Eav› blee†ig i athletes
FIFA is advocating for female football, thus the number of female athletes is on the rise, special attention needs to be given to females during their periods. Menorrhagia affects approximately one quarter of women aged 18–57 years. The International Federation of Gynaecology and Obstetrics (FIGO) defines Heavy Menstrual Bleeding (HMB) as ‘the women’s perception of increased menstrual volume regardless of regularity, frequency, or duration. It focuses on the impact of perceived excessive menstrual blood loss on the patient’s quality of life. Diagnosing HMB can be subjective, and definitions include blood loss of more than 80ml per menstrual cycle or excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life.
HMB IMPACT
In a study of 6 179 women aged 15-55 years old, a total of 1 627 women described their menstrual loss as above average. At 91 per cent of these women reported that when their periods were heavy it impacted their ability to perform sport and fitness activities. Furthermore, 75 per cent felt less confident during this time with 91 per cent stating that their heaviest menstrual flow days influenced the type and colour of clothes they felt comfortable to wear.
SYMPTOMS
Athletes with heavy or prolonged menstrual bleeding typically have one or more of the following: Soak through a pad or tampon every one to three hours on the heaviest days of the period. Have bleeding for more than seven days. Need to use both pads and tampons at the same time due to heavy bleeding.
Need to change pads or tampons during the night. Pass blood clots larger 2.5cm
Iron deficiency anaemia
Initial Investigations
Blood tests to look for anaemia, iron levels, thyroid disease, or a bleeding disorder.
Human chorionic gonadotropin - Pregnancy remains the most common cause of abnormal uterine bleeding in patients of reproductive age. Bleeding usually denotes threatened abortion, incomplete abortion, or ectopic pregnancy.
Pelvic ultrasound is the best non-invasive imaging study to assess uterine shape, size, and contour; endometrial thickness; and adnexal areas.
MRI as a second-line test is to be used when the diagnosis from pelvic ultrasonography is unclear.
WHEN TO REFER
Referral to a gynaecologist is appropriate for patients who have heavy bleeding, severe anaemia, persistent bleeding despite treatment, if there is suspicion of malignancy, or if surgery is required. Referral to a gynaecologist is also appropriate if the primary care clinician is not comfortable performing endometrial sampling or placing an intrauterine device (IUD; for treatment of AUB).
TREATMENT
The female athlete should be provided with information about HMB and its management, alongside a discussion on the risks and benefits of the treatment options. When deciding upon the most appropriate and acceptable treatment for the athlete with HMB the treating clinician must firstly consider if it is the result of specific pathology requiring referral to gynaecology. If it is not, a second consideration is whether pregnancy is desired in the short term and if contraception is acceptable. It is important that the individual is involved in the decision-making process and a personalised management plan is agreed. Medical Care
Nonsteroidal anti-inflammatory drugs;
Oral contraceptive pills;
Levonorgestrel intrauterine system; Gonadotropin-releasing hormone agonists; Tranexamic acid.
Finally let me thank Sakhile Thembsile Maziya and Matiti Luhlanga for being available always to take care of our sisters medically. We wish more professional ladies may avail themselves and join the two. Till next week, let’s remain warm and continue exercising. Love you all.