June 18, 2009
This can reduce heavy periods
A hormone-releasing intrauterine contraceptive device has been found to be a viable alternative to hysterectomy for women with heavy menstrual bleeding. JESSICA JAGANATHAN reports in Beijing
For women with heavy menstrual bleeding, there is a non-surgical alternative to having a hysterectomy (removal of the womb). This alternative is a hormone-releasing intrauterine contraceptive whose brand name is Mirena.
In a 10-year study of 200 Finnish women with heavy menstrual bleeding, Mirena users - compared to those who had hysterectomies - had higher work productivity and health-care costs which were nearly 40 per cent lower.
Those who had their wombs removed also took more sick leave than those who used Mirena. The study's findings were released by Bayer Schering Pharma Asia Pacific at a press conference in Beijing on June 6.
The medical term for heavy menstrual bleeding is menorrhagia. Mirena is inserted into the uterus by the doctor. When used as a contraceptive device, it releases hormones which thin the womb lining, thus preventing sperm from reaching the egg.
The Finnish study also found that women treated with this contraceptive had fewer urinary problems and fewer ovarian cysts than those who had a hysterectomy.
Heavy menstrual bleeding affects one in 20 Singapore women. Apart from the pain, it can limit daily activities, social and working life, and cause emotional stress and lack of energy.
It can be due to hormonal imbalance, blood disorders or an abnormality in the uterus or surrounding tissue, which includes polyps, fibroids, pelvic infection, endometriosis and cervical cancer.
Dr Fong Yoke Fai, a consultant at the National University Hospital's department of obstetrics and gynaecology, said that some women with heavy menstrual bleeding have resorted to sleeping on the floor or placing a protective sheet on their bed in order not to stain it. 'Some women wear diapers and, in extreme cases, have to change their pads every hour,' he said.
Ministry of Health statistics show that, from April last year to March this year, about 800 women here above the age of 40 had a hysterectomy. Dr Fong, who is also the vice-president of the Obstetrical and Gynaecological Society of Singapore, said about 5 per cent of these women could have avoided surgery by using Mirena or other medical therapies if they had sought treatment earlier.
Clinical coordinator Peggy Sin, 41, started experiencing heavy menstrual bleeding in 2003. Not wanting a hysterectomy, she eventually found out about Mirena and opted for it.
Her heavy bleeding has since stopped. 'It's given me so much freedom,' she said.
Mirena's reported side effects include pelvic inflammatory disease, back pain, changes in sex drive and mood changes.
A hysterectomy here can cost between $1,350 and $12,000. Mirena, which costs about $500, has to be changed every five years.
Dr Ritva Hurskainen, who is the lead investigator of the Finnish study, said hysterectomies can cause complications like haemorrhage and infections. 'With Mirena, heavy menstrual bleeding can be treated effectively and economically while preserving a woman's fertility,' she said.
Mirena is recommended as a first line of treatment under guidelines implemented in 2005 in Finland. Since then, the rate of hysterectomy has decreased by more than 1,000 over two years in the country.
In Singapore, current guidelines on menorrhagia issued by the College of Obstetricians and Gynaecologists already recommend medical therapy as a first line of treatment. New guidelines are being drafted and the Finnish findings will be taken into consideration, said Dr Fong.