UTERINE FIBROIDS
Understanding
What are Fibroids ?
The womb (uterus) forms part of the female reproductive system.The inside lining of the womb is called the endometrium and the outer wall is made up of a thick layer of muscle called the Myometrium. It is within this muscle wall that uterin fibroids can form. Uterine Fibroids are small lumps or growths that grow bigger very slowly usually over a few years, But may eventually cause problems. They are known as "Benign" (not cancer) and do not lead to cancer of the uterus or ovaries. Fibroids can be quite small but can grow larger to become about the size of a small plum.
Most Fibroids grow only within the muscle wall but some grow inwards appearing inside the womb(where a baby normally grows) and others may grow outwards from the womb and protude into the pelvic cavity.
Are Fibroids Common ?
Fibroids are the most common condition affecting a womans reproductive system, Its difficult to say exactly how many women have fibroids as they do not always cause problems or symptoms, even though they may be quite big.As many as one in five of all women under 50 are thought to have fibroids and they are more common in women of afro-carribbean origin and in women who have never been pregnant.
What are the Symptoms ?
Many women do not have any symptoms and do not even know they have fibroids until their doctors discovers them during a routine examination. When symptoms do occur they often begin as feelings of discomfort,Bloating and heaviness.Some women suffer from very heavy periods especially if they have fibroids that have grown inside the cavity of their womb. The periods becomes heavier on the 2nd or 3rd day often with flooding (soaking of tampons or sanitary towels) bloodclots and pain.Heavy periods can lead to a condition of the blood called anaemia which tends to make you feel very tired and lethargic. Fibroids do not generally cause pain but some women may suffer with low backache or crampy abdominal pains. If fibroids grow quite large they may press on to other organs nearby as the bladder or bowel causing problems with urination or constipation. Fibroids may be associated with Infertility and may be the cause of Infertility in up to 10% of cases
What should I do if I think I have Fibroids ?
If you have any of the symptoms described you should see your doctor. It is important that you obtain help and advice on how to relieve your symptoms.
How are Fibroids diagnosed ?
Often Fibroids are diagnosed by accident. Most commonly your gp will discover that you have Fibroids during a routine gynaecological examination. Fibroids may also be detected during investigations for Infertility, Although they are not usually the main reason for being unable to become pregnant. Your doctor will probably send you to the specialist (gynaecologist) at your hospital for a scan to confirm his diagnosis of Fibroids. The scan helps doctors assess how many Fibroids you have and exactly where they are.
How are Fibroids Treated ?
This really depends on whether you have any symptoms, There are two main forms of treatment; Medical and surgical, and in some cases both.If the fibroids are small and not causing you any problems, it is likely that you will not need any treatment but your doctor will ask to see you for regular check ups. It is important that you are involved in the decisions on which your treatment will be based.Issues to be discussed with your gynaecologist include your lifestyle, the severity of your symtoms, your age, and whether you wish to have children.The am of treating your Fibroids is to improve your quality of life by relieving your symptoms.If your Fibroids are preventing you from becoming pregnant, treatment to assist you in having a child will be considered
What does Surgery involve ?
If you have severe problems relating to your Fibroids it is likely that you will be offered some form of surgery,Surgical treatment will be either conservative or radical and these terms are explained in a little more detail below.
Conservative Surgery
Tends to be used in younger women, especially those wanting to become pregnant. It aims to remove the Fibroids themselves in a procedure called myomectomy whilst keeping your womb, ovaries and fallopian tubes. This means that you keep all your vital reproductive organs.The procedure is performed under general anaesthetic and the time taken will depend on the number and size of the Fibroids being removed, But is usually 1-2 hours.This treatment may then enable you to have children in the future if desired. It is important to realise that even with conservative surgery you could still suffer from Fibroids again in the future.
Radical Surgery
Is the removal of the womb (hysterectomy) This is undertaken in extreme circumstances and those not wishing to have children. All options would be discussed with your doctors before such measures were taken.
How do medical treatments work ?
The growth and development of Fibroids is affected by the production of a hormone from your ovaries called oestrogen. Medical treatments include hormonal drugs that reduce the amount of oestrogen you have, pain killers and iron tablets. The aim of these drug treatments are to relieve your symptoms and reduce the size of your Fibroids,They will improve your symptoms and make you feel fitter and less tired. You should understand that the hormonal drugs are sometimes only given for a certain length of time and they do not cure Fibroids. However, they will certainly improve your symptoms and even reduce the size of your Fibroids,But once you stop taking them it is likely that your Fibroids will return to their original size within a few months.
Which drug treatments am I likely to receive
If you are suffering from heavy periods due to your fibroids, your doctor is likely to give you a drug to help reduce the monthly bleeding.Hormonal drugs may be prescribed which help to reduce the size of your Fibrois and are usually given for about 3 months before surgery.They help to relieve pain and make the procedure simpler and shorter, so that you experience less pain after a operation. However they are hormonal drugs and there are some side effects associated with their use, Your doctor will give you more information about this.If you also have anaemia it is likely that your doctor will give you iron tablets,pain killing drugs help to relieve the crampy pains you may have during a period,These drugs are usually given the day before your period is due and taken as required.
Could I become pregnant during medical treatment ?
Even though pregnancy may be something you really want,it is important not to become pregnant during treatment with the hormonal drugs described, Your doctor will advise you on this but it is recommended that during such treatment you do use contraception. There is a risk of pregnancy during treatment with hormone drugs as they are not contraceptives.For this reason, you should use non-hormonal methods of contraception with these drugs such as condoms or a cap (diaphragm). Your doctor will be pleased to advise you about alternative methods.
WILL I BE ABLE TO HAVE CHILDREN AFTER TREATMENT
Fibroids are sometimes discovered by the doctor when examining women who has been trying to become pregnant. However, the presence of Fibroids is not necessarily the cause of Infertility. Depending on their size and where they are,Fibroids can affect the womb itself making conditions wrong for a fertilised egg to implant. In pregnancy, Fibroids can sometimes increase the possibility of miscarriage or of the baby being born too early (premature labour). Labour itself can be difficult f there is a Fibroid causing an obstruction in the lower part of the womb. However, Pregnancy can occur in women with Fibroids and cause no problems for mother or baby.If you are pregnant, or hoping to become pregnant, your doctor will be able to offer you advice.
What can I do to help Myself ?
It is important that you talk over any concerns or fears you have about your symptoms and treatment with your doctor, Particularly if surgery is an option. Make sure you get the full facts about an operation before making a decision. Hormone drugs work in a number of ways and although they generally work well, some drugs may cause side effects in a few people so do talk through any problems with your doctor or practice nurse. Treatment for your Fibroids will depend on a number of factors. Your doctor will discuss these choices with you and together you can agree the best way forward to suit you and your lifestyle. You may also wish to contact your local well woman clinic if you have one, or the occupational health department in your place of work, for advice and guidance.
PAGE CREATED BY JOANNA (BINKY)
14th April 2002
