Why it’s so dangerous for doctors to label heavy periods ‘normal’: They could be a sign of a more serious condition that affects two in three women

Caroline Mansi was hiking in the forest with her sister in the spring when she suddenly felt dizzy and felt a large discharge of menstrual blood.

‘I had to lie down on the forest floor because I was so weak and unconscious,’ recalls Caroline, 39, a deputy headteacher at a primary school in Enfield.

It took him ten minutes to feel strong enough to stand up. They took the quickest route to the parking lot, where Caroline ducked into a public restroom.

‘When I looked down I was covered in blood,’ he recalls. ‘I also had a huge clot and coil, 10 cm in diameter. ‘I had to change all my clothes.’

Caroline went to A&E to have blood tests, but after a long wait she returned home disappointed after not getting any answers or advice from doctors.

Caroline Mansi, 43, had no obvious signs of fibroids until she was in her late 30s.

In fact, this was not the first episode of this kind. Eighteen months ago, in the summer of 2019, Caroline began bleeding all day, every day, for no apparent reason. Her doctor had prescribed a Mirena coil to control the bleeding; because this coil secreted hormones that thinned the uterine wall, thus reducing the amount of tissue to be shed. It had no effect.

Provera, a synthetic form of the hormone progesterone, which regulates menstrual bleeding, was also prescribed to ease periods; which made little difference. The GP referred Caroline to a gynecologist, but there was a two-year wait due to Covid.

‘It was terrible. I don’t know how I got through it,” recalls Caroline, now 43.

‘I was regularly passing large clots, experiencing excruciating cramps and bleeding onto my clothes. ‘I had to carry a change of clothes everywhere.’

He had to run to the bathroom a few times after noticing blood running down on my chair while I was teaching. It was so embarrassing.

The blood loss also caused anemia, and he felt exhausted despite taking iron pills every day. The pressure on his bladder sometimes caused him to leak urine.

When she finally saw a gynecologist in 2021, she was prescribed norethisterone, which mimics progesterone. This helped control blood loss. An ultrasound scan revealed the cause: A fibroid – a non-cancerous growth of muscle and tissue that develops in and around the uterus.

Consultant gynecologist at University College London Hospital and HCA Portland Women’s and Children’s Hospital. Myoma diagnosis is a problem in the UK due to long waits to see a gynecologist, says Karolina Afors

‘Just knowing the reason was a huge relief,’ says Caroline. ‘I wish it hadn’t taken so long.’

Although two out of every three women of childbearing age have fibroids, many of them are not aware of it because they do not show any symptoms. Others have heavy periods; swelling; pelvic pain; bladder pressure; constipation as well as pain during sex.

Surveys show that although the condition is very common, general awareness is low.

Another major problem is the long wait to see a gynecologist in the UK. Consultant gynecologist at University College London Hospital and HCA Portland Women’s and Children’s Hospital. According to Carolina Afors, in some European countries, women are examined every year for screening and control.

Ignoring heavy periods by some doctors may contribute to referral delays.

This was also the case for Caroline, who felt ‘tricked by her GP’, who told her it was normal to change sanitary towels every two hours. Fibroids become more common with age and shrink after menopause. In Caroline’s case, there were no obvious symptoms until her late 30s.

There are different types of fibroids. I had a submucosal fibroid that was growing in the muscle lining and protruding into the uterus, causing distortion and heavy bleeding. This, rather than the 1.5 cm size, was what caused the intense bleeding.

Other fibroid symptoms include chronic bloating and needing to urinate more often than normal (as these are similar to ovarian cancer, an ultrasound is needed to rule this out). Fibroids can also affect a woman’s fertility because they can distort the shape of the uterus, making it harder to get pregnant and increasing the risk of miscarriage.

Some can grow very large. Consultant gynecologist at Leeds Hospital NHS Trust and spokesman for the Royal College of Obstetricians and Gynecologists. Hlupekile Chipeta says he operates on women whose fibroids are large enough to grow into the upper abdomen and perform “everyday tasks like bending over or stooping.” ‘Wearing a belt is uncomfortable’.

‘When we talk about fibroids being benign, it underestimates the distress and significant impact they can have, regardless of their size,’ she told Good Health.

But despite such a common and potentially debilitating problem, surprisingly little is known about the causes of fibroids. Hormones, particularly estrogen and progesterone, are thought to play a role.

Women from certain black or Asian groups appear to be more likely to develop them. Being overweight is also thought to be a factor, possibly due to the increased amount of estrogen produced by body fat. Research also suggests that high blood pressure may also play a role.

A review published in the Journal of the American Medical Association found that the risk of fibroids was 19 percent higher in middle-aged women with untreated high blood pressure. The risk was reduced by 49 percent in women who had high blood pressure and controlled it with medication.

Taking vitamin D may also shrink fibroids in women with vitamin D deficiency, according to a study published this year in the journal Nutrition in Cancer. The charity Wellbeing of Women is funding two research projects into fibroids. Researchers from the University of Edinburgh are studying, among other things, how the hormone progesterone acts on the uterine lining in women with fibroids.

One of the researchers, Dr. ‘This is important because many of the medications used to treat heavy menstrual periods act on the progesterone pathway,’ says Varsha Jain.

‘But if progesterone works differently in women with fibroids, this could explain why drugs fail to work in a third of women with heavy periods and they have to resort to hysterectomy.’

In addition to the combined birth control pill, which turns off the hormones that play a role in fibroid growth, available treatments include tranexamic acid, which prevents the breakdown of blood clots and prevents bleeding, and the Mirena coil, which thins the lining of the uterus and causes less bleeding. Tissue that will shed at some point.

Ryeqo, a daily tablet for heavy bleeding caused by medium to large fibroids, has been available on an NHS prescription since 2023.

It acts on the pituitary gland in the brain, inhibiting progesterone production and reducing estrogen; both play a role in fibroid growth. It is also a hormone therapy that compensates for estrogen deficiency; Otherwise, it may cause hot flashes and affect bone density.

Consultant gynecologist at the Private London Gynecology Clinic, Dr. ‘While fibroids may not disappear, they will likely remain stable or reduce in size,’ says Narendra Pisal.

In severe cases, women may be offered injections of gonadotropin-releasing hormone agonists to induce temporary menopause. Symptoms usually improve within four to eight weeks. These can be given for up to six months, or up to two years if taken with HRT. Menstrual periods return a few weeks after the last injection.

Another option is radiofrequency embolization, which uses radio waves delivered vaginally to cut off the fibroid’s blood flow.

Sonata, a new treatment that is a combination of high-intensity ultrasound and radiofrequency energy used to destroy fibroids, has recently been approved for use on the NHS in selected centers under local anesthetic.

Keyhole and abdominal surgery can be done to remove fibroids, but there is a risk of scarring, which can affect fertility. And with all treatments, fibroids may grow back or ‘seedling’ fibroids may be missed and grow in the future.

In severe cases, women may be advised to undergo a hysterectomy.

Following her diagnosis, Caroline was treated using Sonata in November 2022. The process took just over an hour.

‘The bleeding stopped immediately and I didn’t get my next period for nine months,’ she says.

‘When my periods came back they were relatively normal and only lasted four to five days.’

Two years after her treatment, she says: ‘I really want to shout from the rooftops about this. ‘More women need to know that fibroids may be the cause of their heavy bleeding and you don’t have to put up with it.’