The Menopause Exchange Blog

FIBROIDS AND ENDOMETRIOSIS

Fibroids and endometriosis are common women’s health problems. Here’s what you should know about them.

This article was included in issue 90 ( Autumn 2021) of The Menopause Exchange newsletter.

What are fibroids?
Fibroids are non-cancerous growths in the wall of your uterus. They’re made of fibrous muscle tissue and vary from pea to grapefruit in size. They affect one in three women, usually aged 30 to 50, and are more common in African-Caribbean women. The exact cause is unknown but they’re probably linked to oestrogen. In a woman’s reproductive years, oestrogen levels are high, which is when fibroids grow. Fibroids stop growing and may shrink after the menopause. They occur more often in overweight/obese women as body fat contains oestrogen-producing cells. It’s not clear why, but women who’ve had children have a lower risk.

Fibroids may not cause symptoms, but may be found when you’re examined for other reasons. Some women get heavy or painful periods, lower back pain, constipation, needing to pee more or discomfort during sex. This depends on where the fibroids are, how big and how many. More rarely, very large fibroids may cause tummy swelling or infertility or pregnancy complications. Fibroids can be diagnosed with an examination or a scan, usually an ultrasound.

HRT and fibroids
Fibroids may be affected by HRT, but this doesn’t mean you definitely can’t have HRT. Women with fibroids who take HRT should be examined regularly and the HRT stopped if the fibroids get bigger. Choosing the most appropriate HRT is crucial to avoid fibroid growth or symptoms, using the lowest effective dose.

Medical treatments for fibroids
Fibroids don’t need to be treated if they’re not causing any symptoms. But if they’re causing pain or heavy bleeding, your GP may recommend a treatment such as a progestogen hormone coil (e.g. Mirena), or tranexamic acid tablets (a type of NSAID medicine) to reduce blood loss. Other NSAIDs may help, as may the contraceptive pill, progestogen tablets or injections. Specialist prescribed medicines that shrink fibroids include gonadotropin releasing hormone (GnRH) analogues or ulipristal acetate.

Non-surgical fibroid treatments
Uterine artery embolisation (UAE) blocks the blood vessels supplying the fibroids, so they shrink. This involves injecting a special solution through an X-ray-guided tube through a blood vessel under local anaesthetic. Endometrial ablation, a relatively minor procedure, removes your uterine lining (containing any fibroids), by using a laser, heated wire loop or hot fluid in a balloon.

Surgery for fibroids
If medicines don’t help, you may need surgery. Myomectomy – taking fibroids out of your uterine wall – may be an alternative to a hysterectomy if you still want children. Hysteroscopic resection uses special tools to remove fibroids through your cervix under a general or spinal anaesthetic. If you’ve completed your family, a hysterectomy may be recommended to remove your whole uterus and fibroids.

What is endometriosis?
When endometrial tissue is found outside your uterus, this is called endometriosis. It affects women of any age, and the reasons why this happens are poorly understood. Most commonly, the endometrial tissue is found on your ovaries and fallopian tubes or elsewhere in your tummy area, but it may be found elsewhere in your body such as your lungs, bladder, bowel or even skin. During a period, it bleeds in the same way your endometrial lining bleeds. Some women are badly affected; others have no noticeable symptoms. Lower tummy, back or pelvic pain are common, usually at the time of a period. You may also experience bad period pain, very heavy periods with flooding, pain when peeing or pooing during your period and pain during or after sex. Some women get nausea, constipation, diarrhoea or blood in their pee during their period, and some have difficulty conceiving.

Diagnosing endometriosis isn’t straightforward because the symptoms vary and are like many other conditions. But you may have endometriosis if your symptoms are affecting your tummy, periods, bowel or bladder, especially if they follow your menstrual cycle pattern. It helps to write down your symptoms before seeing a doctor. Endometriosis UK has an online symptom diary you can use. Your GP will take a history, examine your tummy and offer a vaginal examination. They’ll refer you to a gynaecologist for further tests, including an ultrasound scan or a laparoscopy – an operation under anaesthetic when a small cut is made in your tummy wall and then a camera is put in to look and take tissue samples (biopsies) to confirm the diagnosis.

Treatments for endometriosis
There’s currently no cure, but treatments may ease your symptoms. These include painkillers, hormonal medicines and contraceptives, including the combined pill, patch or intra-uterine system (IUS) and medicines called gonadotrophin releasing hormone (GnRH) analogues. Hormonal treatments aim to stop you having a menstrual cycle so the bleeding doesn’t happen.

You may need surgery to cut away patches of endometriosis tissue, or (if appropriate) an operation to remove part or all of the affected organs, such as a hysterectomy if your family’s complete. Some women have fertility problems.

Some women develop adhesions, ‘sticky’ areas of endometriosis tissue that join organs together, or ovarian cysts – these are fluid-filled cysts that can get very large and painful, and will need surgery. Endometriosis affecting the bladder or bowel can be difficult to treat and may need major surgery. Endometriosis is a difficult condition, both physically and emotionally. Visit Endometriosis-uk.org, or call the charity helpline (0808 808 2227) for information and support.

About the author
Dr Gill Jenkins works as a GP with special interests in diabetes, travel health and women’s health. She also works part-time as a flight doctor on international air ambulances and, on quieter days, is a medical writer.

Created Autumn 2021
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