Breaking the silence on menstrual misery: Why women should seek help early when it comes to painful cramps and heavy bleeding

Most of us know Bindi Irwin as a bubbly and eloquent Australian television personality who is passionate about wildlife conservation. Behind the scenes, however, the 24-year-old had been struggling with “insurmountable fatigue, pain and nausea” for a decade due to endometriosis, a chronic condition related to menstruation. 

Bindi, who revealed her diagnosis earlier this year, noticed the symptoms when she was 14. Despite the heavy bleeding and severe discomfort that often left her curled up in a foetal position, it was dismissed as something she would have to “deal with as a woman”.

Bindi joins the growing chorus of women who have spoken up about their struggles with uterine health issues, in the hopes of empowering others to take charge of their menstrual wellness and seek help when needed.

In Singapore, menstrual issues have emerged as one of the top concerns in the Women's Health Survey 2022 conducted by Doctor Anywhere and Bayer, with eight in 10 being affected by such conditions. The survey is part of Bayer’s Conversations of Care initiative that seeks to drive awareness and conversations around women’s health. 

Associate Professor Manisha Mathur, deputy head and senior consultant at the Department of Obstetrics and Gynaecology at KK Women’s and Children’s Hospital (KKH), pointed out that misconceptions surrounding excessive menstrual bleeding and menstrual pain mean that many women experiencing those symptoms “suffer silently and do not seek help until it is quite late”. 

THE RED FLAGS: DEBILITATING PAIN AND HEAVY BLEEDING

During the monthly menstrual cycle, it is not uncommon to experience mild aches or discomfort. Assoc Prof Mathur explained that the pain occurs due to the release of hormones called prostaglandins. 

Mild menstrual pain can be treated using anti-prostaglandin medications, such as mefenamic acid or ibuprofen, which are available over the counter, she said. However, if the pain becomes severe, hindering your ability to carry out daily activities, it may signal an underlying issue that necessitates medical attention. 

“A small proportion of women experience severe pain that debilitates them, causing them to stay in bed for extended periods and leading to regular absences from work. Such pain markers warrant further investigation,” said Assoc Prof Mathur. 

On average, a woman loses up to 40ml of blood during her period, though blood loss varies with each individual, shared Assoc Prof Mathur. Bleeding for up to seven days in a menstrual cycle lasting between 21 and 35 days, and changing three to four sanitary pads a day is considered “normal”, she added. 

What deviates from normal is the need to change pads every two hours or having to get up in the night to do so. “Experiencing flooding, characterised by bleeding that leads to staining of clothing or bedding, and frequent passing of large clots, is also not normal,” Assoc Prof Mathur elaborated.

A common misconception about menstrual bleeding is that it is a “cleansing process for the body”. Said Assoc Prof Mathur: “The fact is heavy menses could be caused by an underlying condition such as fibroids or polyps, or a hormonal imbalance, and should therefore be treated.” 

Heavy bleeding is generally more common at certain stages of a woman’s reproductive life, particularly in the initial years after the onset of menstruation in young girls as well as in women over 40.  

“In young girls, heavy menstrual bleeding is likely due to hormonal imbalances that usually resolve as they mature. In older women, there could be several causes – including fibroids, polyps, pelvic infection and hormonal fluctuations – that come with age,” Assoc Prof Mathur explained. It is important to seek help early, she added, as heavy bleeding may, in rare cases, be linked to cancer.

According to Assoc Prof Mathur, if left untreated, heavy menstrual bleeding can lead to anaemia that may affect day-to-day life and require blood transfusions. Symptoms of anaemia include shortness of breath, fatigue and reduced endurance during physical activity. Sexual and mental health could also be impacted by heavy menstrual bleeding in the long run. 

TREATMENT OPTIONS FOR IMPROVED MENSTRUAL HEALTH

There are various treatment options for heavy menstrual bleeding. For example, non-hormonal medications are usually prescribed to women experiencing regular heavy periods, to be taken on days of heavy bleeding. 

However, in cases where hormonal imbalances contribute to the condition, patients may need hormonal treatment. “The most common hormone prescribed is progesterone, either in tablet form or as a hormone-releasing intra-uterine device (IUD), which is highly effective in managing both heavy bleeding and pain,” Assoc Prof Mathur said. “As heavy bleeding is caused by excessive thickening of the uterine lining, the hormone thins the lining and hence reduces the bleeding. The IUD is often recommended as the first line of treatment by authorities such as the National Institute for Health and Care Excellence in the United Kingdom and SingHealth locally.”  

If these medical interventions prove ineffective, surgical options may be considered. 

However, misconceptions surrounding hormonal treatment can lead to delays in seeking appropriate care. Said Assoc Prof Mathur: “Women often feel that hormones can cause problems with fertility or give rise to long-term medical issues. While all medications have potential side effects, hormonal treatment, after careful consideration of contraindications, is an effective approach for managing heavy and painful menstrual periods.” 

Instead of waiting until symptoms manifest, Assoc Prof Mathur advises women of reproductive age to go for yearly check-ups with a gynaecologist. “This would help them gain a better understanding of their own menstrual patterns and identify subtle changes early,” she said. 

Explore the self-check questionnaire centred around heavy menstrual bleeding. 

Take charge of your menstrual health by learning more from KKH.

This advertorial is for informational purpose only and is not meant to be a substitute for advice from a registered medical practitioner. 

PP-MIR-SG-0170-1 (07/23)