Dr Elizabeth Farrell Heavy Menstrual Bleeding Interview

A Silent Health Issue for Women: Jean Hailes Offers Answers

It's a silent health condition that affects up to a quarter of women of reproductive age across Australia"heavy menstrual bleeding. It can lead to fatigue and anaemia and can adversely affect a woman's quality of life.

Many women simply put up with heavy bleeding, which may include flooding through clothes or being unable to leave home on the heaviest days, or are too embarrassed to seek help. Jean Hailes for Women's Health is committed to helping women understand this condition with a series of free resources, including a new podcast.

The podcast features Dr Elizabeth Farrell, Medical Director of Jean Hailes for Women's Health, and Caroline, a woman who suffered from heavy periods for more than 25 years. "It got to the point I couldn't get through the night," Caroline says in the podcast. "During one or two nights I had to sleep with a towel underneath me."

It was taekwondo that finally motivated Caroline to see her doctor, by then aged in her 40s. Caroline was worried about wearing the white martial arts uniform on days when she had a heavy period. "A group of us decided we were going for our black belts, which means we were training three times, four times a week," says Caroline. "There were days when I couldn't go and it was starting to affect my life."

Janet Michelmore AO, Executive Director of Jean Hailes, announced the release of the podcast at a Safer Care Victoria health professional event relating to the new Clinical Care Standard on Heavy Menstrual Bleeding. This new standard, produced by the Australian Commission on Safety and Quality in Health Care, was reviewed and endorsed by Jean Hailes. The standard helps support clinicians in providing appropriate care to women who come to see them with heavy periods.

"The core of this initiative is improving a woman's quality of life," says Ms Michelmore. "What's important about this standard is that it gives health professionals the opportunity to better manage issues relating to heavy menstrual bleeding and also offers women more information to ensure they're being managed correctly."

Jean Hailes has a variety of free, easy-to-understand online resources relating to periods and heavy bleeding, including:
The new podcast, featuring Caroline and how she sought treatment, Heavy menstrual bleeding: what women need to know
A brochure for young women to help understand their cycle, My period: what's normal
A useful one-page sheet to help women track their cycle, including heavy bleeding and pelvic pain, Pain & symptom diary
There is also a link to the Heavy Menstrual Bleeding Clinical Care Standard for consumers at the Jean Hailes website on the heavy bleeding, which also features a webinar and videos

Jean Hailes for Women's Health is a national not-for-profit organisation committed to improving women's knowledge and understanding of complex health issues. Jean Hailes has a unique model, with three integrated units: medical centres, research and a department that translates the latest health findings into practical, accessible information on our website, and through resources, educational programs and health professional events. Jean Hailes only produces trusted evidence-based information reviewed by our in-house team of clinicians. In 2016, Jean Hailes was officially recognised as the Federal Government's national digital gateway for women's health.

Interview with Dr Elizabeth Farrell, Medical Director of Jean Hailes for Women's Health

Question: What is classified as heavy menstrual bleeding?

Dr Elizabeth Farrell: HMB is a common problem affecting 25% of women. It is defined as excessive menstrual blood loss, which affects a woman's quality of life and functioning.


Question: What types of things can contribute to HMB?

Dr Elizabeth Farrell: There are many causes of HMB, some of which are related to specific conditions within the uterus, and others which are associated with changing hormones and other conditions which are at present unidentified. Pathologies such as polyps, adenomyosis, fibroids, endometriosis, cancers and bleeding disorders are all causes of HMB.


Question: In what ways can we manage HMB?

Dr Elizabeth Farrell: In women with HMB, iron deficiency and anaemia must be excluded and treated, as well as other medical conditions such as an overactive thyroid. There are various levels of medicines available to treat the bleeding; either non-hormonal or hormonal medicines. If these medicines are ineffective, a surgical treatment may be sought, such as removal of polyps or fibroids and, as a last resort, hysterectomy.


Question: What are the effects of HMB on a woman?

Dr Elizabeth Farrell: There are the physical effects of blood loss, such as iron deficiency or anaemia, but the effects on a woman's ability to function can be varied. Some women are unable to leave the house on the heaviest days and therefore may have to take time off work/study every month, whereas other women may find their work performance is reduced, or there may be symptoms such as pain, which they have to take off work for. Emotionally it can be very draining and frustrating, as well as impacting on family life and partner intimacy.


Question: How can we treat fibroids?

Dr Elizabeth Farrell: We can treat them by using non-hormonal and hormonal medications, surgery – either to excise the cause, or hysterectomy – or we can use other techniques, such as uterine artery embolisation or MRI-directed ultrasound for fibroid treatment. For more information on HMB, please go to: jeanhailes.org.au/health-a-z/periods/heavy-bleeding

Interview with Caroline

Question: When did you realise you had heavy menstrual bleeding?

Caroline: I always suffered from heavy bleeding and went on the pill in my late teens as a way to help manage it and reduce the cramping as well. It wasn't till after having children and my period regularly lasted between 8 to 10 days did I decide to look into other alternative treatments.


Question: How did heavy menstrual bleeding affect you?

Caroline: I regularly had times when my tampons would leak or I had to sleep on a towel to protect the mattress. I would have to make sure on heavy days I had a bathroom nearby as sometimes I was having to change tampons every two hours. There were some days it stopped me from doing activities such as swimming and taekwondo (a leaking tampon was not a good look when wearing white pants and doing high kicks!). It really wasn't until after my treatment did I realise just how much it did affect my life.


Question: How did you learn to manage your heavy menstrual bleeding?

Caroline: I just lived with it, planned ahead for those heavy days and knew when to wear dark pants; and double protection – tampons and pads.


Question: Have you found a treatment option for heavy menstrual bleeding?

Caroline: Obviously there are many different treatments out there, in consultation with my obstetrician I chose ablation and was extremely happy with the outcome.

Question: How did treating your heavy menstrual bleeding change your life?

Caroline: A surprise benefit was an increase in energy levels. But the biggest change is peace of mind; I now never have to worry leaking, which is amazing.


Interview by Brooke Hunter