Menstruation is a necessary, natural cycle that affects half the world’s population. However, for some women this cycle can have significant impact on their quality of life, meaning that they can face stigma, shame and belittling.
Defined as losing 80ml or more in each period, and lasting longer than seven days, heavy menstrual bleeding is not a mere inconvenience; for many women it is lifestyle limiting, causing fatigue and anaemia, interfering with work and sexual life, resulting in pain, discomfort and emotional upset.
Often these women’s voices are the unheard population, as many hesitate in contacting their GP and instead live with periods and heavy menstrual bleeding.
Improving quality of life and changing national clinical guidelines
Professor Janesh Gupta, Professor of Obstetrics and Gynaecology working as an Honorary Consultant at Birmingham Women’s and Children’s Hospital, conducted the largest randomised clinical trial in the world assessing how women with heavy menstrual bleeding should be treated medically.
The levonorgestrel-releasing intrauterine system, also known as the Mirena coil (LNG-IUS; Mirena®), was developed as a contraceptive, but it also reduces menstrual blood loss. While studies has shown this leads to a reduction in menstrual blood loss, none of these trials measured the effect of heavy menstrual bleeding on women’s lives nor followed women for longer than one year.
Heavy menstrual bleeding is a common problem often going untreated.
The ECLIPSE trial led by Janesh found that the Mirena coil was more effective than usual medical treatment in reducing the effect of heavy menstrual bleeding on quality of life; ECLIPSE’s results influenced the UK’s National Institute for Health and Care Excellence (NICE) guidelines.
“In the past, we used to collect the used sanitary wear of women to measure blood loss, but we have now moved on from that archaic method to focus on quality of life instead,” states Janesh.
“The biggest advantage of the Mirena coil is that it is fitted as a contraceptive device. Progestogen, the hormone released, works on a daily basis and removes the need for taking oral tablets by stopping the period by creating a pseudo-pregnancy, informing the womb that there is no need for a bleed.”
Furthermore, it is thought that any oestrogen-dependent condition – such as fibroids and endometriosis – may be able to be treated with the Mirena coil. In fact, a major study is currently being finalised which examines the effectiveness of the Mirena coil to treat endometriosis.
Making an informed choice
According to NICE, about 1 in 20 women (mostly aged 30-49 years) consult their GP each year because of heavy periods (sometimes called menorrhagia). These consultations lead to around 12% of all referrals to gynaecology services; if the patient has no ‘red flags’ then they are usually fitted with a Mirena coil, either by their own GP if they have the required competencies or by a different GP or at a hospital.
Empowering women to ensure that they can make an informed choice about the best treatment for them and that they are treated with dignity and respect is the mission statement of the All-Party Parliamentary Group on Women’s Health.
The Mirena coil offers a huge number of advantages. For heavy menstrual bleeding, it works all the time, releasing a smaller amount of hormone than tablets and delivering this in a localised area.
The Mirena coil offers hope to women suffering with heavy menstrual bleeding.
The main issue for some women is having the coil fitted and then there can be up to nine months of irregular bleeding. Such experiences can put women off and lead to negative ‘word of mouth’. But, given time and counselling during this settling in period, it is a remarkably effective treatment that is now considered as the first treatment for heavy menstrual bleeding in women with no other factors that exclude them for treatment.
Janesh encourages women not to suffer in silence “What is clear is that when heavy menstrual bleeding affects your quality of life, you should be able to do something about it; you should have a choice. My advice is to see your GP and ask for help. If the Mirena coil is suitable for you, you will be referred by your doctor for a fitting and you should see the benefits within three to six months.”
Reducing unnecessary hyperplasia-related hysterectomies
Janesh’s research has also highlighted the effectiveness of the Mirena coil to treat endometrial hyperplasia, a commonly diagnosed pre-cancerous condition that can, if untreated, become cancer of the womb. Hyperplasia occurs when there is a misbalance of oestrogen and progesterone.
By treating the lining of the womb with progesterone the Mirena coil helps to regain that balance and is expected to reduce the number of hysterectomies carried out worldwide for this condition by at least 80%; this research has been instrumental in the development of national guidelines by the British Gynaecological Cancer Society and Royal College of Obstetricians and Gynaecologists.
Janesh says: “My research has focussed on identifying optimal medical treatment options for many benign conditions that were traditionally treated by surgery, such as hysterectomy.
“The Mirena coil has been shown to be effective in women suffering with heavy periods, endometrial hyperplasia and possibly endometriosis. My research has shown that in the vast number of women, major surgery and its possible complications can be avoided by the introduction of a simple medical treatment option.”
Don’t suffer in silence
“Heavy menstrual bleeding is a silent disorder that many women accept as a normal part of their life, regardless of the major impact that it has on their quality of life,” Janesh explains.
“I am passionate about my research because heavy menstrual bleeding is treatable. In the vast amount of cases, surgery can be avoided. The Mirena coil is a ‘fit and forget’ treatment that can have such a positive impact on a patient’s life; some women may experience negative factors for a time, but the vast majority will benefit significantly.
“The Mirena coil is simple and straightforward; it has the same impact as surgery but with a much smaller form of intervention.”
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