Debilitating periods - go on the pill or not?

[FemaleBrent]

Hi folks, just looking for advice - I’m 45 (almost 46) and my periods are absolutely horrendous :( Painful and extremely heavy for the first 3-4 days and last 8 days. My GP referred me for an ultrasound and transvaginal scan and, apart from some very small fibroids which wouldn’t be causing it, all was normal so it’s just been put down to hormonal changes. One option is to go on the contraceptive pill but I’m not sure about doing this - I’m concerned it’ll ‘mask’ the normal functioning of my body ie me being able to monitor the frequency of my periods and any perimenopause symptoms etc. Is this silly, should I just go on the pill and get some relief from this monthly hell??

The pill could help but it will also mask the symptoms. You also need to properly know why this is happening. Fibroids do grow and can cause heavy bleeding to arise. Painful periods are not normal and this is something you should not have to put up with. This should not be dismissed either as mere hormonal changes as such can cause problems like this.

The wait time for gynaecology in many areas is miles long so if finances permit I would go private and see a gynae for further evaluation. Your GP should be referring you on to such a person. Has the GP suggested any other courses of action?

Thank you @AttilaTheMeerkat!! To be fair I just had the scan on Thursday and it was the sonographer’s opinion, I’d had a small fibroid 5 years ago and she said there’s now a few very small ones there but none that would cause the heavy bleeding. She was saying half of all women have them, I didn’t know that! No cysts or anything either, so she said it’ll likely be hormonal. I know sonographers aren’t doctors nor endocrinologists though 😆 My blood tests were all normal too, the GP had ordered those when I had my phone consultation with her. My GP should get the scan results by next week so my plan was to speak to her again about next steps/options but I’m just pre-empting it as she’d already mentioned going on the pill as an option during our initial call. I know what you mean re: going private, I’ll consider this too!

My blood tests were normal too and the constant heavy bleeding continued all the same. It was put down to constant rises and falls of both progesterone and estrogen. I ended up having ablation surgery to remove the lining.

Fibroids are the most common gynae issue seen in women with the second most common being endometriosis.

I would also consider going private particularly if the gps only suggestion going forward is the pill. Gp should be able to write a referral letter. Something is causing this heavy bleeding and you do not have to put up with it.

Well if they are that heavily it’s very likely you’ll end up anaemic soon and that’s not a fun place to be. I had to have two blood transfusions and basically had no iron stores left in my body the Doctor told me. Iron deficiency anemia if left untreated can lead to awful side affects.

The pill or the coil will help regulate it and in my case (the coils) has stopped them pretty much and the pain should ease. Prevention is better than cure so if I were you I’d seriously consider some sort of contraception to control it before it gets worse.

I third going private. The NHS scans found the same and said the fibroids were nothing to worry about, so continued to heavily bleed for two years. I then went private and they said that even though one fibroid was small, it was the one causing all the bleeding. Had it out plus a mirena coil in and it was the best thing I’d ever done for myself.

Coil was a lifechanger for me no more painful and heavy periods in fact haven't had a period for several years.

Can I ask, how does the ablation work in the longer term? I can understand if it’s for polyps/fibroids etc…to get rid of them’and make it normal, but the uterine lining builds up each months so I’m curious if it helps stop the build up in the longer term? I assume it must or they wouldn’t do it for it only to last a month or so?

Thanks all, lots of food for thought - wasn’t sure about the coil either so will think about that too!

The ablation removes the entire womb lining so it does not and should not grow back. It did help in my case and I have felt much better as a result. It’s not for everyone though and I had a number of discussions with the consultant about this and other options before going ahead.

The pill won't mask functioning of other body systems. It simply provides a higher hormonal level. But it won't disrupt other body parts from actually working. The point is to treat the symptoms, and as long as everything has been checked for a more sinister cause then why wouldn't you want better symtpoms. You can further investigate while also treating the symtpoms and pain, and bleeding. One doesn't cancel out the other.

I recommend asking the GP to try the pill and/ or mirena coil can be amazing with heavy bleeding and pain. You might try different pills for a while. The mirena will may the uterus lining thinner, less bleeding, and less cramps), but with the pill, will treat symptoms. So definitely try that. Sometimes the progesterone only pill (mini-pill) can be better for some.

Also, ask your GP for mefenamic acid and/or naproxen (NSAIDs, which help a lot as they are anti-inflammatories and give pain relief). and tranexamic acid (helps reduce heavy bleeding) - you need to start taking it days before your period starts so that it can work at the best capacity. The same is true with ibuprofen and/or paracetamol. Start taking it 3/4 days before, and it will be much better.

Also, you can try some meds to try and shrink the fibroids. Progesterone through the mirena coil or pill, GnRH meds which cause a temporary, medically induced menopause to shrink fibroids. So, for example, linzagolix or injections like goserelin) or nasal sprays.

FYI GnRH meds can cause a temporary medical menopause as well. You can however get add-back therapy (so HRT) with low-dose estrogen to help manage side effects and allow you to take the GnRH meds for 6-12 months. Often its not taken for longer due to risks for bone health etc. Or you can get vaginal progesterone instead like the pessary or the gel.

The mirena and the pill essentially mimick the luteal phase, as your fibroids aren't that big, if you get it inserted right it could help - so make sure you take paracetamol and ibuprofen 1h before and also insert licodaine into your cervix and also numbing gel/spray. Call them before/write on any like booking or online forms and make sure they give you all of that and have it ready. Just as sometimes they don't offer them but have them available. It depends on the place but I know it's becoming more common now, as it should be. So during a menstrual cycle, progesterone is released later on (luteal phase) - it basically tells the hypothalamus and pituitary glands, stop now you've done your job (which is thickening the uterus lining, estrogen's job), let's not go overboard and progesterone maintains the uterus lining (whereas after your period, estrogen stimulates it to grow more). Essentially, the hypothalamus, or pituitary glands, at that point stop producing FSH, LH - that means that less estrogen is produced. Because when LH and FSH are released, it triggers a follow-up of estrogen.
The mirena uses synthetic progesterone to thin the uterus lining and help to shrink things like fibroids. It also suppresses estrogen secretion to hopefully stop more growth of the uterus lining (helpful for periods as there should be less bleeding and cramps). So, mirena coil mimics the luteal phase. I'd really recommend based on my personal experience, but not for fibroids in my case.

@TheLivelyViper thanks so much for this detailed response! Really helpful.
I’ve actually tried tranexamic acid and it had no effect whatsoever - but I followed the instructions and took it on the first day of my period so perhaps I should’ve tried taking it a few days before?
I also started taking mefenamic acid yesterday but it didn’t seem to be doing anything so just took paracetamol today which dulled it a bit. I’m also on hydroxychloroquine which you’re not supposed to take with mefenamic acid so that put me off a bit as well.
I’m now definitely going to speak to the GP about the coil as that’s something I’ve never considered and could be an option 👍🏼

If you decide to try a coil then you might find the insertion is not painful at all. I took paracetamol before my appointment but having a mirena put in felt like a mild period cramp. The cramps I had afterwards were the same level of pain as the actual insertion (maybe 1/10?) Some women obviously do find the insertion painful but I was worried about it and was pleasantly surprised! I have had 2 kids which might help.

I'm 2 years older than you. From around 42 I started having periods every 21 days. They were heavy and painful. I ended up anaemic so do have a look at your ferritin levels. Ridiculously, being anaemic can cause longer and heavier bleeding so it just keeps worsening until addressed. I also had a small fibroid. It's really common at this age and stage. At 44 I tried HRT and the progesterone really helped. I used a small amount of estrogen gel alongside it.
After a year I tried a pill that's good for peri - qlaira? but didn't like how I felt mentally so went back on the HRT. The HRT periods were controlled, only every 4 weeks and much lighter due to the progesterone.
A year ago (2 years of treatment) I came off and am doing pretty well. Periods are much less regular and are much lighter. I skip one every now and then.
The HRT Helped me through a very difficult phase of perimonopause.
You could also try tranexamic acid which you can get over the counter but can't be used alongside the pill or HRT.
Good luck, I hope you get some relief soon. You don't have to suffer.

Just seen you have tried tranexamic acid.
Don't take it before you start bleeding x

With the tranexamic acid - it takes up to 24 hours to start working and it needs the build up. So, take it three times a day for the first 3 days of period to see if it actually works (it did for me, it sometimes stopped the bleeding entirely).

Mefenamic acid works a treat for me. Reduces pain AND significantly reduces blood loss. I have adenomyosis

Yes, for tranexamic acid to be most effective, you need to take it every 12 or so hours, and try 1 day before your period. Check with your doctors, but they said it was fine for me. The packing advice says to not, but it can help in my experience once your doctors clear it. Also, talk to your GP about getting a higher dose. Try that 1-3 times first, doing all of that and a higher dose, and 2 every 12 hours as well.

If all that doesn't work, switch to northisterone instead and try that for a while.

Mefenamic acid can help a lot. If it doesn't, after a while, try another NSAID. There are quite a few, and sometimes a different one just gels with you better. But make sure you take it with food and are consistent with it as well, that is when it works best, also again before the pain starts. That is bard to predict, but for your period, try it a 3/4 days before as well.

Look into some low dose topical oestrogen and low dose HRT as well to help. Or discuss using it with your GP.

What do you take your hydroxychloroquine for? Lupus or another autoimmune condition? Naproxen and I think some other NSAIDs can be taken with it, so maybe ask about that instead of mefenamic acid, as if it's for another autoimmune condition, you may not want to stop it.

Also there are a few other options for fibroids if they get bigger, definitely ask for a scan in 4-6 months to check on their growth or shrinking. If the bleeding gets worse them ask for one earlier.

But if they grow or you get more or after 6+ months of the progesterone they don't shrink, you can look into Acessa or Sonata (radiofrequency ablation of fibroids) or fibroid embolization (interventional radiology procedure to block blood flow). But again wouldn't be done right now but if they grow etc.

Is either Acessa or Sonata available in the uk though?. I’ve only ever seen both mentioned on US based websites and both cost a small fortune.

Sonata is available in the U.K. (Good!) but only around 16 hospitals offer it. In any case I would further speak to your GP and don’t feel too disheartened if neither tranexamic or mefanemic acid tablets don’t ultimately work out.

@BatsatHalloween see that’s the thing, my first 3 days of bleeding are the absolute worst so it’s not much use to me for it to start working after that point!

@TheLivelyViper thanks, I take hydroxychloroquine for urticarial vasculitis, an autoimmune thing but I’m ‘lucky’ in that it’s the non-hypocomplementemic type and affects my skin only (I get hives all over my body but it doesn’t affect my organs).
I’ll definitely do as you suggest and make sure I speak to my GP about all of this - she thankfully was very nice and sympathetic so that helps!

Yes absolutely - my last blood tests showed I wasn’t anaemic so that’s something at least - I guess because the heavy bleeding doesn’t last for the full 8 days at least.

What about the mirena coil? Will help with the menopause too.

To my knowledge it's becoming more offered but not for the OP's level as it is considered small for that. There are other techniques without names with gynecologists and interventional radiologists are trained in, which are similar and are used more regularly.

I noted that only 16 NHS hospitals offer Sonesta currently. In the NHS a myomectomy can be offered for fibroids.

And does the NHS actually have interventional radiologists?.