Tuesday March 7, 2017
At London Doctors Clinic, our GPs are not just here for the quick-fix conditions such as tonsillitis and cystitis; they are also able to advise on more complex conditions, such as gynaecological issues. Should you prefer to discuss such issues with a specifically female GP you're welcome to get in touch and we'll ensure to accommodate this for you.
Today, we focus on one of the most common gynaecological conditions many women across the country live with: fibroids.
What Are Fibroids?
The wall of your womb is made up of 3 layers, an inner glandular layer (endometrium), a central muscular layer (myometrium), and a thin outer layer (serosa). Fibroids are non-cancerous growths of the muscular tissue of the womb which can occur in and around your womb (uterus).
Fibroids are very common, affecting around one in three women. The cause is not fully understood, but their growth is linked to the hormone oestrogen, which is produced by the ovaries during a woman’s reproductive years. Fibroids occur most commonly:
- Between 30-50 years of age
- In overweight and obese women
- In Afro-Caribbean women
The risk of fibroids is reduced in women who have had children, taken the combined oral contraceptive pill or the depot progesterone contraceptive.
Most women won’t experience symptoms and won’t be aware that they have a fibroid. Fibroids are often found by chance in a scan or routine gynaecological (vaginal) examination. However, one in three women experience persistent symptoms including:
- Heavy or painful periods
- Tummy pain
- Increased need to urinate if a fibroid is pressing on your bladder
- Constipation if a fibroid presses on your bowels
- Pain during sex
If you are experiencing these symptoms, book into your GP surgery so that they can be investigated. Your GP or private GP will ask you about your symptoms and may advise you to have a gynaecological examination. You may then be referred for further tests to confirm the diagnosis.
When diagnosing fibroids it is important to identify the number and size of fibroids. Additionally, where the fibroid is found in the womb determines how it is named:
Where it grows
Inside the muscular layer of the womb
Outside the muscular wall into the pelvis - can become very large
Just below the inner womb lining, inside the muscular layer. Grows into the space inside the womb
Outside the womb-attached to the womb by a narrow stalk of tissue
An ultrasound scan is commonly used to diagnose fibroids. This painless procedure uses a probe, either placed on the tummy or inserted into the vagina. If your results suggest fibroids, you will be referred to a gynaecologist who may suggest further tests. This may include an MRI scan, or inserting a small camera through the vagina (hysteroscopy) or through a small cut in the tummy (laparoscopy) to look for fibroids or other problems inside and outside your womb respectively. They may also take a small sample of tissue. A blood test will check if you have anaemia.
An ultrasound scan is often used to diagnose fibroids
Complications of Fibroids
Most women do not experience complications - but they can occur, due to fibroid size or position. Fibroid ‘degeneration’ occurs when blood supply to fibroids is insufficient and may cause sudden tummy pain. If you experience this symptom you must see your doctor.
Large fibroids can lead to difficulties becoming pregnant (infertility). Additionally, in pregnancy, fibroids increase your risk of miscarriage, bleeding and premature labour. Occasionally, caesarean section may be needed to deliver your baby if your fibroid blocks your vagina or causes your baby to lie breech. If you have fibroids and are pregnant, your GP or midwife can provide you with information and advice.
Treatment is not required if symptoms are only minor, and following menopause, fibroids usually shrink, reducing symptoms. Treatment for women with moderate to severe symptoms may involve medical, surgical or other procedures. A discussion with your doctor about your symptoms and whether you would like to have a baby in the future, together with the size, number and location of fibroids will determine your best treatment option.
Your GP may recommend medications for pain relief and medications to treat heavy bleeding including, some forms of contraception, and other medications which do not affect fertility. If these are ineffective and you are not trying to conceive, you may be referred to a gynaecologist to try some other medications which shrink fibroids.
Surgical and other procedures:
For women who do not want to have a baby in the future, open or keyhole surgery to remove your womb (hysterectomy) can be performed. This is the only way to completely get rid of fibroids but does not allow for future pregnancies. Another option, endometrial ablation uses energy to remove your inner womb lining. Following this, contraception must still be used due to a small risk of pregnancy and increased risk of miscarriage and complications.
For women who still want to have a baby in the future, a surgical procedure to remove fibroids from the wall of your womb (myomectomy) can be done using open or keyhole surgery. Another option, uterine artery embolisation uses a small tube guided by X-ray from a vessel in your leg to inject a chemical into the blood vessels that supply your fibroids to make them shrink.
So, if you're worried you might be suffering from fibroids, or need any more information, why not book at appointment with LDC? We have 8 private clinics, located across central London, so should always be close by when you are in search of a "doctor near me".
By Ayala Shirazi