We don't know, most of the time, what causes heavy periods in most women. It’s a common
experience, and many people would say that it's a normal experience that women have,
it’s just that some women have heavier periods than others. So in most cases, heavy periods
are a normal part of the menstrual experience for women, rather than being reflective of a disease.
First of all this is a very common problem. It affects a significant number of women and
is very limiting and debilitating for some women and as such it's a common problem in
general practice and also an extremely common reason for referral to a gynaecologist.
In terms of this study, before we started, we knew that there were plenty of usual treatments
that we use that can reduce the amount of bleeding that women have. But what we didn't
know was, in what way treatments might be able to reduce the interference that heavy
menstrual bleeding has on women's lives and on their quality of life, and that's what
we were interested in. Because often for the individual it's not so much the amount of
bleeding as the effect it has on their work, or on their family, or on their social relationships,
or indeed their emotional well-being. And we were interested in looking at those outcomes.
There's a whole range of different treatments available for heavy periods. The commonest
ones that we use in general practice are tablet type treatments, like Mefenamic and Tranexamic
Acid, and also the contraceptive pill, and other different types of hormone and indeed a
long acting hormone injection, those would be the usual sorts of treatments that there
are available. But more recently, people have proposed using a contraceptive coil called
Mirena, which was designed to be used as a contraceptive. It’s inserted in the womb
and it releases a hormone called levonorgestrel, and that acts as a contraceptive, but it clearly
had potential to also reduce people's bleeding. So we wanted to compare use of this contraceptive
coil to the other usual types of treatment that we use in general practice.
This has been an excellent collaboration between people who work in general practice like myself,
and a whole number of gynaecologists, a very busy and diligent trial team, and many, many
general practices, and other NHS centres right across the Midlands and indeed beyond.
And we wanted to try and answer our research question, “Which treatment is better?”, definitively,
in order to help women and doctors make informed decisions. Now in order to do that we had
a stiff challenge, because we needed to recruit around 600 women to this study, women who
were consulting their general practitioner about this problem. So it was sufficient for
women to come to a GP and say, “Look, I've got this problem” and to then agree to be
randomly allocated to either using one of the usual treatments or using the contraceptive coil.
We followed women over the next two years and asked them if these treatments were helping
and how. And in a nutshell, both types of treatment, both the usual sorts of treatments
and the contraceptive Mirena coil, significantly improved women's quality of life. But those
who had the Mirena coil improved significantly more over the two-year period. And by improvement,
I mean that women experienced much less interference in their lives, so they had much less practical
difficulties, running to the toilet and so on. They had much less interference with their
social lives, their family life, their relationships, their emotional well-being, they could go
to work more easily. These were the sorts of improvements we saw. The other thing to
say is that those women who got the coil actually tended to stick with it better. So more women
still had the coil, still had it in, two years later, they hadn’t asked for it to be taken
out, it was still suiting them, than were using the usual treatments. And so the really
important messages are, first of all, that we found that these sorts of treatments are
helpful, are effective, and we didn't know whether they made much difference to women’s
quality of life. We now do know that. But secondly it helps us in making more informed
decisions about what to choose, bearing in mind an individual woman's preference for
a contraceptive coil being inserted or not. And perhaps the other thing that I think is
also very important, which we didn't look at directly, is that we now need to make women
more aware that there's a range of treatments available that can be helpful. And we know
that many women don't come forward for treatment for this problem, either because they're embarrassed
or perhaps they don't know that there are treatments available that can help. And this
study, it’s a very big study, and it underlines that we can help women if they choose to consider
some of these options. Perhaps finally, the other point, as a General Practitioner, would
be that we need to offer the option of the Mirena coil more often in our range of treatments
that we have available for women.
In our study, around a third of women did not persist
the coil. It didn't suit them, they had irregular bleeding that persisted for longer than might
have been expected. Normally, one would expect some irregular bleeding with this coil for
about three to six months. And for some women it was possible to put up with that because
in the longer-term their bleeding settled down. But for other women, that was not acceptable,
and so people wanted it out. That’s probably the biggest problem. I suppose the other is
that, you know, having a coil inserted is simply not for everybody. It’s sometimes
not suitable medically for some people, if they have fibroids, for example, it may not
be possible, or if they have had pelvic inflammatory disease. For other women, it's simply a case
of, “Well, it's just not for me. I’d much rather have some other form of treatments
than have to go through a relatively straightforward procedure but nevertheless a procedure,
to have a coil inserted”.