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What treatment is aimed at, and questions for your clinician

The end of this course is the start of a conversation with somebody who has examined you.

Lesson 5 of 5

10 min Text

What this lesson says

  • Treatments are aimed at different goals and the right one depends on which goal is yours
  • Whether you want a pregnancy, now or later, changes the whole conversation
  • Treating the anaemia and treating the bleeding are two separate jobs and both are worth doing
  • Ask what a treatment is aimed at, how long before it works, and what happens if it does not
  • Surgery is one option among several and is rarely the first

This is general education. It is not advice about your own situation, and it does not replace seeing a clinician.

Written lesson.
  1. 1. There is no single treatment for heavy bleeding, because heavy bleeding is not one thing. What is offered depends on what is behind it and on what you want — lighter bleeding, less pain, your iron back, a pregnancy, or to be left alone by the problem until menopause deals with it.
  2. 2. Say the goal out loud early. A woman who wants to conceive next year and a woman who has finished her family are offered genuinely different options for the same fibroid, and a clinician who does not know which one you are will guess.
  3. 3. Treating the anaemia is a separate job from treating the bleeding, and it is worth insisting on both. Iron replacement, in whatever form is appropriate for you, is what makes the stairs easier and the fog lift; it does nothing about the bleeding. Stopping the bleeding does nothing about the iron you have already lost. Doing one and not the other is the commonest way a woman leaves a clinic still feeling terrible.
  4. 4. For every option you are offered, ask four things: what is this aimed at, how long before I would notice a difference, what are the common side effects, and what do we do if it does not work. A treatment with a three-month horizon and one with a same-cycle effect are different promises, and knowing which you have been given is the difference between patience and being let down.
  5. 5. Surgery exists and it is rarely the first step. If it is raised, ask what it would and would not change, what the alternatives are, what recovery involves, and what it costs including the follow-up. Ask what happens if you do nothing for six months; sometimes the honest answer is that nothing much happens, and that is a legitimate option to have been offered.
  6. 6. Write your questions down in priority order before you go, and open with the one that matters most. Appointments end sooner than expected, and the thing you came about should not be the thing you ran out of time for.

All lessons in this course

  1. 1 What ordinary looks like, and how wide the range is 10 min
  2. 2 What counts as heavy, when nobody can measure it 10 min
  3. 3 What is usually behind heavy or painful bleeding 12 min
  4. 4 What gets checked, and why iron is in the first set of tests 11 min
  5. 5 What treatment is aimed at, and questions for your clinician 10 min Reading now

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