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Fibroids are benign (non-cancerous) tumours of the womb (uterus). They are also known as myomas. They are growths of smooth muscle and fibrous tissue. The size of fibroids can vary from as small as a pea to that of a melon. At least one in five women develop a fibroid at some stage of their life, usually between the ages of 30-50 years old.
Fibroids are named according to where they are found in the womb. There are three types:
Intramural fibroids are found in the wall of the womb and are the most common type of fibroids found in women.
Subserosal fibroids are found growing outside the wall of the womb and can become very large. They can also grow on stalks (called pedunculated fibroids).
Submucosal fibroids are found in the muscle beneath the inner lining of the womb wall.
The majority of women with fibroids show no symptoms. However, if symptoms develop, they may experience one or more of the following:
Heavy or painful periods- in some cases this can lead to anaemia
Discomfort, or swelling, in the lower abdomen, particularly if the fibroids are large
Urinating frequently, usually if the fibroids are pressing on the bladder,
infertility Very rarely, fibroids can cause problems during pregnancy and labour
As fibroids rarely have symptoms, they are often found during a routine gynaecological (vaginal) examination. If fibroids are suspected, an ultrasound scan can be used to confirm a diagnosis. A trans-vaginal scan is sometimes used to diagnose fibroids. It involves a small scanner being inserted into the vagina to take a close-up image of the womb.
Fibroids near your inner lining, and those within the cavity of your womb, can be seen directly using a hysteroscope (small telescope used to examine the inside of your womb). To look at the size and shape of the outside of your womb a laparoscope (small flexible tubing used to look inside the abdomen) is used.
If you do not have any symptoms from your fibroids, treatment may not be necessary. Some women with minor symptoms, such as heavy periods, choose not to have treatment as their day-to-day life is not affected. After the menopause, fibroids often shrink, and your symptoms will either disappear or ease slightly.
To treat fibroids, your GP may recommend medication. However, in more severe cases, surgery can be considered.
- Treatment with medication
- Tranexamic acid these tablets are taken from the start of your period for up to four days. The tablets work by helping the blood in your womb to clot, which reduces the amount of bleeding.
- Anti-inflammatory medicines such as ibuprofen and mefanamic acid help to ease your periods and are taken for a few days during your period. They work by reducing your body’s production of a hormone-like substance, called prostaglandin, which is linked to heavy periods. They are also painkillers but are not a form of contraceptive. Common side effects include indigestion and diarrhoea.
- The contraceptive pill is often taken, during your period, to prevent your menstrual cycle (period) from occurring. Some contraceptive pills also help to reduce any period pain you may experience.
- Levonorgestrel intrauterine system (LNG-IUS) is a small plastic device that is placed in your womb and slowly releases the progestogen hormone called levonorgestrel. It prevents the lining of your womb from growing quickly so your bleeding becomes lighter. Possible side effects of LNG-IUS include; having irregular bleeding that may last for more than six months, acne (inflamed skin on the face), headaches, and breast tenderness. The most effective medication to treat fibroids is an injected hormone medicine called
- Gonadotropin releasing hormone agonist (GnRHa). GnRHa works by preventing your menstrual cycle (period), but it is not a form of contraceptive. However, it does not affect your chances of becoming pregnant after you stop using it. Common side effects include menopause-like symptoms, such as hot flushes, increased sweating, and vaginal dryness. Osteoporosis (thinning of the bones) is a less common side effect.
- Surgical procedures Surgical procedures, for treating fibroids, are usually considered for large fibroids (>5cm) or if medications are ineffective in relieving symptoms. Common surgical procedures that are used to treat fibroids include:
- Myomectomy involves surgery to remove the fibroids from the wall of your womb. A myomectomy is an alternative to having a hysterectomy, particularly for women still wishing to have children. However, the procedure may not always be possible as it depends on your individual circumstances, such as the size, number and position of your fibroids.
- Hysterectomy involves surgery to remove the womb. A hysterectomy is not usually necessary unless the fibroids are very large or you have severe bleeding. A hysterectomy may be advised in order to prevent fibroids recurring.
- Endometrial ablation is removal of the womb lining. It is usually only carried out if your fibroids are near the inner surface of your womb. The affected womb lining is removed, which may be done in a number of ways, including using laser energy, a heated wire loop, microwave heating, or hot fluid in a balloon.
Menopause is the time in your life when you naturally stop having menstrual periods. Menopause happens when the ovaries stop making hormones. Menopause marks the end of the reproductive years. The average age that women go through menopause is 51 years.
The years leading up to menopause are called perimenopause. Cycles may become longer than usual for you or become shorter. You may begin to skip periods. The amount of flow may become lighter or heavier. Although changes in menstrual bleeding are normal during perimenopause, you still should report them to your doctor. Abnormal bleeding may be a sign of a problem.
What are the other signs and symptoms of menopause?
Some women do not have any symptoms of perimenopause or have only a few mild symptoms. Others have many symptoms that can be severe. Common signs and symptoms include the following:
Hot flashes - A hot flash is a sudden feeling of heat that rushes to the upper body and face. It may last from a few seconds to several minutes or longer. Some women have hot flashes a few times a month. Others have them several times a day. Hot flashes that happen at night (night sweats) may wake you up and cause you to feel tired and sluggish during the day.
Sleep problems - You may have insomnia (trouble falling asleep), or you may wake up long before your usual time. Night sweats may disrupt your sleep.
Vaginal and urinary tract changes - As estrogen levels decrease, the lining of the vagina may become thinner, dryer, and less elastic. Vaginal dryness may cause pain during sex. Vaginal infections also may occur more often. The urethra can become dry, inflamed, or irritated. This can cause more frequent urination and increase the risk of urinary tract infections.
What types of bone changes can occur after menopause?
During the first 4–8 years after menopause, women lose bone more rapidly. This rapid loss occurs because of the decreased levels of estrogen. If too much bone is lost, it can increase the risk of osteoporosis. Osteoporosis increases the risk of bone fracture. The bones of the hip, wrist, and spine are affected most often.
What do other health risks increase during perimenopause and menopause?
The estrogen produced by women’s ovaries before menopause protects against heart attacks and stroke. When less estrogen is made after menopause, women lose much of this protection. Midlife also is the time when risk factors for heart disease, such as high cholesterol levels, high blood pressure, and being physically inactive, are more common. All of these combined factors increase the risk of heart attack and stroke in menopausal women.
What is hormone therapy?
Hormone therapy can help relieve the symptoms of perimenopause and menopause. Hormone therapy means taking estrogen and, if you have never had a hysterectomy and still have a uterus, a hormone called progestin. Estrogen plus progestin sometimes is called “combined hormone therapy” or simply “hormone therapy.” Taking progestin helps reduce the risk of cancer of the uterus that occurs when estrogen is used alone. If you do not have a uterus, estrogen is given without progestin. Estrogen-only therapy sometimes is called “estrogen therapy.”
How is hormone therapy given?
Estrogen can be given in several forms. Systemic forms include pills, skin patches, and gels and sprays that are applied to the skin. If progestin is prescribed, it can be given separately or combined with estrogen in the same pill or in a patch. With systemic therapy, estrogen is released into the bloodstream and travels to the organs and tissues where it is needed. Women who only have vaginal dryness may be prescribed “local” estrogen therapy in the form of a vaginal ring, tablet, or cream. These forms release small doses of estrogen into the vaginal tissue.
What are the benefits of hormone therapy?
Systemic estrogen therapy (with or without progestin) has been shown to be the best treatment for the relief of hot flashes and night sweats. Both systemic and local types of estrogen therapy relieve vaginal dryness. Systemic estrogen protects against the bone loss that occurs early in menopause and helps prevent hip and spine fractures. Combined estrogen and progestin therapy may reduce the risk of colon cancer.
What are the risks of hormone therapy?
Hormone therapy may increase the risk of certain types of cancer and other conditions:
Estrogen-only therapy causes the lining of the uterus to grow and can increase the risk of uterine cancer.
Combined hormone therapy is associated with a small increased risk of heart attack. This risk may be related to age, existing medical conditions, and when a woman starts taking hormone therapy.
Combined hormone therapy and estrogen-only therapy are associated with a small increased risk of stroke and deep vein thrombosis. Forms of therapy not taken by mouth (patches, sprays, rings, and others) may have less risk of causing deep vein thrombosis than those taken by mouth.
Combined hormone therapy is associated with a small increased risk of breast cancer.
There is a small increased risk of gallbladder disease associated with estrogen therapy with or without progestin. The risk is greatest with oral forms of therapy.
Can plant and herbal supplements help with menopause symptoms?
Plants and herbs that have been used for relief of menopause symptoms include soy, black cohosh, and Chinese herbal remedies. Only a few of these substances have been studied for safety and effectiveness. Also, the way that these products are made is not regulated. There is no guarantee that the product contains safe ingredients or effective doses of the substance. If you do take one of these products, be sure to let your doctor know.
Can vaginal moisturizers and lubricants help with menopause symptoms?
These over-the-counter products can be used to help with vaginal dryness and painful sexual intercourse that may occur during menopause. Vaginal moisturizers replace moisture and restore the natural acidity of the vagina and can be used every 2–3 days as needed. Lubricants can be used each time you have sexual intercourse.
What can I do to stay healthy after menopause?
A healthy lifestyle can help you make the best of the years after menopause. The following are some ways to stay healthy during midlife:
Exercise—Regular exercise slows down bone loss and improves your overall health. Weight-bearing exercise, such as walking, can help keep bones strong. Strength training strengthens your muscles and bones by resisting against weight, such as your own body, an exercise band, or handheld weights. Balance training, such as yoga and tai chi, may help you avoid falls, which could lead to broken bones.
Routine health care—Visit your doctor once a year to have regular exams and tests. Dental checkups and eye exams are important, too. Routine health care visits, even if you are not sick, can help detect problems early.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Combined oral contraceptive pills or “the pill” are a form of daily birth control. The pills contain two naturally-occurring hormones, an estrogen and a progesterone. There are many different types of pills available, each with slightly different types of hormones and hormone concentrations. Pills work to prevent pregnancy by preventing the egg from being released from the ovary, and also by changing the cervical mucous to prevent sperm from reaching an egg.
Pills must be taken every day, at the same time each day, to work properly. Pills are less effective when not taken perfectly. Try to associate taking your pills with something else that is regular and routine. For the typical woman using the pills, it is 91% effective at preventing pregnancy (9 pregnancies in 100 women using the pill for year).
What to do in the case of missed pills:
- If you miss one pill, take the pill as soon as you remember even if it means taking two pills together. Continue taking your pills as usual. No back-up contraception is needed.
- If you miss two pills, take the pill as soon as you remember even if it means taking two pills together. Do not take any earlier missed pills. Use condoms or abstain for the next 7 days.
- If you have had unprotected intercourse, ask your health care provider about emergency contraception.
Pills do not protect against sexually transmitted infections (STIs). Condoms are the best way for sexually active people to reduce the risk of infection. Always use a condom to prevent STIs.
Advantages of pills:
- Decreased pain with periods and/or lighter menstrual periods
- May improve PMS (premenstrual syndrome) symptoms
- Can decrease risk of uterine (endometrial) and ovarian cancer
- Ability to become pregnant returns quickly when you stop taking the pill
Disadvantages of pills:
- Must take a pill every day, at the same time each day
- Some women experience side effects such as breast tenderness, nausea or change in mood or libido. Most of these symptoms improve with time
- The pill may interact with certain epilepsy (anti-seizure) or anti-retroviral medications
Risks of using pills:
- Venous thromboembolism - Very rarely, a blood clot can develop in the veins of the legs or in the lungs. These conditions can be life-threatening. Use of the pill increases the chance of developing a blood clot slightly. the risk of having a blood clot while taking the pill is approximately 1 in 500.
- Stroke or heart attack - Very rarely, younger women can have a stroke or heart attack. Use of the pill can increase the chance of this happening slightly if you also have other risk factors (such as high blood pressure, smoking or a certain type of migraine headaches).
- High blood pressure - The pill can slightly increase your blood pressure. For most women, this increase is small and does not affect your health.
Pills cannot be used by women who:
- Smoke and are 35 years or older
- Have high blood pressure (hypertension)
- Have certain types of migraine headaches
- Have a history of blood clot (DVT or PE), or if you or a family member have certain blood disorders which can increase the risk for a blood clot
- Currently have, or have a history of breast cancer
- Have a history of stroke or heart disease
- Have abnormal vaginal bleeding that has not been evaluated
- Have liver disease
- Have severe diabetes (with eye, nerve or kidney problems)
- Have recently given birth (within 3-6 weeks)
Tell your doctor if you have any of these risk factors or conditions, or of any other past or current medical problems or concerns. Your clinician will evaluate your history to help you decide if pills are the correct choice for you.
Warning signs – Call your healthcare provider or right away if you:
- Think you are pregnant
- Have been, or might have been, exposed to sexually transmitted disease
- Have unusual pain or swelling in the legs, unusual pain in your chest, or difficulty breathing
- Have sudden change in vision, severe headache, weakness, numbness or difficulty speaking
- Have new or worsening headaches
- Have depression or change in mood
In case you have a concern or query you can always consult an expert & get answers to your questions!
Hi, I'm pregnant for 21 weeks. I took folic acid tablets till 3 months and stopped. Should I continue or stop? I have a doubt. Please help me.
My wife took the unwanted pill for the third time. She had continuous bleeding for 9 days and daily spotting another week. What is the reason?
If you lose a baby before 24 weeks of miscarriage. If this happens in the first 3 months of pregnancy, it is known as an early miscarriage. Unfortunately, early miscarriages are common, with 10–20 in 100 (10–20%) pregnancies ending this way. Late miscarriages, after 3 months of pregnancy but before 24 weeks, are less common: 1–2 in 100 (1–2%) pregnancies end in a late miscarriage. When a miscarriage happens three or more times in a row, it is called recurrent miscarriage. Recurrent miscarriage affects 1 in 100 (1%) couples trying to have a baby.
Why does recurrent miscarriage and late miscarriage happen?
Sometimes there is a reason found for recurrent and late miscarriage. In other cases, no underlying problem can be found. Most couples are likely to have a successful pregnancy in the future, particularly if test results are normal.
There are a number of factors that may play a part in causing recurrent and late miscarriage:
- Age, the older you are, the greater your risk of having a miscarriage. If the woman is aged over 40, more APS- a syndrome that makes your blood more likely to DNA and the features we inherit from our parents). Although this may not affect the parent, it can sometimes cause a miscarriage
- Weak cervix is known to be a cause of miscarriage from 14 to 23 weeks of pregnancy. This can be difficult to diagnose when you are not neck of the womb opened without any Infection that makes you very unwell can cause a miscarriage. Milder infections that affect the baby can also cause a miscarriage. The role of infections in recurrent miscarriage is unclear.
- An abnormally shaped uterus may contributes to recurrent miscarriage or late miscarriages. However, minor variations do not appear to cause miscarriage.
- Smoking and too much chromosome
Tests for abnormalities in the baby You should be offered tests to check for abnormalities in your baby’s chromosomes. This is not always possible but may help to determine your chance of miscarrying again. If you have had a late miscarriage you may also be offered a postmortem examination of your baby. This will not happen without your consent and you will have the opportunity to discuss this with your health team beforehand.
Tests for abnormalities in the shape of your uterus. You should be offered a ultrasound scan to check for any abnormalities in the shape of your uterus. If an abnormality is suspected, further investigations may include a vagina and cervix) or a abdomen and swabs may be taken at the time to look for any source of infection.
What are my treatment options?
Treatment for APS
If you have APS and have had recurrent miscarriage or a late miscarriage, treatment with low-dose heparin injections in pregnancy increases your chance of having a baby. Aspirin and heparin make your blood less likely to clot and are safe to take in pregnancy.
Having APS means you are at increased risk of complications during pregnancy such as pre-eclampsia, problems with your baby’s growth and premature birth. You should be carefully monitored so that you can be offered treatment for any problems that arise.
Treatment for thrombophilia
If you have an inherited tendency to blood clotting (thrombophilia) and have had a miscarriage between 12 and 24 weeks of pregnancy, you should be offered treatment with heparin. At present there is not enough evidence to say whether heparin will reduce your chance of miscarriage if you have had early miscarriages (up to 12 weeks of pregnancy). However, you may be still offered the treatment to reduce the risk of a blood clot during pregnancy.
Your doctor will discuss what would be recommended in your particular case.
Referral for genetic counselling
If either you or your partner has a chromosome abnormality, you should be offered the chance to see a specialist called a clinical surgery with you.
If it is unclear whether your late miscarriage was caused by a weak cervix, you may be offered vaginal ultrasound scans during your pregnancy to measure the length of your cervix. This may give information on how likely you are to miscarry. If your cervix is shorter than it should be before 24 weeks of pregnancy, you may be offered an operation to put a stitch in your cervix.
Surgery to the uterus
If an abnormality is found in your uterus, you may be offered an operation to correct this.
progesterone or human chorionic gonadotrophin hormones early in pregnancy has been tried to prevent recurrent miscarriage. More evidence is needed to show whether this works.
Treatment to prevent or change the response of the immune system (known as immunotherapy) is not recommended for women with recurrent miscarriage. It has not been proven to work, does not improve the chances of a live birth and may carry serious risks (including transfusion reaction, allergic hepatitis).
What if no cause is found?
Where there does not appear to be a cause for recurrent miscarriage or late miscarriage, there is currently no evidence that heparin and aspirin treatment reduces the chance of a further miscarriage. For that reason this treatment is not recommended in these circumstances.
What does this mean for us in the future?
You and your partner should be seen together by a specialist health professional. Your doctor will talk to you both about your particular situation and your likelihood of having a further miscarriage and a successful pregnancy. If a cause has been found, possible treatment options will be offered to you to improve your chance of a successful pregnancy.
When you’re ready to take the plunge into parenthood, there’s no way to predict exactly how soon you’ll see a positive pregnancy test. If you’re in pretty good health, and having regular sex without birth control, you should expect to conceive in your first year of trying. In general, about half of couples will get pregnant within 6 months, and about 70%-80% will get pregnant within 1 year. But you and your partner can boost your odds of being parents-to-be by knowing the dos and don’ts of fertility. Set yourself up for success with these guidelines.
Him: Keep Tabs on Your Health
There’s a big connection between your overall health and your reproductive health, so making time for a quick health check can go a long way for your fertility.
Good diet, regular exercise, a healthy body weight, better sleep patterns, less stress -- all those things have been correlated with semen quality. Your doctor can help you make any changes you might need to be your healthiest self, as well as address any issues that might be a barrier to baby-making. Avoid hot baths and saunas- The testicles are a few degrees cooler than the rest of the body, because that's a better temperature for sperm production, so anything that warms them up can potentially be an issue. It takes your body 2-3 months to make new, mature sperm. Another heat source to watch out for: laptops.
Her: Learn How to Read the Signs
All pregnancies start when egg meets sperm. So they need to be in the same place at the same time. To help that happen, you can keep track of when your ovaries release an egg, called ovulation, and have sex during that time frame.
If your cycle is regular (with periods coming 26 to 32 days apart), that may just mean having sex on days 8-19 after your period. If you have irregular periods, you may not be able to rely on the calendar alone to know when you’re ovulating. However, there are other ways your body tells you it’s go-time.
To start, take note of your daily discharge. Cervical mucus increases and becomes very thin, stretchy, and clear as you approach ovulation. Watch for a consistency like egg whites.
You can also track your basal body temperature (BBT), which is your body’s temperature when it’s fully at rest. A rise of 0.6 degrees or more for over 10 days is a sign that you’ve ovulated. But your most fertile time is 2-3 days before that boost. When you track it for a few months, you’ll get an idea of when you might ovulate on your next cycle. For a more precise measure of those pre-ovulation days, you can buy an ovulation predictor kit from the drugstore. It tests your urine for hormone levels that spike a few days before ovulation.
Watch your weight: extra pounds make you more likely to have irregular menstrual cycles, or to not ovulate at all. Losing even a small percentage of body weight can increase fertility and decrease health risks during pregnancy.
Being too thin impacts fertility, too. Not only are you more likely to have irregular periods if you’re underweight, you’re also at risk for preterm birth once you do get pregnant, and your baby is more likely to be born at a low birth weight.
It's fine to get in some moderate activity. But engaging in strenuous, vigorous and extreme exercise might impact your menstrual cycle, leading to infertility. So, pass on the marathon when you're trying to get pregnant.
Both: Timing of intercourse
Once you’ve got a handle on your fertile window, set a good schedule for sex. We recommend couples have sex about every other day from a few days prior to ovulation until a few days after. Doing it more often doesn’t hurt your odds, but there are some studies that show it may lower a man's sperm count.
Before trying to concieve, review your medications with your doctor to be sure they don’t affect your fertility -- or won’t cause harm to a future baby.
Birth control pills use these hormones to prevent pregnancy. But if you’ve recently stopped taking them, there’s no need to fret about a post-pill waiting period. Your body should be ready to conceive right away, even if you took them for years. The length of time you used any form of birth control doesn’t affect your ability to get pregnant. Taking a daily folic acid supplement not only helps prevent birth defects, it may increase fertility as well.
Benefits of breastfeeding
- Breast milk contains the right balance of nutrients for your baby. Breast milk is easier to digest than is commercial formula.
- The antibodies in breast milk boost your baby's immune system. Breastfed babies get fewer colds and sinus and ear infections. They also have less diarrhea and constipation and a decreased chance of having allergies.
- Helps to increase the bonding with your baby
- Helps to reduce the risk of breast cancer in the mother
- No frantic runs to the store. No bottle cleanup. Many moms just roll over (especially if their baby is in a co-sleeper) and nurse in a sleepy state. Breast milk is instantly available and delivered warm.
- If you mostly breastfeed, you save money on formula
- Breast-feeding might even help you lose weight after the baby is born.
Its tough in the begining
Consider a breastfeeding class while you're pregnant. Getting baby to latch on may not feel natural. Ask for help in the hospital. Those first days, you might feel what experts call extreme tenderness -- and what we call pain. But once your baby is properly latched, discomfort should diminish during each nursing session and go away completely with time. Don't ignore shooting pain; a knot in the breast accompanied by soreness and redness could be a plugged milk duct, which can lead to mastitis, a nasty infection that requires antibiotics.
Start by getting comfortable. Support yourself with pillows if needed. Then cradle your baby close to your breast rather than learning forward to bring your breast to your baby. Support the baby's head with one hand and support your breast with the other hand. Tickle your baby's lower lip with your nipple to encourage your baby's mouth to open wide. Look and listen for a rhythmic sucking and swallowing pattern.
If you need to remove the baby from your breast, first release the suction by inserting your finger into the corner of your baby's mouth. If your baby consistently nurses on only one breast at a feeding during the first few weeks, pump the other breast to relieve pressure and protect your milk supply.
You're the food supply, so mother yourself
The nutrient needs of a woman are at an alltime high during breastfeeding. Keep taking prenatal vitamins, get ample calcium. By weight, 88% of breast milk is water. Breast milk volume increases from as little as 50 ml on the first day, to as much as 750 ml a day, when breastfeeding is well established. So, the most critical nutrient needed for the production of ample breastmilk to meet a suckling baby s demand, is water. Aim to drink at least 1.5- 2 litres/day.
You'll also need to learn to relax, however you can -- stress might affect letdown (the start of your milk flow). Take a warm shower, sink into a chair, and remember to breathe as you help your squirmy baby latch on.
Select wholesome food such as wholegrains, fruit, vegetables, low fat dairy products, lean meat, fish, poultry, eggs, beans, nuts and seeds to maximise the overall nutrient quality of your diet.If you need medication (for anything from a cold to a chronic condition), check with your doctor. Most meds -- but not all -- are fine in breast milk.