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Fibroids & HRT

When your doctor describes fibroids as non cancerous growths on the lining of your womb the very name can cause anxiety, so it is vital to stress that they are not cancer, but, depending on which type of fibroid, they can be very painful, in particular, intramural fibroids, which are the type that grow within the muscle wall of the uterus.

Having fibroids does not have to be an issue; in fact, many women may have fibroids and not even know they do. The symptoms vary from non-existent to extreme pain and discomfort. Doctors see many women who may or may not have fibroids, but who describe symptoms such as heavy bleeding, abdominal pain and painful intercourse: unless the symptoms are severe GPs may decide not to offer any treatment.

The uterus is a muscle and once a month its lining will thicken in the hope of implantation, however, when this does not occur that lining has to be disposed of and the uterus will contract and literally squeeze out the lining. If there is a fibroid, especially intramuscular, the pain of contractions will be more severe. A fibroid can grow anywhere within the uterus and cause pressure on other organs such as the bowels or bladder. Women may be aware of this pressure as a cramping similar to period pains, or bloating because the intestines are being pushed against. If you experienced heavy periods or painful periods it is likely that fibroids were starting to develop and as you grow older these fibroids come to light and may become more of a nuisance. You may have finished with periods, but are left with the legacy. Your clinician should be aware of this when prescribing any HRT treatment.

If your mother or sisters have fibroids it is likely that you may have too, as, to a greater or lesser degree, they can be genetic. However, the most likely cause is hormones. Oestrogen is a hormone that ‘grows things’, making parts of your body more elastic and more supple. The positives of this include: bone density, skin texture and tone, hair shine and strength, sex drive etc. However, if a woman is receiving too much oestrogen, for example, if she is taking HRT and the balance is incorrect, then she may experience weight gain or fibroids.

This is where progesterone comes into play: the balance between progesterone and oestrogen needs to be maintained and checked on a regular basis when a woman is receiving HRT to ensure fibroid symptoms are not exacerbated. A blood test will show whether a woman has oestrogen excess or progesterone deficiency and thus inform treatment. These scenarios are very commonly encountered during perimenopause and menopause and it is important that they are appropriately addressed.

One of the reasons why we need to manage our stress levels is because stress produces cortisol, which stimulates the production of insulin, which is the body’s only fat making hormone. If insulin production goes unchecked a condition called insulin resistance can result. Not only is this dangerous in terms of excessive weight gain (obesity), but it is also likely that levels of oestrogen will increase and contribute to fibroid growth. So, once again, we are talking about stress being a contributing factor to an undesirable condition.

If you’ve ever noticed your belly swell after eating food such as bread and biscuits it is because the sugar in those foods is inflammatory. Internally, this sugar will be encouraging the growth of fibroids or worsening existing symptoms, so they are best avoided if you think you may have fibroids.

Treatment for fibroids can vary, but it is always important to seek medical advice if you experience spotting or bleeding after your periods have stopped. Although the most common reason is fibroids, endometriosis or hormone imbalance, there is a slim chance that it could be more sinister.  Removal of larger fibroids by surgery is fiddly and can cause lots of bleeding because each fibroid has its own blood supply. Uterine artery embolization is an option where the blood supply of the fibroid is blocked under radiological guidance. However sometimes a hysterectomy, although a bigger decision to take, ensures that you won’t ever have fibroids again.

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