Often, the egg is not fertilised and it dies. The hormones change and the endometrium also dies and is shed. There is some bleeding from the raw endometrium for a few days. This is a typical period. The cycle then starts again for the next month. If the egg is fertilised it starts making extra hormones. These make the uterus and endometrium grow to take the developing baby.
What has gone wrong?
You have formed fibroids in the walls of your uterus, just under your endometrium. These swellings are a very common reason for heavy or painful periods. This is because they make the surface area of your endometrium larger than normal. The uneven surface of your endometrium over the fibroids can prevent a fertilised egg from lodging there properly. This can lead to infertility. The fibroids can also dislodge a growing baby. This can cause repeated miscarriages.
The aims
We remove the fibroids to make your uterus as normal as possible. The best method of removing the fibroids depends on their size, position and number.
In cases such as yours, where the fibroids are lying just under the endometrium, we do the operation using a special telescope, called a hysteroscope. We pass this through your vagina and cervix, into the body of your uterus. We pass instruments through the hysteroscope to remove the fibroids. We send the removed fibroid tissue to the laboratory for tests.
The benefits
We remove the fibroids to return the surface area of your uterus to a more normal size. This should make your periods less heavy and relieve your symptoms.
Removal of fibroids blocking your Fallopian tubes or cervix may cure infertility and reduce your chance of further miscarriages.
Are there any alternatives?
There are other ways of dealing with the fibroids.
- Drug treatment - You can take drugs to make the fibroids smaller, but this is unlikely to be permanent and the fibroids may grow back.
- Keyhole surgery - We can sometimes remove smaller fibroids using keyhole instruments passed through tiny cuts in your abdomen. This is more commonly used for serosal or intra-mural fibroids.
- Embolisation - This is a method of shrinking single fibroids by cutting off their blood supply. Under x-ray guidance we pass a fine tube, called a catheter, into an artery in your leg. We push it along to a position near the artery supplying blood to the fibroid. We inject tiny particles down the catheter to block the fibroid’s blood supply.
- Hysterectomy - This is an operation to remove your uterus. If you never want to become pregnant and do not mind losing your uterus then this will stop your bleeding problems permanently.
Discuss the pros and cons of each treatment with your gynaecologist.
What if you do nothing?
If you do nothing your period problem is likely to continue until you reach the menopause. The average age of the menopause is 51 years, but it may not start until you are 56. You need to consider if you can cope with your period problem until then.
If your bleeding is heavy you may become anaemic over time. Anaemia is when your blood does not contain enough oxygen-carrying, red blood cells for all your body’s needs.
Fibroids often slowly grow over years. They could become large enough to cause pressure symptoms as they push against your bladder or bowel.
Author: Dr David Hutchon F.R.C.O.G. Consultant Gynaecologist.
© Dumas Ltd 2006
