of occasions, and it was incredibly humiliating and embarrassing," she said.
High rates of hysterectomy in Australia
Now, new guidelines for doctors will help ensure women have access to the best available treatment for heavy menstrual bleeding.
Professor Anne Duggan, senior medical advisor at the Australian Commission on Safety and Quality in Health Care, said some women were not being offered the full range of treatments.
"Hysterectomy used to be one of the few options for women with heavy menstrual bleeding, but there are now several less invasive treatment options."
While hysterectomy stops menstrual bleeding, it is a major surgical procedure and is not recommended as a first-line treatment under the new guidelines.
Studies show Australia has one of the highest reported rates of hysterectomy in the OECD, with marked differences between regional and metropolitan areas.
"These differences in admission rates for hysterectomy suggest that the full range of options is not being used across the country, and may indicate women are not being informed about all the options," said Professor Duggan, who was involved in developing the new guidelines.
Non-invasive treatments recommended
The new guidelines recommend women are offered pharmaceutical treatments in the first instance.
If pharmaceutical treatments are not effective, an intra-uterine hormonal device (IUD) may be considered if appropriate.
But, if surgical intervention is necessary, endometrial ablation — the removal of the inner lining of the uterus — and other "uterine-preserving alternatives" are encouraged.
"The first procedures to consider are those that will leave your uterus in place," the guidelines state.
A hysterectomy is discussed when other treatment options are ineffective or unsuitable, or if the woman requests the procedure.
"I was quite keen to avoid a hysterectomy, because it's obviously major surgery," Jenny said.
After having no success with pharmaceutical options, unwanted side effects from an IUD, and not being able to use an oral contraceptive, Jenny decided to have an endometrial ablation.
"I had that done and that's cured the problem.
"I get very little bleeding now, and it only lasts for two to three days. So it's very manageable. And I'm hardly going through tampons at all," she said.
Causes of heavy bleeding
- There are many causes of heavy menstrual bleeding, but in about half of cases no cause can be identified.
- It may be the result of a structural abnormality such as fibroids — non-cancerous growths of muscle tissue that form within the walls of the uterus.
- Another possible cause is a disorder in the way blood-flow is regulated in the lining of the uterus.
- Either way, the timing of ultrasounds in screening for heavy menstrual bleeding is crucial to get an accurate diagnosis, the guideline experts said.
- The scan should be done five to 10 days from the first day of a woman's period. "This is when the lining of the uterus is thinnest and the reading will be the most accurate," the guidelines state.
Women with heavy menstrual bleeding are at greater risk for iron deficiency and anaemia, and around 50 per cent who are referred to specialists experience severe or very severe pain.
But for many women, recognising heavy bleeding as a medical condition isn't always easy, Jenny said.
"As much as it was affecting me and it was horrible and frustrating, I kind of thought, 'yeah but it's my period, what can I do? It's just a period and I've got to put up with it'."
Jenny lived with heavy menstrual bleeding for a year before deciding to seek help.
"The worst thing was just being so afraid that I was going to get my period and thinking if it comes, does that mean I should take a few of days off work?
"That was really difficult."
She said it was important for women to know that help is available.
According to the new guidelines, women with heavy menstrual bleeding should be offered easy to understand information about the risks and benefits of the various treatments for heavy menstrual bleeding.
It's hoped that improving access to less invasive treatments may help some women avoid the need for a hysterectomy.
The guidelines were developed by medical experts, including doctors, nurses and a patient representative.