“We decided to go and see a fertility specialist, and I was really nervous about it all,” she recalls. “I had friends who’d gone this route, and one of them had been on hormone treatment for months and been badly affected by it; another had tried in vitro fertilisation unsuccessfully – and at huge expense – and I was really unsure about the whole process. But we wanted a baby badly, so off we went.”
First Tina’s boyfriend was tested, but his sperm count and fertility were found to be normal. Next it was Tina’s turn. The specialist started by performing an ultrasound scan to look at the inside of Tina’s uterus (womb)and there it was – a fibroid about the size of a tennis ball, blocking one of her Fallopian tubes. She was given some hormone treatment to shrink the fibroid, it was removed through a simple operation and a couple of months later, Grace was pregnant with her first baby.
Sindi* had a slightly different experience. She’s much older than Tina – in her mid-40s – and although she’s now married for the second time, she never wanted children, so fertility was never an issue.
A few years ago, however, Sindi started experiencing very heavy periods and extremely severe period pain. “I’d always suffered from reasonably heavy periods, but this was something else,” she says. “I often had to take time off work because it was the only way I could cope with both the bleeding and the pain. After a couple of months of this, I decided to visit my gynaecologist to find out what was going on.”
The culprit, again, was a fibroid – but in Sindi’s case, it was the size of a football. “It had grown to that size in just over a year,” she says. “I couldn’t believe it. They removed it via abdominal surgery and took my uterus out with it – I wasn’t going to be using my womb for anything, anyway! The doctor said it weighed about 2,5kg – that’s the size of a small new-born baby!”
Dr Nick Clark, a Sandton gynaecologist, explains what fibroids are. “The uterus – apart from its lining, the endometrium – is made up largely of muscle. A fibroid, or uterine myoma, is a benign or non-cancerous tumour of the uterus – an overgrowth of cells.”
These lumps of tissue are the most common type of growth that affect women, and up to one-fifth of women may experience them at some time in their lives. Fibroids are most common in women over 35 and never appear for the first time after menopause because they develop in response to the female hormone, oestrogen, which is decreased in post-menopausal women.
Usually women who suffer from fibroids have more than one at a time. They can also vary tremendously both in size and in the rate at which they grow. And, while they often grow within the wall of the uterus, they can sometimes protrude into the cavity of the womb or grow outwards from the surface.
Dr Clark explains that while there are symptoms that indicate the possible presence of fibroids, some women experience no symptoms at all. “There are many women who probably aren’t even aware that they have fibroids,” he points out. “Others might feel a lump in their tummy, or have very heavy periods, bad period pain, or even chronic backache. In some cases, fibroids may even prolapse through the cervix, although that’s less common.”
And while, in themselves, fibroids aren’t harmful, they can interfere with other processes in the body. Dr Clark elaborates: “Fibroids can affect fertility – either mechanically, because they cause blockages of the Fallopian tubes, for example – or they can cause problems with implantation of the fertilised egg into the uterus.
Fibroids can also grow to the size of a football, and many women don’t come for treatment until they’ve been having symptoms for quite some time. If they get very big, women can suffer pressure symptoms from them, which might lead to something like kidney failure. Anaemia (a lack of oxygen-carrying cells in the blood) is also a common presentation, because patients have had such heavy periods.”
Small fibroids usually don’t require any treatment, because they tend to shrink and disappear after menopause. But once they’ve developed to a certain size, they usually persist, and may slowly grow larger unless removed.
Regardless of their size, Dr Clark says fibroids are usually only treated when they’re symptomatic and become problematic in patients’ lives. “Surgery is the most common way of treating them, usually through a hysteroscope (a tubular instrument with a light source for observing the interior of the uterus and facilitating surgery through the vagina), or a laparoscope (a similar instrument which is inserted through tiny incisions on the abdomen, and which leaves minimal scarring). If the fibroids are very big, we have to open patients up in the conventional way to remove them.
“Here there are also two options: a myomectomy, which means we leave the uterus – and, therefore, the patient’s fertility – intact, or a hysterectomy, where the entire uterus is removed. The latter is usually only performed on patients who’ve completed their families.”
Recovery after surgery varies, depending on the kind of surgery you’ve had, and how extensive it was. If a hysteroscope or laparoscope are used to remove the fibroids, it takes about two to four weeks to recover. However, if you have to have conventional abdominal surgery, it can take approximately six weeks to recover, and you probably won’t be permitted to drive for that period.
Says Dr Clark: “There’s not much one can do to prevent fibroids. They’re oestrogen-sensitive, so they only really occur newly in pre-menopausal women. We also find that black women are far more prone to fibroids. It’s possible to shrink them through oestrogen suppression, which we sometimes do.”
You can, however, minimise their effect on other processes in your body by reporting any symptoms to your GP or gynaecologist sooner, rather than later.
You should consult your gynaecologist if your periods become markedly heavier than usual or more painful, if spotting occurs frequently or if you experience unusual swelling or pain in your lower abdomen.
Your doctor will probably carry out an internal pelvic examination, take a blood test for anaemia and suggest an ultrasound scan to check if fibroids are the problem, or whether it’s something else causing your discomfort. If fibroids are the culprit, remember that the smaller they are, the easier they’ll be to remove – and the faster you’ll recover.
Polyps
The word “polyp” is a general descriptive term for any mass of tissue projecting outwards from the surface of surrounding tissues in the body. Some women may suffer from polyps on the endometrium, the lining of the womb.
Polyps develop from mucous tissue to form dangling shapes and are usually harmless. They may be single or multiple and may range in size from 1-2mm, to masses that fill or even distend the uterus.
Most polyps arise near the top of the uterus and extend downwards. Polyps aren’t well understood, but are presumed also to be oestrogen-sensitive.
Polyps may also cause heavy periods, as well as spotting between periods, and are frequently detected via a hysteroscope. Left unchecked, they can cause excessive pain and bleeding, and can affect fertility. They could also be pre-malignant.
They’re usually removed surgically, followed by a dilatation and curet
