(Continued from last week)
How to find out if you have fibroids
Because there are often no symptoms, you may only find out you have fibroids when you go for an internal examination. If you have symptoms and think you might have fibroids, see your doctor. You may be referred to a gynaecologist who should be able to diagnose whether you have fibroids or another condition. The doctor will give you a vaginal examination to feel your uterus for lumps or bulges.
If your doctor says you do have fibroids, ask if there is more than one, where they are and how large they are. This will help you better understand your symptoms and decide what action to take, if any. Your doctor may want to confirm a fibroid diagnosis with additional tests:
An ultrasound uses sound waves to get an image of your internal organs. This can help determine if the lumps are fibroids or another type of tumour. It can also provide more detailed information about the size and location of fibroids.
You may be given an abdominal ultrasound, a vaginal ultrasound or both. An abdominal ultrasound is best at finding large fibroids. Before your appointment you will be asked to drink up to a litre of liquid so that you have a full bladder for the test. The scan itself is not painful (the doctor simply moves the probe over your belly), but waiting for your appointment with a full bladder may be uncomfortable.
A vaginal ultrasound is used to find small fibroids. The scanner (probe) will be put into your vagina and may be a little uncomfortable. You do not need to have a full bladder for this scan and it should not be painful.
If the ultrasound results are unclear, your doctor may suggest a hysteroscopy or laparoscopy
A hysteroscopy examines the inside of your womb by using a small telescope (hysteroscope) which is inserted into your womb through your vagina. Hysteroscopy can also be used to take a biopsy (tissue sample) of the lining of the womb. You may be given a local anaesthetic, general anaesthetic or in some cases, neither. If you do not have an anaesthetic, the procedure may be slightly painful. Hysteroscopy is done in hospital and you can usually go home the same day.
Where a hysteroscopy (see above) looks at the inside of the womb, a laparoscopy looks at the size and shape of the outside of the womb. It can also be used to take tissue samples. The procedure involves making a small cut (about 1cm wide) in the lower abdomen, just below the belly button, and inserting a thin telescope (the laparoscope). You may also have a probe inserted into your vagina to help move your womb so the laparoscope can see it from different angles.
The operation usually takes about 30 minutes and is done in hospital. You will be given a general anaesthetic before the procedure and will have a few stitches afterwards. Sometimes air is pumped into the abdomen as part of the procedure and this may leave you feeling bloated.
Living with fibroids
The most common approach to fibroids that are causing heavy bleeding is to monitor rather than treat them. You will probably be asked to have regular check-ups, but you may still want help with your symptoms.
Although a healthy diet may not reduce your fibroids, it may help reduce some of the symptoms:
• Avoid alcohol, sugar and saturated fats. They make it difficult for your body to regulate hormones. This can increase cramps and bloating.
• Eat fruits and vegetables, particularly broccoli and spinach – they also may help your body regulate its oestrogen levels.
Get plenty of B vitamins, calcium, magnesium and potassium – thought to help reduce cramps and bloating.
If you have fibroids that are not causing you any problems, you don’t need treatment. Your doctor may suggest you keep an eye out for any changes, or s/he may ask you to have regular ultrasounds to check if the fibroids are growing. If your doctor does suggest treatment, it will depend on several factors, including the severity of your symptoms, the size and position of your fibroid(s), your age and whether or not you want to have children in the future. If you are nearing the menopause, for example, when fibroids tend to shrink on their own, you may want to wait and see if your symptoms improve without treatment.
Treating fibroids has traditionally meant undergoing major surgery, but now there are other options to consider (see table below). Talk to your doctor about treatment options. Ask for a full explanation of each approach, including the risks, benefits and success rates. You may also want to talk with women who have had the treatment you are considering. (Women’s Health may be able to put you in touch with a woman who has been in a similar situation.
Drug treatments – GnRH analogues
A group of drugs, called GnRH analogues, reduce oestrogen levels in your body and, as a result, cause fibroids to shrink. Studies have shown that when taken for six months, GnRH analogues can reduce the size of fibroids by up to 50%. They also stop menstrual bleeding and pelvic pain. But GnRH analogues should not be taken for more than six months in total and there are a number of side effects. These include menopause-like symptoms such as hot flushes, vaginal dryness and bone loss (osteoporosis).
Once you stop taking the drugs, fibroids begin to grow again.Your periods should also return within a few weeks, although some women may no longer ovulate after treatment.
GnRH analogues are most commonly used to reduce the size of fibroids before surgery. In some cases, doctors may recommend them as a temporary treatment for women who are nearing the menopause, when fibroids should begin to shrink naturally.
Surgical and non-surgical procedures
The main treatments for fibroids are:
• Myomectomy (removing fibroids individually, leaving the womb intact)
• Hysterectomy (removing the womb entirely)
• Uterine artery embolisation (blocking the blood supply to the fibroids)
There is also a new procedure that is not included in the treatment chart because it is still undergoing trials. The procedure involves inserting four specially designed needles through the abdomen. Magnetic resonance imaging (MRI) is then used to guide the needles directly to the fibroid. The MRI is also used to monitor the effects on normal tissue around the fibroid in order to prevent any damage during the procedure. Once in place, the needles release laser energy into the centre of the fibroid, burning its tissue and halting its growth. Results so far suggest this procedure is effective in reducing symptoms and fibroid size, is minimally invasive and is without complications. These are, however, only the first set of results. More research and longer follow-up is needed to fully understand the benefits, risks and long-term effects.