In her own words, Laksmi Hapsari, the owner of an enrichment school for children, tells us how she lived with heavy menstrual bleeding (HMB), a debilitating condition.
I had been experiencing heavy menstrual bleeding (HMB) since I got my first period at 13. My periods sometimes lasted for as long as 15 days at a time, with excessive and painful bleeding. As an adult, my HMB got in the way of my work, and I have had to cancel many business meetings because of it.
At times, the bleeding was so excessive, to cope with the heavy flow, I was forced to wear adult diapers instead of sanitary pads. Although wearing adult diapers was uncomfortable, I endured it as it was the most practical option for me to continue running my business and caring for my son and family. My family, friends and staff have been supportive of me as I live with HMB, and I felt like I must do my part and not let them down.
At first, I sought treatment for my condition at home in Surabaya, Indonesia. I saw two gynaecologists there. In addition to prescribing hormonal pills and injections, they asked me to undergo dilation and curettage (D&C) procedures to reduce the excessive bleeding. D&C dilates the cervix and surgically removes part of the uterus lining and/or contents of the uterus. I was also put on painkillers and iron tablets to manage my pain and anaemia respectively. Little did I know that D&C procedures, painkillers, iron tablets and hormonal pills would become a way of life for me.
In 2003, I got married. Five years later, I stopped the treatments as I wanted to conceive. The HMB with all its debilitating symptoms returned with a vengeance. However, with the help of intrauterine insemination (IUI), I managed to conceive, and gave birth to a healthy baby boy. Trying to conceive was challenging for me as I had mood swings and cramping for several cycles, and I felt immensely relieved when I finally conceived.
After I gave birth, my HMB returned and although I expected it to be quite severe, I did not expect it to be so much worse than before! Soon, I was back on the routine of hormonal pills and injections, and underwent one or two D&C procedures a year to manage my condition. I found it frustrating that I had to undergo so many D&C procedures, as I was often tired and in pain for several days each time. Once, following a D&C procedure, I did not menstruate for three months, which made me worry! I was put on hormonal pills to induce menstruation; and with it, the full range of symptoms of HMB returned. It felt like I was going around in circles with no end in sight.
In August 2017, my family decided that I should seek help from a gynaecologist in Singapore, who also advised me to undergo another D&C. I chose not to proceed with it as I was just so tired of undergoing multiple D&C procedures with no clear, definitive solution on the horizon.
However, upon returning home to Surabaya I began bleeding excessively, and immediately relented to undergoing a D&C procedure. Days later, still unwell but determined to find a better solution, I returned to Singapore and consulted with another obstretician-gynaecologist, Dr Dharshini Gopalakrishnakone, from the Kierauniv International Clinic for Women who ordered a pelvic ultrasound which showed a thickened womb lining.
In December that same year, I had exhausted all options except for the intrauterine system (IUS), and so I agreed to have the IUS inserted following a hysteroscopy and another D&C procedure. A hysteroscopy is the inspection of the uterine cavity through the cervix, which enabled Dr Dharshini to visualize the lesion and confidently remove the concerning tissues during the D&C procedure. I was then diagnosed with simple hyperplasia of the endometrium.
After the insertion of the IUS, I have not had any menstrual pain or heavy bleeding, and have not needed pain control medication or iron pills. My menstrual flow has been reduced, the pain has disappeared, and I no longer need to wear adult diapers to cope with my menstrual flow!
Six months after the IUS insertion, Dr Dharshini ordered a womb lining biopsy in the clinic and confirmed that the hyperplasia had been resolved! Another six months later, I underwent another womb biopsy that confirmed that my womb lining was healthy.
People around me have told me that I appear considerably happier and have become more efficient, as I have been able to run my business and care for my family with fewer disruptions and less stress.
The IUS has since been removed and the bleeding so far has been light and normal. A recent ultrasound of my uterus showed a normal womb with a healthy thin womb lining.
Dr Dharshini has said that I could even try for another baby if I want to!
Laksmi Hapsari photo courtesy of Laksmi Hapsari.
Dr Dharshini Gopalakrishnakone photo courtesy of Dr Dharshini Gopalakrishnakone.