I’ve given up on white trousers

QI’ve always suffered with heavy periods, but they’re getting worse and I’m anaemic. I was diagnosed with fibroids a few years ago and my GP said they’d shrink after the menopause. I’m only 44 – is there anything I can do now?

AFibroids – non-cancerous growths of the muscle layer of your womb – are very common. At least one in four women gets them in their lifetime, usually in their 30s and 40s, and they’re more common if they run in your family, if you’re of Afro-caribbean origin or if you weigh over 70kg. Fibroids are sensitive to oestrogen, so they do usually shrink after the menopause, unless you’re on HRT.

They can cause heavy, sometimes more painful periods, bloating, painful sex and, occasionally, fertility problems. They shouldn’t cause bleeding between periods or after sex – this should always be checked out.

Fibroids can get more troublesome as you approach the menopause, when periods often become more erratic and heavy as you stop ovulating regularly. In years gone by, they were commonly treated by hysterectomy. These days, there are other effective options.

Tranexamic acid tablets make your blood more prone to clotting, and can dramatically reduce menstrual flow. Anti-inflammatory tablets, such as mefenamic acid and ibuprofen, are less effective for bleeding but do also help with period pain. You take these just during your period. The Mirena coil (IUS) is an effective treatment for heavy periods of any cause as well as providing contraception, although it can lead to changes in your periods for up to six months.

For fibroids over 3cm that are causing anaemia, NICE recommends ulipristal acetate, which blocks the effect of the hormone progesterone. It can be given under specialist advice for up to four courses. Another hormone-blocking medication called GNRH analogues can also be used if the alternative would be surgery.

Even if you do need surgery, there are other options than hysterectomy. Individual fibroids can be removed surgically or their blood supply can be cut off so they shrink. Alternatively, the lining of the womb can be stripped away under anaesthetic.

QI have a healthy diet but take great care to avoid the sun since I had a skin cancer scare. Do I need supplements?

AI know many people take vitamin tablets as an ‘insurance policy’ to top up in case they don’t get enough in their diet. Actually, with a balanced diet and a little effort, you can get enough of most vitamins without needing supplements. But vitamin D is an exception – in fact, it’s not a vitamin, but rather a hormone. Of the vitamin D in our bodies, 90% is made in our skin when we’re exposed to sunshine, which makes deficiency almost inevitable if you cover up for religious reasons or don’t get out much. People with darker skin, small children and older people are also at higher risk. The Chief Medical Officer has recommended everyone over the age of one takes a 10mcg (400IU) supplement in Winter, and anyone at high risk should take supplements all year round. But over-the-counter supplements don’t always give you the amount on the label – there’s a lot of variability. Personally, I take Fultium, which was previously only available on prescription – but you can now buy it over the counter, too.