A north London teacher whose cervical condition caused unpredictable bleeding, huge blood clots and the breakdown of a relationship says a pioneering treatment gave her back the freedom to live a normal life
A mother and primary school teacher said she had “no freedom” and “couldn’t carry on (her) life as normal” as cervical fibroids caused gushing bleeding and 10cm clots for five years.
Caroline Mansi, 45, who lives in Enfield, north London, began experiencing unusual menstrual symptoms in 2017, when she was 36. Her symptoms started with “heavier periods, much, much heavier than I’d ever experienced before”, but progressed to bleeding in between periods and then “passing quite sizable clots that just got bigger and bigger, the further on it went”.
After trying multiple prescription medications and even the hormonal IUD – which her body ejected when it passed a large clot through her cervix – Caroline, who has a daughter aged 22, was referred for a treatment newly available in the UK which gave her life back “overnight”.
Despite suffering a relationship breakdown because of the impact of her symptoms and being prescribed antidepressants for the fibroids’ mental toll, Caroline said the treatment meant she “got (her) life back that day” – and she avoided a complete hysterectomy, which she had been advised would be her only course of action.
Caroline first began experiencing unusual menstrual symptoms in 2017, though for years she had no idea what was causing them.
“The worst symptom that I had was extreme flooding, it was completely unpredictable,” Caroline said.
“I would always use pads, because I never knew when it was going to happen. When the flooding was really bad, it would come all of a sudden, and it would be uncontrollable… I would pass ridiculous amounts of blood.
“I would always have to take a change of clothes everywhere I went. I had spare clothes in my cupboard at work. Every chair I sat on ended up with some kind of stain on it.
“Obviously, it’s mortifying.” There were times that I’d have to leave work and go home and shower and come back,” she added.
“My classroom was right opposite the toilet so that I had access to it whenever I needed, because there was no pattern. It was so unpredictable, it was so restrictive… I couldn’t carry on my life as normal.”
In 2021, Caroline’s relationship with her partner of five years broke down because of the impact her illness was having on their lives.
“It ruined a relationship,” she said.
“There was no possibility for any kind of sex life, not only from a practical point of view – the mess – but also just why would I want to? I was bleeding constantly.”
After first visiting her GP in 2018, Caroline was prescribed medroxyprogesterone, which is used to treat hormonal conditions such as heavy periods, endometriosis and polycystic ovary syndrome, but found it made her symptoms worse.
As time went on, Caroline’s symptoms progressed from “flooding” blood without warning to passing blood clots, some of which were 10cm in diameter, which she said felt “almost like contractions”.
Passing clots of this size even meant that she ejected the hormonal IUD she had inserted in the hope that she, like many users, would experience significantly lighter, shorter and less painful periods, but it had no effect on her symptoms.
In 2019, while on a forest walk with her sister, the IUD expelled itself as her body passed a large clot and bled, resulting in a trip to A&E where she begged for a gynaecology referral.
Thankfully, after more back and forth to her GP, Caroline was referred to a gynaecologist, but when the Covid pandemic hit everything was put on hold.
It was not until 2021 that she saw a gynaecologist who diagnosed her with fibroids – common, non-cancerous growths that develop in or around the womb, which cause no symptoms for many people. However, Caroline’s fibroids were attached to her cervix, which explained why they were causing her such significant symptoms.
Caroline was advised that the most effective route was a full hysterectomy, and while her doctor was hesitant to perform the surgery immediately, Caroline insisted that she just wanted it all to be over.
She was in her late 30s, and having another child was “still a possibility” – she only had one child, and always imagined she’d have more – “but at this point it had been at least two years of the symptoms, and I felt so low,” she said.
“I was on antidepressants because of how low I was. My relationship had broken down completely. I had no quality of life. I had no freedom to do anything, because I was completely restricted by it. So I was just like, I don’t care what you do. I was at that point.”
In December 2022, however, Caroline’s care was transferred to consultant gynaecologist Mr Mahantesh Karoshi at Chase Farm Hospital in Enfield, run by the Royal Free London NHS Foundation Trust.
In his work in the private medical sector, he had come across a pioneering procedure called Sonata – Sonography-Guided Transcervical Fibroid Ablation – which delivers radiofrequency energy that heats the fibroid tissue to a temperature that causes it to break down, and is conducted under local anaesthetic.
Mr Karoshi believed Caroline would be a prime candidate for the procedure, which was only just starting to be conducted in the UK, and referred her case to a multidisciplinary team for consideration.
Following a precautionary MRI, doctors established that her fibroids were relatively small – her largest was three to four centimetres in diameter – but since the fibroids were attached to the lining of the cervix, that was what was causing the “horrendous issues”.
Caroline underwent the Sonata procedure in December 2022, and she said “the most pain I had through the whole experience was the injection that I had for the local anaesthetic”.
“The Sonata team was also there, because it was very early days in terms of its rollout in the UK. I think there were eight medical professionals in the room – not what you need when you’re legs akimbo!” she laughed.
“It was so straightforward. It took, I would say, about 20 minutes.”
Almost immediately, Caroline noticed the difference.
“Even when the local anaesthetic wore off, I didn’t have pain, certainly not anything like the pain that my symptoms caused me anyway,” she said.
Caroline did not have a period for around six months after the procedure, and she wasn’t sure whether it was perimenopause. However, when they did come back they were “normal” – “four to five days in length, not 28 out of the 30 days in a month… no clots at all, and not even particularly heavy”, she said.
“My symptoms went overnight.
“I can swim, I can go to the gym, I can take my dogs for walks in the park without having to go to A&E that night. I can walk down the street without having a change of clothes.
“I don’t have to have my classroom right opposite the toilet. I don’t have to worry about the children seeing me leak or sitting on a chair.”
“Literally, I got my life back that day,” she added.
To find out more about Sonata, visit: sonatatreatment.uk
