Until recently, there were few options for women with problematic fibroids. However, the good news is that, if necessary, fibroids can be removed surgically by themselves, and the uterus saved. Natural therapies can be an effective option for fibroids, especially small and medium sized ones.
Fibroids are made of smooth muscle and fibrous tissue. They can vary from the size of a pea to a size of a melon. They are made of hard white grisly tissue that has a whorl-like pattern. Fibroids can be easily diagnosed through a pelvic ultrasound.
Fibroids can cause no symptoms at all, or cause irregular or heavy bleeding, and pressure symptoms. In fact, heavy or irregular bleeding is the most common presenting symptom of fibroids. Sometimes a large fibroid can cause symptoms by pressing on a pelvic organ. For example, urinary frequency may result from pressure on the bladder. Fibroids can also cause a sense of fullness in the rectum, lower back or abdomen. Usually these symptoms are annoying, but not harmful.
Small slowly growing fibroids which are causing no symptoms can be left alone. Symptomatic small fibroids can be removed through a new procedure known as hysteroscopy. Hysteroscopy refers to an operation in which a small lighted instrument (scope) is used to look inside the uterus (hystero).
Fibroids under 1 to 2cm (about an inch) in diameter, or that have a stalk, or that are protruding into the uterine cavity can be easily removed through the hysteroscope. Fibroids between 2.5 and 5 cm. (one and two inches) can be removed the same way, after they have been shrunk through medication. Fibroids larger than 5cm (two inches) must be shrunk medically, and then removed in two steps. Some fibroids can be also be removed through the laparoscope, which involves two to four small surgical incisions in the abdomen.
Fibroids larger than the size of a grapefruit that are causing pressure symptoms or severe bleeding can be cut out by themselves through abdominal surgery known as myomectomy. Depending on the location and size of the fibroids, myomectomies can be more complicated, take a longer time, and cause more blood loss than hysterectomies. It may take some research and input from women's groups to find a gynaecologist skilled at removing fibroids while preserving the uterus.
There is a new non-surgical technique being studied in Toronto called "embolization". This treatment involves injecting tiny granules of polyvinyl alcohol to plug up the tiny blood vessels that enable the fibroid to grow. The fibroids then shrink in size or sometimes disappear altogether.
During this procedure, a catheter is inserted through a vein in the groin area to the uterine arteries. The granules are then injected through the catheter and travel with the blood into the small blood vessels supplying the fibroids and block them up. The main uterine arteries may also be blocked, so this technique is not suggested for women who still intend to become pregnant. The fibroids then break down, and this can cause pain in the first few days following the embolization.
Dr. Andrew Common, head of vascular radiology at University of Toronto has successfully used this treatment to treat ten women at St. Michael's Hospital in Toronto, and more than 200 cases have been performed worldwide. A five year study involving four Toronto hospitals and enroling 400 to 500 women is in progress and will be completed in 2003.
Fibroids will grow larger if you are taking estrogen pills. Fibroids will also shrink after menopause. So if you are close to menopause, the best course may be to leave them alone until that time.
Some women have had success treating symptomatic fibroids naturally. The natural approach involves diet, nutritional supplements, natural progesterone and liver support. Improving pelvic circulation is also important through osteopathy, through "visceral manipulation" (a special type of chiropractic manipulation) hydrotherapy, and castor oil or clay packs to the lower abdomen. Usually the supervision of a skilled naturopathic physician or chiropractor is necessary to co-ordinate a multi-pronged approach.
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