Meet Dr Marlies Bongers (She/Her)
Dr Marlies Bongers – Gynaecologist
“Knowledge about your menstruation helps you take better care of yourself. You often hear about the biology of menstruation, but not about the experience. A period causing a lot of pain is not normal. If someone around you, or a doctor, says “well, that pain is just part of it”, you would never go back to a doctor with your complaints.”
Dr Marlies Bongers is undoubtedly a Game Changer in gynaecology and has worked tirelessly to break the taboo around problems with menstrual health. She established the first Dutch clinic specifically focused on severe menstruation complaints and was a pioneer in the Netherlands with the innovative methods to alleviate these issues. Her contributions have been significant in the development of knowledge and treatments for menstruation problems. Her work has been recognized with awards such as the Els Borst Lifetime Achievement Award and an appointment as Officer in the Order of Oranje-Nassau. Although Marlies retired last year, she is certainly not standing still. She continues to actively advocate for more knowledge and innovation, for women with severe menstruation issues to receive better care.
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First of all, a personal question: do you remember your first period?
Yes, I do. I grew up in a family with three girls, I was the oldest. My father was always very proactive about health education, so we did know a lot already. I think I was twelve, definitely not very early and not very late. I went to the bathroom in the morning, and when I saw blood, I was quite shocked. So, I went to my parents’ bedroom, opened the door, and said, “I’m on my period.” And my father, I saw him jump up straight away, and my mother rose up slow behind him. “Well, that’s nice”, they said. So yes, it was overall just a very positive experience.
How did you experience your period yourself?
I was quite lucky because I never had any menstrual problems. Never extreme blood loss, never severe cramps.
The menopause was a strange period. I went through it quite late, I think I was already about 56, so that was somewhat lucky. I had hot flashes and sometimes I couldn’t sleep well, but all of that was manageable. However, during that time, I did have permanent dizziness. That wasn’t so pleasant, especially with work. But the neurologist said it wasn’t anything serious, and in the end, it just went away. Now, I do think it was probably related to the hormonal cycle.
In your work as a gynaecologist, you have specialized mainly in heavy menstrual bleeding, endometriosis, and pelvic floor issues. What sparked your interest in gynaecology in general, and in these topics specifically?
When I had to choose what to study, it was clear that I would pursue medicine because I enjoyed biology in school, especially studying the human body. During my residency, I worked at the women’s clinic in Groningen, where Rik van Lunsen at the time was involved in gynaecological research. Women would voluntarily participate in research, to ensure physical examinations were conducted appropriately, they could indicate where they experienced pain, and so on. After that, I did my residency in Zwolle in obstetrics, where I had a lot of freedom and worked with great people. Based on these positive experiences, I decided to become a gynaecologist.
In my work, I saw so many women of whom I thought, “gosh, what a suffering.” In my early years, I wondered why so many women with heavy menstruation needed to have their uterus removed. Alternatives, like the hormonal IUD, didn’t exist back then. Innovations, such as endometrial ablation, were starting to emerge. This procedure treats the uterine lining once so that heavy menstruation no longer occurs, because if there is no lining, there’s nothing to shed. I worked hard to introduce these new techniques in the clinic.
In the early 2000s, you established the very first Dutch clinic specifically focusing on heavy menstrual problems. How did you come up with this, at the time, groundbreaking idea, and what was so revolutionary about this clinic?
Through my work and research on endometrial ablation, I came into contact with gynaecologists from around the world at international conferences, and I saw that the Brits were ahead. They had introduced a “one-consultation clinic”: women with heavy menstrual bleeding could, after their consultation and examination, immediately have an ultrasound if needed. And if a polyp or a piece of endometrium was visible, it could be removed on the spot. So where women used to require five visits to the gynaecologist, this was now reduced to one or two visits. I found this so patient-friendly that I asked if we could introduce it here. At the time, we were really ahead in the Netherlands with this. There are still clinics today that don’t offer such one consultation clinics.
It’s no secret that many women still walk around with pain issues or are not properly referred. Especially because pain is subjective, not often discussed, and women are still often told “the pain is just part of it”. Can you give general advice on when women should really speak up about menstrual problems?
Yes, I think that if, as a woman, you think “help, here comes my period again”, that’s just not right. For example, due to the amount of blood loss, or when you’re curled up on the couch thinking, “I just have to get through the first day”. But also, if you feel like you can hardly function due to mental symptoms prior to your period. So, pain, blood loss, and overall well-being around that time.
And that’s so hard to determine for yourself because you don’t have a reference point. Of course, sometimes you have sisters, friends, or your mom. But if someone around you or a general practitioner says, “Yes, the pain is just part of it”, then you’ll never go back to a doctor with this complaint.
Is there any indication as to why one person has more menstrual bleeding than the other?
It does happen that mothers and daughters have similar menstrual issues, but this only explains about fifteen percent of the cases. However, if a mother mentions having had heavy periods, it’s usually less alarming for the daughter.
There could also be medical causes for heavy menstruation, such as abnormalities in the uterus. For example, uterine fibroids. These can cause heavy bleeding and cramps if they are located in the uterine cavity. If they are on the outside, they often don’t cause any symptoms and can grow unnoticed. So, by the time you actually feel it, it’s often already quite large. Another condition is adenomyosis, where the uterine lining grows into the glandular pathways of the uterine muscle. During menstruation, it will menstruate within the muscle as well. You can imagine that this can lead to heavier periods, abdominal pain, and it can also cause irregular bleeding.
The theme of this year’s International Women’s Day is: “For all women and girls: Rights. Equality. Empowerment”. Unfortunately, racism is still a prevalent issue in the medical world, such as in pregnancy and childbirth care, where inequality due to “the white gaze” – prejudice and stigmatization in medical care – still occurs (RoSa vzw). Are there specific challenges in menstrual care for people of color?
Some conditions that lead to heavy menstrual bleeding appear to be race-dependent, such as uterine fibroids. Black women experience far more issues with them than white women. But why it’s so race-dependent, we simply don’t know yet. That certainly requires further research.
In 2022, your book Biografie van de Baarmoeder was published, and on March 13, it will also be released in English under the title Pear Shaped. You also contributed to the recently published Menstruatieverhalen, which is a part of Praten Over Gezondheid, and focuses on the experiences of people who menstruate. What do you hope to achieve with both your book and your contribution to Menstruatieverhalen, and what can we learn from the different experiences shared here?
Mainly, I want to help women gain insights. I believe that knowledge helps in taking better care of yourself. In Menstruatieverhalen, you can hear others’ stories, and you might think, “Oh, I’ve experienced that too”. Or, if you’re young, you can read about menopause in our book and understand what’s going to happen. It helps to have a bit of a knowledge base rather than having menopause come as a shock. It’s also kind of funny that there are so few books about the uterus, because the fact that the Americans are translating our book because they don’t have a book about the uterus is pretty remarkable.
We need to discuss the topic of menstruation much more, not just amongst women, but also with boys. The more we normalise it, the easier it will be for men to accept that it’s just part of life.
How can schools contribute to this?
Sex education in schools can be much better and is essential. You hear about the pituitary gland and hormones, but not that a period which causes a lot of pain is not normal. This message about the experience is often not given in schools, and although there are some small initiatives to change this, it’s still far too limited.
I also noticed in Menstruatieverhalen that many people mention having difficult experiences with their doctors: complaints are dismissed, misunderstood, and/or referrals are not made accurately. As a result, many people resort to self-education through online research, in order to demand care with the knowledge they’ve gained. What’s needed, in your opinion, to ensure that complaints are taken seriously?
For general practitioners, it’s difficult to recognize conditions that cause heavy menstruation, especially because they don’t deal with it on a daily basis. Research has shown that general practitioners only see six to eight women per year with menstrual complaints. Many women don’t bring it up with their GP. So if you aren’t confronted with it frequently, you also don’t investigate it as much. That’s why knowledge among the population is essential; the more you know, the easier it is to go to the doctor. We’re also actively working on raising awareness about Menstruatieverhalen among general practitioners and important medical websites like Thuisarts and DeGynaecoloog. Women need to come across this information, because if you think your complaints are normal, you won’t search for information.
You may officially be retired, but you’re certainly not standing still. What are you currently working on?
For the hospital here, Máxima MC, I’m still a member of the mProve Transformation Team. Together with the other six mProve teaching hospitals in the Netherlands, we focus on scientific innovation and collaboration to improve healthcare. We’ve set up transformation projects, including eight clinical and four digital innovations. As a specialist, I help assessing the medical issues. One example is a project for uterus removal as a day treatment, so women can go home the same day. This is more comfortable for the women themselves, and it saves hospital beds and nursing resources. We now want to offer this as standard care in all seven hospitals.
Additionally, I’m still a professor at Maastricht University Medical Center (MUMC), where I continue to supervise PhD students. Together with them, I focus primarily on endometriosis. We for example work on a national study investigating whether endometriosis cysts should be medically treated or surgically removed. This study is unique worldwide, and we’re currently analysing the data to determine the best treatment. The main focus is both on symptom reduction as well as quality of life.
It’s clear that throughout your entire career, and still today, you’ve been very focused on innovation in gynaecology. What are the most exciting innovations/developments we should look out for?
In our hospital, someone is working on an alternative technique for endometrial ablation. Currently, this is done using the NovaSure technique, but sometimes patients aren’t satisfied with it. In ten to fifteen percent of women, the uterus is still removed. I’m involved in the development of this technique and whether it can be improved beyond the current method.
Additionally, there’s Choice, a very innovative technique for hormone-free contraception, using a small valve in the fallopian tubes. This valve can be opened, so you can get pregnant, or closed so you cannot. The ultimate goal is to develop a product that can easily be removed if someone no longer wants it. They are technically quite advanced now, but it requires a lot of patience; development takes a lot of time and money.
If you could choose one thing that medical science should solve, what would it be?
The cause or origin of endometriosis. You want to know why some women experience it and others don’t, and we still don’t know that. That would give us clues about where to start in prevention. The whole world is looking for biomarkers, but so far, they haven’t been found.
Reading tip:
Links
- Read more on the website for Menstruatieverhalen
- Follow Dr. Marlies on LinkedIn
