'The curse'; 'I've got the painters and decorators in'; 'It's that time of the month'. One of my friends sums it up as her 'I wish I as a man' week of the month. Feeling uncomfortable already, chaps? Hang on - reading this really could be in your interest!
We're talking about a condition which affects about one in four British women in a lifetime. It's the commonest (non cancerous) tumour in women of child bearing age; the single biggest reason for hysterectomy; and the reason 75,000 women a year are admitted to English NHS hospitals alone.
The condition is fibroids. Although they are tumours, it's important to stress that they aren't cancerous. They grow from the muscle wall of the womb, 'fed' by the women's hormone oestrogen. About half of women who have fibroids don't get any symptoms from them. For the other half, the most common symptom is long and/or heavy periods. This in turn can cause anaemia and the tiredness, breathlessness and dizziness this can bring. The bleeding can be so debilitating that you have to put your life on hold for several days a month. Sufferers can also cause stomach pain, bloating, painful periods, pain on making love and even recurrent miscarriage or infertility.
Treatment very much depends on the severity of your symptoms and your priorities. For instance, hormone treatments such as the combined oral contraceptive pill ('the pill') and a hormone coil called the Mirena can reduce heavy bleeding effectively, but clearly aren't an option if you want to get pregnant. Other tablets taken during your period can reduce heavy bleeding but may not help for large fibroids.
In our mum's day, the only really effective permanent solution was hysterectomy. These days, NICE (the National Institute for Clinical Excellence) recommends several surgical alternatives to hysterectomy for women with larger fibroids (more than 3cm in size). These include removing the fibroid (about 2-3% of them a year will grow back) or cutting off the blood supply to the fibroid so it 'dies' and shrinks. However, big fibroids can be technically challenging to remove, and the bleeding can be hard to control during the operation. Women need to be aware that there's a risk the surgery won't succeed and they'll need a hysterectomy while they're under the same anaesthetic.
Cutting out the fibroid is still a highly tempting option, especially if you want to be able to have children afterwards. Hormone treatment can shrink the fibroid by up to 50% in size, which may make it a less complicated operation to carry out. Until now, the standard treatment for that has been a course of monthly injections, usually for 3 months before surgery. They're highly effective at reducing bleeding as well as the size of the fibroids, but cause significant menopause-like hot flushes for up to two in five women. Now a new treatment, given as a daily tablet, is available on the NHS. It's just as effective at reducing bleeding - in a head to head study between the two, bleeding was controlled in 98% of women taking the tablet and 89% of women taking the injection. It also causes far less flushing, with only 10% of women getting moderate or severe flushing.
It's inevitable that when we have a 'ladies' problem', many of us still turn to our mums for advice. In her day, the only options were 'put up and shut up' or 'have it all whipped out'. It's good to know that in some respects at least, the good old days are far behind us!