Women could be spared surgery that risks their fertility by a simple test for blood-clotting disorder, treated by taking a pill.
Each year 30 000 women in England and Wales aged 30 to 50 have a hysterectomy (surgical removal of the womb) or a procedure called endometrial ablation, which burns away parts of the lining of the womb in order to end debilitating heavy monthly bleeding.
Although ablation does not always leave a woman infertile, it is not recommended for those who wish to have children in future.
Both ablation and hysterectomy are considered a last resort.
But now a ground-breaking study carried out by specialists at Sheffield Teaching Hospitals NHS Trust suggests that more than 20 per cent of these patients may suffer from blood-clotting disorders.
These patients may lack a blood protein which acts like glue to help cells clump together and form a clot, or the cells themselves called platelets may not be working properly. In women, this can affect the monthly cycle as tiny blood vessels in the womb bleed profusely and for a longer than normal time.
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Menorrhagia and blood-clotting disorders can both cause iron deficiency and anaemia, but women with clotting issues may also notice that they bruise easily, get nose bleeds, or have bleeding gums when they brush their teeth.
Once a blood-clotting disorder has been established, patients could be offered a monthly dose of the blood-clotting drug tranexamic acid, normally in pill form, which may see hysterectomy or ablation avoided.
Patients with certain known blood-clotting disorders such as platelet dysfunction or von Willebrand disease may also be offered a drug called DDAVP, or desmopressin, which is administered as a monthly injection or nasal spray.
But this treatment can be given only after diagnosis of a specific bleeding disorder. For women with heavy periods in whom no bleeding disorder is found, the cause may remain unclear, and surgery could still be the only option.
Dr Clare Samuelson, specialist registrar at the Royal Hallamshire Hospital Haemophilia and Throm-bosis Centre, who is leading the study funded by The Platelet Charity, said, there are currently no routine tests for deficiency or dysfunction of blood-clotting proteins, or for problems with platelet function, for women suffering with these problems.
We don’t yet have evidence that surgery can definitely be avoided by accurate diagnosis of a bleeding disorder. But some of these women could avoid complications of surgery, or even avoid it completely, if an underlying disorder is diagnosed and appropriately treated.
Ria Peake, 23, a student from Manchester, has been affected since the age of 12, and due to her young age, she was unaware that bleeding for six to eight weeks was abnormal. I was essentially housebound, in great pain and missed a lot of school, says Ria.
She tried everything, including several methods of hormonal contraception such as the Pill and a progesterone coil. But the conditioned worsened, and at one point she suffered daily bleeding for a year, which saw her develop anaemia, fainting and lethargy.
Doctors said a hysterectomy or endometrial ablation would help, but that she was far too young.
Ria was then referred to the Royal Hallamshire Hospital, where she was tested and it was discovered that she suffers from von Willebrand disease, which is the most common inherited bleeding disorder.
Ria now takes the combined pill and targeted medication, and her symptoms are under control. I think every woman with heavy bleeding should be offered testing for blood-clotting disorders, she says. Treatment has transformed my life, so now I don’t need surgery.
Janet Richards, CEO of The Platelet Charity, said, heavy monthly bleeding has a huge impact on many women lives, to the point where some of them are housebound and many face drastic surgery.
However some women could be treated for undiagnosed platelet disorders, which is why this study could change so many women lives.
Daily Mail