What do all these phrases have in common: “Aunt Flow”; “the painters are in”; “time of the month”; and, (my all time favourite) “there are Communists in the funhouse”? They are all slang terms for menstruation. Western women will have approximately 450 periods over their lifetime. In sharp contrast, prehistoric women only had 50. Whilst periods can be inconvenient they are also perfectly natural, and a very good indicator of a female’s overall health.
However, what do you do when your periods become un-natural? Seven weeks ago I had a total abdominal hysterectomy as this is precisely what happened to me. Yes, my periods were so disruptive and painful that I resorted to life changing surgery. In the previous 6 years my periods had become a nightmare, severely impacting my quality of life and making me generally unwell. I hope that the following will help others who are going through (or, have yet to go through) a similar journey.
My story began back in 2011 when I began to feel exhausted. I was sleeping 9 plus hours a night and napping throughout the day. A blood test diagnosed me with iron deficiency anaemia, most commonly seen in women of reproductive age. Excessively heavy periods (menorrhagia) is often to blame. However, at the time I felt everything in that department was normal, and I was otherwise in good health. My GP prescribed a 3-month course of ferrous sulphate (an iron supplement) and my energy levels gradually returned.
Fast forward 3 years and I was now taking ferrous sulphate daily. My periods were painful, heavy (I was spending 5 times more on sanitary products than I used to) and I often needed to pee. I constantly worried about being caught “short” and took 2 spare uniforms with me to placement each day. Plus, my abdomen was mysteriously changing size and shape and I had difficulty fitting into my clothes. I honestly thought my symptoms were due to aging, so I resolved to get on with life and focus on studying.
Then, a patient asked me when I was “due”. I was mortified that I obviously now looked pregnant. I went straight to my GP who performed a pelvic examination. She detected a mass in my lower abdomen which she suspected to be a fibroid. An ultrasound 2 weeks later confirmed that I indeed had 2 fibroids and that my uterus was the size of a 22-week pregnancy (explaining my increased need to pee).
I had never heard of fibroids, so went home to do some research. Fibroids (medically termed uterine myomas or leiomyomas) are non-cancerous growths made of muscle and fibrous tissue. Fibroids are very common, with 1 in 3 women having them. However, the majority aren’t problematic. They grow in or around the uterus and cause a variety of symptoms, including: heavy periods; pain; and discomfort during sex. Larger fibroids can press on the bladder and bowels causing increased urination and constipation. They can also interfere with fertility and cause problems during pregnancy. The precise cause of fibroids is unknown. However, their development appears to be driven by the female hormone oestrogen. Overweight or obese women are at greater risk (oestrogen levels increase with body weight) as are women of African Caribbean origin.
Obviously this wasn’t the best news. But I couldn’t help but feel vindicated – finally I had an explanation for my symptoms. Much to my friends’ amusement I christened my “babies”: Finola (the size of grapefruit at 10cm); and, Fred (the size of a walnut at 3cm). I was prescribed the progesterone only contraceptive pill which thankfully stopped my periods and I was referred to a gynecology consultant.
The consultant prescribed me a medication called Esmya. This causes fibroids to shrink by blocking specific progesterone receptors. I was naturally keen to avoid the trauma of surgery as I was nearing the end of my training. However, unfortunately my symptoms returned with a vengeance as soon as the 3 months prescription was finished. Clearly Finola and Fred were particularly stubborn!
It was time to up the ante: my symptoms were getting worse, my confidence was plummeting and I was now becoming increasingly reclusive. I decided to have uterine artery embolization (UAE), a non-surgical procedure that blocks the blood vessels that supply the fibroids, prompting them to shrink. It’s carried out under local anaesthetic, has a recovery period of only 1-2 weeks and is thought to not affect fertility. As with all procedures I was to expect some side effects; pain, the expulsion of fibroid tissue and adhesions. But oddly, I felt no ill effects. However, 8 weeks after the procedure I began to have abdominal pain. The pain was so intense that I thought I had appendicitis. However, my GP confirmed that this wasn’t the case, prescribed strong opioid painkillers and booked me in for an urgent MRI.
I was hopeful that the scan would show 2 necrotic (dying or dead) fibroids. But bizarrely, whilst Fred had shrunk by 1mm, Finola had actually increased in size (now 11.5 cms) and a new fibroid (Fenella) had sprouted. It’s important to add that UAE is successful for the majority of women. I had just been unlucky. However, this news was not part of my plan and I began to feel despondent. I was offered a further UAE but declined. I felt that I needed a permanent solution, so when my consultant suggested a hysterectomy, I did not hesitate. Although I knew this meant that I would not be able to have children, my priority was to be rid of these nightmare symptoms.
The thought of being free from my fibroids was liberating. So much so that I half skipped half danced down the corridor that led to the operating theatre. The post-surgery pain was surprisingly easily to manage (I had experienced much worse pre-surgery) and my recovery went reasonably smoothly.
So, 7 weeks after radical and life changing surgery I’m gradually returning to full speed. I can (albeit gently) exercise; my “baby bump” is shrinking and I can almost fit back into my clothes; I definitely have more energy and feel positive for the future. I believe that everything happens for a reason and that I wasn’t destined for motherhood. Acceptance has been key to my recovery and I don’t regret my decision for a second.
Any opinions above are the author’s alone and may not represent those of his/her affiliations. Any comment is based on the best available evidence at the time of writing. All data is based on externally validated studies unless expressed otherwise. Novel data is representative of sample surveyed. Online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice.
Image courtesy of Pixabay
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