Living with Heavy Menstrual Bleeding: Forced to wear adult diapers to cope with heavy flow
After inserting an intrauterine system, Laksmi Hapsari has not had menstrual pain or heavy bleeding, and her fertility is preserved
From her first period at 13, Ms Laksmi Hapsari has suffered from heavy menstrual bleeding (HMB).
And for the next 25 years, the enrichment school owner continued to struggle with the debilitating symptoms of the condition, like painful prolonged periods that could last up to 15 days.
The bleeding was so excessive that at times, the 39-year-old Indonesian - who is married with a 10-year-old son - was forced to wear adult diapers to cope with the heavy flow.
According to Ms Laksmi's obstetrician-gynaecologist, Dr Dharshini Gopalakrishnakone from The Obstetrics & Gynaecology Centre at Mount Elizabeth Novena Specialist Centre, while the average woman loses about 40ml of blood every menstrual cycle, those with HMB lose twice that amount and sometimes more.
Symptoms include soaking through one or more sanitary pads or tampons every hour for several consecutive hours, needing to wake up to change sanitary pads or tampons during the night, bleeding for longer than a week, passing large blood clots, severe cramping that may lead to the overuse of painkillers, anaemia and symptoms of anaemia such as fatigue, shortness of breath and headaches.
According to Dr Dharshini, the most common causes of HMB in older women are hormonal imbalances, fibroids and polyps, but it can also be caused by other conditions such as endometriosis, where endometrial cells grow outside of the womb rather than inside it.
She told The New Paper in an e-mail interview: "The number of women with endometriosis and HMB caused by endometriosis has increased.
"Many experts suggest this is linked to women having fewer babies and having them later in their reproductive years, if at all.
"The hormones released during pregnancy and breastfeeding are thought to suppress the symptoms of endometriosis."
Dr Dharshini describes HMB as common, affecting about 20 per cent to 30 per cent of the women she sees in her practice.
She said: "Between 30 per cent and 40 per cent of women will probably experience HMB at some point... but it is under-reported, with many suffering for years before seeking help."
Ms Laksmi first started seeing two gynaecologists for HMB in her hometown of Surabaya.
In addition to being prescribed hormonal pills and injections, she underwent dilation and curettage (D&C) to reduce the excessive bleeding.
D&C refers to the dilation of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus.
Ms Laksmi was also given painkillers and iron tablets to manage her pain and anaemia respectively, which soon became "a way of life" for her, she told TNP.
In 2008, in a bid to have a baby, she stopped the treatments and the HMB "returned with a vengeance".
She managed to conceive with the help of intrauterine insemination, a fertility treatment that involves placing sperm inside a woman's uterus to facilitate fertilisation.
However, her HMB worsened after she gave birth, and she ended up undergoing one or two D&C procedures a year to manage her condition.
Determined to find a better solution and desperate to avoid a hysterectomy, she came to Singapore and consulted Dr Dharshini, who ordered a pelvic ultrasound, which showed a thickened womb lining.
Ms Laksmi agreed to have an intrauterine system (IUS) inserted following a hysteroscopy - the inspection of the uterine cavity by endoscopy with access through the cervix - and D&C in December 2017.
Thereafter, she was diagnosed with simple hyperplasia of the endometrium.
Dr Dharshini explained: "Hormones released by the IUS reduces HMB symptoms and symptoms of conditions that may contribute to HMB.
"It is an excellent alternative to unnecessary hysterectomy.
"It can also alleviate pain in women with endometriosis and takes away the need for them to be on prolonged oral contraceptives, which can cause many long-term complications."
Six months later, Ms Laksmi's hyperplasia was resolved and her fertility preserved.
Said a relieved Ms Laksmi: "For the past year, since the IUS insertion, I haven't had any menstrual pain or heavy bleeding and have not needed iron pills.
"People have told me that I appear considerably happier and have become more efficient (due to) fewer disruptions and less stress.
"The IUS has since been removed and the bleeding has been light and normal. An ultrasound of the uterus showed a normal womb with a healthy thin womb lining.
"I could even try for another baby if I want to."
Dr Dharshini advised: "It is important that all women, especially those above 40 who have had prolonged heavy menstruation, to undergo sampling of the womb lining to ensure that there are no serious underlying medical issues.
"If left untreated, endometrial hyperplasia can progress to endometrial cancer."