I am a 36-year-old mother of two. About 18 months ago I started to experience horrendous period pains and severe loss of blood. I can feel blood clots passing; it reminds me of giving birth and I am having bad cramping along with it. Sometimes I can go through a box of pads in a week and most days during my period I just want to stay in bed because the pain is that intense. More recently, my period has come at irregular times and I am worried that I might be starting the early stages of the menopause. My GP has told me not to worry and has suggested that I take some Evening Primrose to relieve the pain. This doesn’t seem to be helping the situation and I am worried that my body is changing. Is it worth seeing a specialist to sort my life out?
Mr Tim Broadhead, Consultant Gynaecologist:
It is very unlikely that there is anything seriously wrong at the age of 36 but these symptoms could be due to a variety of benign conditions including fibroids, polyps or endometriosis. In the first instance, you should have an internal examination by your GP and it would be helpful for your doctor to organise a scan to check your womb and ovaries. If the examination and scan is normal, there are treatments that your own doctor could try without needing to see a specialist. However, you would need to be referred to a specialist if the examination or scan was not normal, or if the treatments that you were trying did not work.
There are a variety of treatments that your own doctor could prescribe, but my view is that evening primrose tablets are unlikely to help! There are a couple of tablets that you could take just during your periods called tranexamic acid or mefenamic acid, which should make them much lighter. Alternatively, depending on your circumstances, the contraceptive pill, implant or injection could help.
Another good option could be the Mirena coil, which is a device that can be easily fitted inside the womb by your own doctor and slowly releases a hormone called progestagen. Apart from being a very good contraceptive, it should make your periods much lighter and in some women, they can stop completely. The pain should improve too.
If these treatments fail to help or if you would prefer to consider a surgical option, you should be referred to a gynaecologist for further assessment. Depending upon your circumstances, a test called a hysteroscopy may be required where the inside of the womb is inspected with a small camera. This can usually be done in an outpatient clinic under local anaesthetic and apart from ruling out anything serious, it will also help to decide what surgical treatments might be appropriate.
One such option could be an endometrial ablation; this is a daycase operation where a probe is placed inside the womb and uses radiofrequency energy to destroy the lining. It is very successful; in 9 out of 10 women, the periods are much lighter and in 6 out of 10, they stop completely, but it is not appropriate for everyone.
The ultimate solution would be hysterectomy which would definitely stop your periods but does involve more major surgery, although the risks are small.
A specialist would be able to discuss the risks and benefits of the different surgical options with you.