Image caption Many women experience debilitating heavy periods

Around a quarter of women of reproductive age suffer from heavy bleeding which blights their lives every month.

A report by experts at the Royal College of Obstetricians and Gynaecologists has found significant variations in the care they are offered.

Sarah, now 44, has experienced severe, prolonged, bleeding ever since she started her periods at the age of 13.

"We had a register for PE and were excused showers if we were on our periods. But because my name was down on the register for the previous week, I was made to go into the communal showers, even though I was bleeding.

"I've suffered on and off from anaemia, and so had to take iron tablets, all my life."

She saw her first specialist at the age of 17, but that was to be the first of many appointments which failed to find a solution.

Sarah, who lives in Cornwall, said: "I particularly remember seeing a male consultant when I was very young. He was really awful, and had no time for me at all. I came out in floods of tears."

She has had two surgical procedures to try to ease her symptoms, one in her early 30s to have polyps and fibroids removed, and a second five years ago to remove the damaged lining of her womb - a procedure called endometrial ablation.

On both occasions, her symptoms abated - but then came back as bad as they had been before.

'I'm 100% ready'

Sarah was recently told she has severe endometriosis (where small pieces of the womb lining are found outside the womb) and adhesions caused by her previous surgery.

She says she is now "100% ready for a hysterectomy".

"My bleeding affects my sleep because I have to get up to go to the toilet in the night, I get chronic diarrhoea, migraines.

"And it affects me at work.

It is possible that the quality of care does vary throughout the country Professor Allan Templeton,, RCOG

"I've had to take in plastic bags to put on my chair in case I leak through. Sometimes I've taken in changes of clothes too."

Sarah has been told she needs an exploratory procedure to assess exactly how surgeons would carry out her hysterectomy, but she hopes to have had it by the end of the year.

The RCOG investigation found significant regional variations in surgical rates.

Between 2003 and 2006, the proportion of women having surgery who underwent endometrial ablation (a less invasive surgical procedure) ranged from 46% to 75% within the 10 strategic health authorities in England.

The rest had hysterectomies.

After April 2006, the proportion varied from 64% in the east midlands to 82% in the north east.

Professor Allan Templeton, from the RCOG, said: "We don't know why there is this variation, and are carrying out further work to investigate further.

"But it is possible that patients' expectations are different, that the range of care and treatments offered are different in different areas.

"What we really want to find out is what women think of their care. Are they satisfied? Do they think they are being offered all of the options? Are people taking their problems seriously? And is their quality of life improving?

"With the regional variations, it is possible that the quality of care does vary throughout the country."