Bleeding through your clothes is not normal. Pain which keeps you indoors is not normal. Nor is anaemia. These are some of the common signs and symptoms suffered by millions of girls and women every month around the time of their period. Not to mention diarrhoea, vomiting, dizziness, fainting, sleeplessness, depression and anxiety. Accompanied with this are missed school days, sick leave from work (citing reasons unrelated to their period in 73% of women), inability to attend social activities and a feeling of helplessness. Not knowing what is causing it fuels further anxiety each month.
Many women may think that this is “normal” for their period. Some women may have contacted their GP with the advice to take simple pain relief and that things will improve. Work colleagues may be suspicious about someone calling in sick due to their period. Even in the NHS there can be an attitude to “suck it up” as this happens to all women. I see it, and I hear the comments. This is not only unhelpful but also dismissive of the impact of period related health issues on a woman’s life. It does not happen to all women. And if it does happen, it is not ok to trivialise it.
I spent a full day every month during medical school in agony, writhing around on the floor in my student room feeling like my insides were about to explode, due to heavy and painful periods. At some point I would have passed out before coming around to find that the pain had somehow ebbed away- a total state of Nirvana. Registration of students during lectures is not the norm any longer. I would have struggled had I been working. Even as a medical student I thought the symptoms I was experiencing were normal. After an episode in which I found myself in A&E having morphine injected into my buttock for the pain, the A&E doctor looked sympathetically at me and told me that this was indeed “normal”. It would get better when I had a baby. Really?! This was the advice to treat my horrendous periods! To go and have a baby?!
I was not surprised to read the findings of a new survey for the “Am I Number 5?” campaign, which aims to raise awareness and provide information on heavy periods; helping women understand whether they are ‘1 in 5’ affected and encourage them to see their GP for help. Heavy periods, for which the medical term is menorrhagia, affects 4 million women in the UK. Commonly pain (dysmenorrhoea) is accompanied with menorrhagia. Almost two thirds of the women surveyed did not realise that menorrhagia is a health condition which can lead to further health problems. Heavy periods over a prolonged period of time can commonly lead to anaemia, a condition in which there are fewer red blood cells available causing lack of iron. This soon leads to symptoms of fatigue, breathlessness and palpitations which may require a blood transfusion to treat. The cause for heavy and/or painful periods includes fibroids and adenomyosis, both benign conditions affecting the muscle of the womb. Endometriosis is a further chronic condition that can cause significantly painful periods, painful sex and impaired fertility. If severe it can even involve the bowel and bladder.
Not only do heavy periods cause considerable impact on millions of women across the nation but also on employers. The survey highlights the 5,581,186 days off work every year due to menorrhagia, costing over £531 million. When more than two thirds of women feel unable or unwilling to report the cause of their sick-leave to be related to their period we have a problem.
The problem is stigma and to quash it we need to find a way to openly discuss period related health issues.
So what is menorrhagia? Menorrhagia, or heavy periods, is defined as excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life (Heavy menstrual bleeding, National institute of clinical excellence). It is not by quantity, but by the impact on the woman’s quality of life. Dysmenorrhoea, painful periods, usually requires pain relief, with a cocktail of paracetamol, NSAIDs (such as Ibuprofen, Neurofen or Mefenamic Acid) and/or opioids (Codeine, Buprenorphine) to manage throughout the day. A small number of women may need to be admitted to hospital during a particularly bad episode to receive morphine as an in-patient, which can cause side effects of vomiting, itching and significant dizziness. Furthermore many endometriosis treatment centres work closely with a chronic pain clinic to manage dysmenorrhoea as an out-patient.
A recent report by the All-Party Parliamentary Group on Women’s Health of over 2600 women in the UK (with endometriosis and fibroids) revealed that 42% women felt they were not treated with dignity and respect by their healthcare providers. More than 60% felt dissatisfied with the information provided related to their periods and nearly half are not told about treatment side-effects appropriately when counselled about their gynaecological health. Women consult their GP’s more often than men, particularly in their reproductive years, between the ages of 15 and 44. As healthcare professional we need to listen more carefully to women’s concerns about their periods. We need to ask the right questions and invite their concerns. To provide information both during the consultation and in written form will allow women the chance to make an informed choice of the type of treatment they would like to receive. They should actively be offered the chance to come back and see their GP should their symptoms not improve, and/or be referred to a gynaecologist for further advice and management.
We have a lot of work to do. This is not “women’s problems”. We do not talk about period related health issues and this silently continues to impact both on our work and family lives. Heavy and/or painful periods do not affect all women, but when they do, they can cause debilitating effects. A chronic condition like fibroids or endometriosis can mean several hospital appointments with possible medical or surgical treatment. There has got to be an open conversation about supporting young girls and women to be open about the impact period related health issues will have on their work, activities and personal life. Employers need to listen and encourage an open environment to allow for honest reporting of sick-leave related to periods. We cannot afford to feel embarrassed to talk about it.
I only found out what was causing my symptoms once I was a qualified doctor. But this took me 10 years to do. I would like to encourage women to not delay seeking help or support. There needs to be no excuses made.