Uterine Fibroids

It depends on whether the myometrium was opened. If it was a laparoscopic myomectomy for a subserous, pedunculated fibroid where the myometrium was not opened, pregnancy can usually be attempted after about six months. If the myometrium was opened to remove the fibroid, the advice is to wait one and a half to two years, similar to the healing time given after a previous caesarean section.

Dyspareunia from pelvic inflammatory disease usually comes with vaginismus, foul-smelling vaginal discharge and sometimes urinary tract symptoms. With a fibroid, the dyspareunia is not accompanied by these features. A vaginal swab sent for examination will show an infective organism in pelvic inflammatory disease, which is usually absent when a fibroid is the cause.

GnRH analogues are used to shrink a fibroid before a planned myomectomy, since a smaller fibroid means less bleeding during surgery; a monthly or three-monthly dose is given for this. The second use is in a perimenopausal woman, where these hormones hasten the natural shrinkage that would occur anyway as menopause approaches, since fibroids are otherwise known to delay menopause.

The two are not alternatives for diagnosis. MRI is a radiological procedure with no radiation that gives a detailed, thin-sliced view of a fibroid, and it is used when there is diagnostic doubt on ultrasound, for instance the rare possibility of a cancerous change. Hysteroscopy is a minimally invasive endoscopic procedure passed through the cervix, and it is never used as an investigative tool for diagnosing a fibroid. It is a treatment modality: it is used once a fibroid or polyp inside the cavity has already been identified, so it can be removed under direct vision.

Weight control through exercise and diet is important, since fibroids are more common in obese patients. An anti-inflammatory, broadly Mediterranean diet is recommended: plenty of green leafy vegetables, omega-3 sources like walnuts, flax seeds and olive oil, and less caffeine, alcohol and smoking. Red meat is considered inflammatory, so white meat such as fish, turkey and chicken is the better choice.

Uterine fibroids are benign smooth muscle tumours that grow from the musculature of the uterus. They are hormone dependent and very common, affecting up to 70% of women by the age of 50, most often between the ages of 30 and 50.

A family history of fibroids, an early first period, obesity, and lifestyle factors such as diabetes and hypertension all raise the risk. Fibroids are also more common, larger and more severe among women of African descent.