Book review: Flow Fighter

August 18, 2018

Canadian author Holly Bridges suffered from heavy menstrual bleeding for years. Eventually she was diagnosed with fibroids. Her gynaecologist suggested a hysterectomy, by then presented to her as the only option. But was it? Because of her profession (Bridges spent 15 years as a CBC radio and television journalist and talk show personality) she was used to ask questions. Or, to be more precise, to place the right question marks when needed. Spoiler: she didn’t undergo the hysterectomy, but instead became a passionate advocate for minimally invasive surgery and other alternative treatments. And she wrote a brilliant book: Flow fighter: How I kicked my fibroids & heavy periods to the curb. A must-read for everyone suffering from heavy menstrual bleeding problems. And that’s about 1 in 5 women.

Honest & personal: ‘Lying in bed at two in the morning, soaking through a super-plus tampon and four overnight pads I had taped together from front to back’

How I kicked my fibroids & heavy periods to the curb. The subtitle already gives an impression of style of the book. Despite the heavy (pun intended) subject, it’s written with a lot of humour – reading it is like having a face-to-face talk with your best friend – and a personal note. Because apart from giving information about fibroids (non-cancerous tumors growing in or outside the uterus), heavy bleeding and treatment options, Bridges (pictured above) also shares her own story, which includes ‘lying in bed at two in the morning, soaking through a super-plus tampon and four overnight pads I had taped together from front to back’. She doesn’t hold back, describing her fears, worries, intuition and the procedures she has eventually chosen in detail and with honesty. The fact that she explains the many medical terms used in the book in normal language makes it easy to understand, also if you don’t happen to have a PhD in gynaecology.

Around 650,000 American women undergo a hysterectomy each year. Too many?

Bridges discusses North America’s high hysterectomy rate. It’s often the only option recommended to women with fibroids, which results in it being the most common major surgery for women in the US, with around 650,000 American women undergoing one each year. Of those surgeries, a third will include also the removal of the ovaries. Probably a wise decision if you also have an increased risk of ovarian cancer or carry the BRCA gene, but perhaps not so wise if you don’t, as ovary removal increases the risk of developing heart disease, lung cancer and other conditions.

Contrary to many other diseases, when it comes to heavy bleeding complaints there are no set guidelines and there’s no one perfect way of treating them. But despite the fact that hysterectomy remains the only definitive cure for painful and heavy menstrual bleeding, there’s still a lot that can be done apart from removing the uterus (and sometimes even also the cervix, ovaries and fallopian tubes).

Exploring other, less invasive, options

The book includes interviews with both doctors and patients, all with the goal of letting women make an informed choice. Because sometimes a hysterectomy isn’t medically necessary. For women who still want to get pregnant it’s a no go, for those close to menopause or others it might just ‘not feel right’. It all depends on the woman and her individual situation.

Before deciding on major surgery, it’s definitely worth exploring the possibility of minimally invasive surgery. Or non-surgical treatment options such as watchful waiting, drug and hormone therapy and the Mirena IUD, and surgical treatment options like dilation and curettage, hysteroscopy and endometrial ablation. Other non- or minimally invasive treatments include focused ultrasound, uterine artery embolization and volumetric embolization. All these procedures are discussed in the book with their advantages and disadvantages. Most of them also include a personal story, which gives a patient’s perspective.

Every woman initially thought her menstrual complaints were ‘part of the deal’

These personal stories of women suffering from fibroids vary greatly. From having a 4.5 pound fibroid removed to being prescribed antidepressants and sent on their way as it’s ‘probably the menopause’. Some have chosen to undergo a hysterectomy; others have opted for alternative therapies or to do nothing at all. But perhaps most surprising is that each of these women initially thought their pain and heavy bleeding was normal. Part of the deal.

And that’s how we come to the books’ main message: talk about menstrual complaints. Because yes, Flow fighter offers a lot of medical information, about the different types of hysterectomy and myomectomy, their risks and benefits, and other treatment options. It also touches on the latest research (including robotic surgery) and features warnings of the FDA and Health Canada about the risk of morcellators (a medical device used during hysterectomies and myomectomies) and Esmya (a medication used to manage uterine fibroids, called Fibristal in Canada). But all this info has the same goal: increasing the conversation about female health problems.

Ask yourself: is this normal? And if not, what can be done about it?

Key points: when suffering from menstrual complaints, ask yourself: is this normal? Or isn’t it? And if it’s not, what can be done about it? What are the options? Seek medical attention and talk with your doctor. While doing that, don’t just take ‘no’ for an answer. Many of the women interviewed in the book have suffered for years; some were even told by their doctors their problems were ‘a natural part of aging’ or, even worse, ‘all in the head’. Flow fighter actively encourages women to investigate other options so they can make informed decisions. After all, your gynaecologist might not be familiar with minimally invasive surgery. Don’t know how to discuss these things? Check out the ‘ten tips for connecting with your doctor’ (pages 128 & 129) which include ‘be polite, but assertive’ and ‘ask for a specific referral’.

Don’t suffer in silence!

Every chapter ends with the most important things listed in bullet points. In her final chapter, Bridges explains that she’s partly written this book for her daughters, wanting to raise them to be proactive about their gynaecological health. Her hope for the future: that ‘touchless, scarless surgery becomes the standard of care for every woman’. This last chapter’s takeaway messages urge women to ‘start sticking up for themselves’. ‘As women, we deserve the right treatment at the right time in the right place in a manner that’s right for us, not our doctors.’ Because even though heavy menstrual bleeding is a common condition, this doesn’t mean it’s normal having to change your tampon or pad every hour. Menstrual complaints don’t have to be a part of your life. Bottom line: don’t suffer in silence. And if your flow f*cks you over, fight back!

Doctor approved

Because the author hasn’t a medical background, at least not a professional one, Dr. Sukhbir Singh features as a medical editor. Singh is vice-chair of gynaecology at the Ottawa Hospital & University and has a clinical practice with a sub-specialty focus on complex gynaecologic disorders requiring surgical intervention or advanced medical therapies. He has also helped develop a new index known as technicity to measure the appropriateness of hysterectomies being performed in Canadian hospitals and encourage gynaecologists to perform the procedure less invasively, either vaginally or laparoscopically. A true expert. As the book cover says: ‘Doctor approved’.

Order a copy?
You can find Flow fighter: How I kicked my fibroids & heavy periods to the curb on Amazon.

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