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Heavy Menstrual Bleeding - not just a physical affliction

  

  Heavy Menstrual Bleeding can impact all premenopausal women, and physical symptoms such as pain, cramping, bloating and blood-loss are commonplace. Less acknowledged however are the social and psychological implications of having a heavy period which can cause women to experience isolation and withdrawal, and can impact on work, family and relationships.

     For younger Australian women who are coping with the condition, it is more important to be able to continue their day-to-day activities than to undertake an evasive treatment. Many wait until it has reached a point of severe distress before considering seeking medical attention, often causing the condition to be more advanced.

      To an otherwise healthy younger woman, yes, taking medication daily, or even timing medication with the day of the first onset of bleeding, may be the golden ticket in treating what they consider the burden of their condition, but consideration needs to be made for the lengthy conversation around the side effects of those medications, as they can have just as much a negative outcome on a younger woman’s physical and lifestyle aspects as the condition itself.

     Acne, weight gain, mood swings, spotting, irregular bleeding, nausea, diarrhoea, breast soreness, changes to libido and sex drive... It may be straight forward to a health care professional, ‘’take the tablet… decrease your chances of experiencing a heavy bleed’’, but on taking that tablet, these women may experience symptoms that would potentially further isolate.  So, the option may in fact be supportive treatment.

  Surgical options for their individual condition are often considered if medications are unsuccessful or contraindicated. Endometrial ablation (removal or destruction of the lining of the uterus), myomectomy (removal of fibroids from the uterus) and hysterectomy (removes the entire uterus) are the three procedures that are offered for treatment of heavy menstrual bleeding. Significant education and consideration needs to be taken when surgical treatment options are given to patients, especially those of a younger demographic. Younger patients often want the quick fix, the easiest option - even if it in itself is a drastic medical procedure that can permanently impact their ability to have children later in life.

Health care isn’t as textbook as it once was, and in an age where you can download an app to monitor your heart rate (albeit not a very accurate or thorough app) it is important for health care practitioners to understand what can be utilised in the younger age groups to help them become informed, empowered and engaged in their healthcare.

  The physical impact of the condition is more often than not, easier to treat than the psychological and social impact. It is important that a support system be established for the patient, and that her condition is treated in a holistic manner, that does take into account her current condition and symptoms, the impact of those, all treatment options (both surgical and non-surgical) and the potential side effects or impacts of those options, as well as the long term goals that the patient wants to achieve.

  Establishing a long term treatment plan is as important as short term treatment goals, with more younger women approaching their health from a collaborative perspective by using a multitude of health care providers, pharmacists, psychologists, alternative therapies and also technology to bring together and actively treat their conditions. Health care isn’t as textbook as it once was, and in an age where you can download an app to monitor your heart rate (albeit not a very accurate or thorough app) it is important for health care practitioners to understand what can be utilised in the younger age groups to help them become informed, empowered and engaged in their healthcare.

  The conversation surrounding heavy menstrual bleeding is uncomfortable for many women – even for women working in the healthcare industry – but it needs to be a critical component of treatment.  Healthcare professionals need to encourage a discussion about the social needs and future goals of their young patients, especially when considering medical intervention to prevent further psychological implications.

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Stephen CarboneHolly Robinson
BN GDipMid AAPM. Winner of 3 professional awards, Holly has been nursing for over 10 years, 8 years in primary health care and now practice manager of a busy private practice in Campbelltown. Holly is qualified midwife and her passion lies in child and family health and women’s health with a keen interest in sexual health and continence care and promotion.