This week the UK’s Chief Medical Officer Prof Dame Sally Davies published her annual health report which focused on women’s health. We were very happy that the report had this focus as many of the health issues that affect women can often be ignored,  not talked about or are felt to be too trivial to be of any importance to society. The report communicates this sentiment by stating that:

“Problems ‘below the waist’ are not generally seen as attractive topics for public or political discourse. Women are often reluctant to seek help for conditions that are common, disabling and taboo…”

The report covers a number of women’s health issues including gender-based violence, FGM, eating disorders, pre-conception health, prenatal screening, perinatal mental health, post-pregnancy care, menopause, incontinence, prolapse and women’s cancers. They make 18 recommendations on how to address the challenges associated with these issues and you can read about these here

We were disappointed to see that fibroids weren’t mentioned in this report despite fibroids being very common and having a significant effect on quality of life. It would have been very relevant for fibroids to be have been explored in a report on women’s health and we feel that this was a missed opportunity to explore the impact of fibroids and begin to develop a national strategy to support women.

The authors highlighted the fact that obesity tended to be a common theme in all of the health issues they explored and stressed that action is needed to prevent obesity. Therefore the report made the recommendation that the Government should include obesity in its national risk planning.  This led to the many media headlines this week stating that “Obesity is the biggest threat to women’s health” and that “obesity is as dangerous as our terror threat”.

We were very happy that the Chief Medical Officer’s report focused on women’s health, a very important area and hope that her recommendations are taken forward to ensure that we improve the health and wellbeing of all women. We were disappointed that key issues such as fibroids were excluded from this report and we’ll continue our work in this area.

You can download her full report below.

At the end of last year we conducted a prostate cancer engagement pilot project as part of a large piece of work funded by Prostate Cancer UK to determine the most effective method of reaching the black community with the key messages about prostate cancer.

Local charities were invited to apply for funding to carry out small projects over 3-4 months and we applied for funding to focus on black churches to determine whether, in reality, this is an effective and practical environment to raise awareness of prostate cancer.

Targeting black churches has two main advantages. Firstly, if we take London as an example, a large number of London’s black population attends church regularly. The London Church Census, covering the time period 2005-2012, found that 48% of inner London’s church goers and 21% of outer London’s church goers were black¹.  Based on their figures this equates to 238,158 people from the African and African Caribbean community. This means that by targeting black churches we can reach a significant proportion of the African Caribbean community.

The second advantage of targeting churches is that it provides a very structured environment where a large number of people meet regularly. This, in theory, makes it a convenient environment to deliver health awareness messages. Additionally, many churches have developed their institutions beyond just preaching on a Sunday. Many churches have Men’s Fellowships, Young Professional Networks, Women’s Fellowships, Over 50’s Clubs, Men’s Conferences, Women’s Conferences and social functions. This means that there is the opportunity, in some churches, to select a sub-population within a church that would most benefit from a particular health message.

Whilst there are advantages to targeting black churches there are some logistical challenges. Firstly, churches tend to have a busy programme of events that will have been planned months in advance making it difficult to fit additional events into their schedule. Secondly, the ideal situation would be to deliver a presentation on a Sunday where there is access to the entire congregation, but many churches may not be able to accommodate this.  This means that awareness presentations would have to be delivered on a Saturday or during the week where only a small percentage of the congregation is likely to attend.  Through a flexible approach, being creative with the methods of engagement  and developing  long term relationships with churches it is possible to overcome some of these challenges.

The Lake Foundation being based in Croydon, where there is a diverse population and a significant number of black churches, decided to work locally and target churches in Croydon and the surrounding area.  In our pilot we worked with two churches and explored the best strategy for working with churches to raise awareness amongst their congregations.

From our pilot we  found that:

1. Engaging with black churches can be an effective way of reaching the African Caribbean community with the key messages about prostate cancer because of the potential of reaching large numbers.
2. To reach large numbers in a church setting requires the development of a long-term bespoke engagement programme.
3. There is a need to understand the structure of individual churches to ensure the best strategy is implemented to reach as many of their members as possible.
4. Engaging with churches may include targeting Sunday services for maximum reach and/or organising awareness sessions on a weekday/Saturday to ensure members have a more in-depth knowledge of prostate cancer.

 Recommendations

Overall The Lake Foundation recommended that Prostate Cancer UK explores developing a structured awareness program for African Caribbean churches in the UK or contracting this work out to community organisations. Whilst this may require significant time, personnel and resources we believe it is an effective way of reaching the black community.

Our specific recommendations:

Target Sunday Services

This pilot has shown that targeting Sunday services would ensure large numbers of people are reached but with limited information because of the time constraints of fitting into the Sunday service’s programme

Targeting churches successfully on a Sunday would require two approaches:

• A short presentation during all their Sunday services
• Setting up an information table throughout the day on a Sunday

Specific recommendations:

• Develop a  5-7 minute presentation that could be used for Sunday services
• Develop an easy method to measure the impact of delivering short presentations at a Sunday service
• Be flexible and persistent

Target churches outside of a Sunday service to achieve depth of knowledge

If the aim is to deliver in-depth information about prostate cancer to church goers and if this isn’t possible through a Sunday service due to time constraints then an additional approach will need to be taken.

The pilot has shown that targeting churches through a one-off event (not on a Sunday) is not the most effective method of reaching the largest number of people, this  only reaches a small percentage of a church’s congregation.  Therefore a regular engagement programme is needed.

Specific recommendations:

• Work with individual churches to understand their structure and how best to reach their members
• Identify groups, departments, events and forums within individual churches that can provide an effective environment to raise awareness
• Organise regular events with the same church throughout the year
• Make good use of churches’ communication platforms – social media, website, newsletters, bulletins, TV stations, YouTube channels etc.

We believe that by taking a long-term, flexible and creative approach in targeting churches a significant impact can be made and we’re delighted to learn that Prostate Cancer UK will be launching a new Faith Based Outreach Project using what we learnt from this pilot. We wish them all the very best in this project and hope that is makes a significant difference in increasing cancer outcomes by facilitating early diagnosis and we’d like to thank Prostate Cancer UK for giving us the opportunity to conduct this pilot.

You can download our full report below.

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References

1.       Brierley Consultancy, London Church Census and London City Mission, 2013. London’s Churches are Growing.Kent: Brierley Consultancy

We were absolutely delighted to be interviewed on Croydon Radio once again about the work of our charity. We featured on Worker’s Playtime this week where we discussed our mission to improve the health and wellbeing of the African and African Caribbean community and also talked about some of the support we’re offering with our cancer support group.

You can listen to a recording below,  our interview starts about an hour into the show.

We get a lot of questions about natural ways of treating and managing fibroids and in this week’s blog post we take a look at what the research tells us about the effectiveness of complementary medicine in treating the symptoms of fibroids.

Fibroids are non-cancerous growths that develop in or around a woman’s womb. They can cause a number of symptoms including pelvic (tummy) pain, infertility, heavy and/or painful periods, back pain, anaemia, constipation, frequent urination and pain during sexual intercourse.

The exact cause of fibroids is unknown but research does suggest that fibroids are caused by a combination of genetic, lifestyle and hormonal factors.  Those most at risk of developing fibroids are: black women, those who are overweight, women of child bearing age (particularly women who are 25-45 years old), those with a family history of fibroids and women who haven’t given birth.

There are several treatment options for fibroids these include a hysterectomy, myomectomy, embolization, endometrial ablation and new MRI-based treatments. Some of these treatments such as a hysterectomy and endometrial ablation result in infertility and because of this as well as unease with medical procedures, many women are exploring less invasive more “natural” options for managing their fibroids, but are these effective. What does research tells us about “natural” methods, more formally known as complementary and alternative medicine (CAM), for treating fibroids?

What Does the Research Tells Us?

To explore this area we’ll look at one recent research paper which was published in 2014 in the European Journal of Obstetrics & Gynaecology and Reproductive Biology and is entitled ‘Use of Medicine, Surgical and Complementary Treatments among Women with Fibroids’.  This paper summarised a study of 933 premenopausal women aged 31 to 54 with symptomatic fibroids. In this study women took part in face-to-face interviews every year for up to eight years to assess their symptoms following use of the treatment they opted for.

Researchers explored and compared the effect of CAM, Western Medicine and uterus-preserving surgeries. They classified CAM as the use of exercise, herbs, diet, acupuncture and physical therapy; Western medicine included hormonal contraception, analgesics and narcotic pain medicine; and uterus-preserving surgeries included myomectomy, embolization and endometrial ablation.

The majority of women in this study, 57%, didn’t have a hysterectomy or uterus-preserving surgery. The majority of these women used Western medicine to treat their symptoms and the most commonly used type of Western medicine used was anti-inflammatory analgesics followed by narcotic pain medicine.  Fifty percent of women who used the anti-inflammatories said it made their symptoms “a lot” better, but 10% were bothered “a lot” or “some” by the side effects. For women who used narcotics, 60% said it made their symptoms “a lot” better but 30% were bothered “a lot” or “some” by the side effects. Fifty-five percent of women who used the combined hormonal contraception said it made them feel “a lot” better, but 22% were bothered “a lot” or “some” by the side effects. Finally, the progestin IUD was the most effective with 71% of women who used it saying it made them feel “a lot” better, but 24% were bothered by the side effects.

CAM was used by a significant number of women to treat their fibroid-related symptoms. The most common methods used were exercise, herbs and diet. Improvements in symptoms were lower than that observed for Western medicine with 39% of women trying exercise, 38% of women trying herbs, 43% of those trying dietary changes, 45% trying acupuncture and 41% trying physical therapy  saying it made their symptoms “a lot” better, and as expected bothersome side effects were rare, less than 5% in all CAM therapies.

When looking at surgery, women who underwent uterus-preserving surgery had a greater improvement of pelvic symptoms compared to women who used Western medicine or CAM, but the researchers noted that despite this observation women who used Western medicine or CAM“observed significant improvements in pelvic problems as well as dyspareunia (pain during sex), pelvic pressure, bladder pain and menstrual cramps.”

In explaining how CAM works in improving symptoms, it was stated that some foods, vitamins and minerals can decrease the production of prostaglandins which cause a number of fibroids-related symptoms.

Based on their  finding the researchers concluded that “uterus-preserving fibroid surgery is effective, but many symptomatic women can be successfully treated with non-surgical management, including complementary and alternative therapy”

From this research study we can see that diet, exercise, acupuncture, herbs and physical therapy may be effective in some women at treating fibroid-related symptoms. Women wanting to explore any of these as an option should have a discussion with their doctor.

We do recognise that what’s missing from this study is the detail around what herbs and dietary changes women tried and we’ll be contacting the researchers to get some more information about this.

You can read the full paper by downloading it below.

A few weeks ago the International Agency for Research on Cancer (IARC) and WHO announced that:

“After thoroughly reviewing the accumulated scientific literature, a Working Group of 22 experts from 10 countries convened by the IARC Monographs Programme classified the consumption of red meat as probably carcinogenic to humans (Group 2A), based on limited evidence that the consumption of red meat causes cancer in humans and strong mechanistic evidence supporting a carcinogenic effect.

This association was observed mainly for colorectal cancer, but associations were also seen for pancreatic cancer and prostate cancer.

Processed meat was classified as carcinogenic to humans (Group 1), based on sufficient evidence in humans that the consumption of processed meat causes colorectal cancer.”

This was picked up by hundreds of media outlets throughout the world with headlines stating that bacon causes cancer.  Today we wanted to take a look at this and get to the bottom of the media headlines.

Firstly IARC and WHO’s announcement wasn’t really new information, a number of research studies over the years have shown that red and processed meats increases a person’s risk of developing bowel cancer and charities like Bowel Cancer UK and Beating Bowel Cancer have been raising awareness of this fact for a number of years.

The wording of the statement and the classification of red and processed meat suggested that bacon and other processed meats were in the same league as tobacco and asbestos but this is not the case and WHO has since clarified this.  They have said whilst they have placed them in the same category “this does NOT mean they are all equally dangerous.”

If we look at global statistics about one million cancer deaths a year are caused by smoking whilst 34,000 cancer deaths are caused by consuming high levels of processed meat and red meat could be responsible for about 50,000 cancer deaths a year.

Research by the World Cancer Research Fund has shown that people who consume the most processed meat have and 17% higher risk of developing bowel cancer that those who consumed the least.

If you put that into the UK context, 21% of bowel cancers are linked to high consumption of processed or red meat, that’s 8,732 cases per year. So by reducing consumption of red and processed meats we can prevent over 8,000 cases of bowel cancer every year.

You may be wondering why red and processed meats increase a person’s risk of developing bowel cancer and to answer that question we have to understand what processed and red meats are. Processed meats are any meat that has been preserved for example cured, salted,  smoked or had a preservative added. This includes bacon, ham, corned beef, pepperoni, hot dogs, salami etc. And, red meat includes beef, pork, lamb and goat; these are meats that are red when uncooked.

It is not entirely clear why red and processed meat increase a person’s risk of developing bowel cancer, but there are some theories. It is thought that processed meats increase risk of bowel cancer because the methods of preserving these meats lead to the development of cancer-causing substances.  When it comes to red meat,  scientist suggest that it may cause cancer due to the molecule that  gives red meat its colour (haem). This molecule may lead to the development of cancer-causing chemicals too. Additionally, cooking both red and processed meat at high temperatures may also generate cancer-causing substances.

The recommendation is that we should all cut down on red meat and avoid processed meat, these can be replaced with white meat or vegetarian options, and we should all be eating more fruits, vegetables and fibre.

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Sources
WHO
International Agency for Research on Cancer
Cancer Research UK
World Caner Research Fund

Last week the UK government published its report ‘Sugar Reduction: The Evidence for Action’. This is an interesting report which we hope the government will follow through on and take action to ensure that we improve the health of our nation.

In the report, we get a good summary of the problem – we are all eating too much sugar and this is contributing to our ill health. The report states that all population groups are consuming above the recommended amount of sugar.  The report notes that sugar sweetened drinks are a particular problem for school children with their consumption of these drinks being very high. Additionally they state that sugar consumption is the highest amongst disadvantaged groups, and this needs to be tackled.

We learn from the report that one of the key reasons that we are now consuming so much sugar is that food is more readily available, more heavily marketed, promoted and advertised and food is now cheaper than ever before and all these factors mean we over indulge, particularly when it comes to sugar.

The report quite helpfully discusses the factors that affect our sugar consumption which is important if we’re going to tackle sugar consumption and encourage people to change their behaviour. They divide these factors into three categories – influencers,  the food supply and knowledge/education.  Influencers include strategies  that influence our consumption and buying behaviour. This would include advertising and marketing campaigns as well as product promotions. The major players in this area are the food industry, supermarkets etc. but could actually be charities, the government and NGOs who should have a positive impact on our behaviour. Next is the food supply chain. This factor looks at what food is available to purchase and how easy is it to purchase certain foods. This focuses on all food outlets including supermarkets, restaurants, schoolsand workplaces, their pricing strategies and what they choose to offer the public. Finally we have knowledge and education, this is the information we disseminate to the public which can empower people to make healthier choices.

With the above in mind the report stresses that multiple actions need to be taken to reduce our sugar consumption. They believe that by everyone reducing their sugar consumption to no less than 5% of our total energy intake, within 10 years residents of the UK can significantly improve their health and start to reverse the increasing prevalence of obesity, diabetes and heart disease.

The report makes the following recommendations as to how we can begin to tackle this issues and break our addiction to sugar:

• Reduce and rebalance the number and type of price promotions in all retail outlets including supermarkets and convenience stores and the out of home sector (including restaurants, cafes and takeaways)
• Significantly reduce opportunities to market and advertise high sugar food and drink products to children and adults across all media including digital platforms and through sponsorship
• The setting of a clear definition for high sugar foods to aid with actions 1 and 2 above. Currently the only regulatory framework for doing this is via the Ofcom nutrient profiling model, which would benefit from being reviewed and strengthened
• Introduction of a broad, structured and transparently monitored programme of gradual sugar reduction in everyday food and drink products, combined with reductions in portion size
• Introduction of a price increase of a minimum of 10-20% on high sugar products through the use of a tax or levy such as on full sugar soft drinks, based on the emerging evidence of the impact of such measures in other countries
• Adopt, implement and monitor the government buying standards for food and catering services (GBSF) across the public sector, including national and local government and the NHS to the ensure provision and sale of healthier food and drinks in hospitals, leisure centres etc
• Ensure that accredited training in diet and health is routinely delivered to all of those who have opportunities to influence food choices in the catering, fitness and leisure sectors and others within local authorities
• Continue to raise awareness of concerns around sugar levels in the diet to the public as well as health professionals, employers, the food industry etc., encourage action to reduce intakes and provide practical steps to help people lower their own and their families sugar intake

The Lake Foundation is in strong agreement with the above recommendations and will do our part in taking forward these recommendations. This area is of particularly importance to the black community who suffer higher rates of diseases like type 2 diabetes and stroke which are linked to high sugar consumption.

You can download the government’s report below.

Last Sunday, we teamed up with the Cycling Instructor for a 4-hour cycling session with 10 of our cycling group members. This was an extension of our summer cycling sessions and this event was organised to challenge our members and but also to discover the beautiful countryside of north Surrey.

We started off at 9:30am at Croydon Arena and cycled through Addiscombe,  West Wickham and Biggin Hill on our way to Warlingham. This was a tough route with us having to tackle a number of hills, but it was a really scenic and enabled us to appreciate the beauty that is just on the doorstep of Croydon.  Once we got to Warlingham we stopped off at the very lovely Almno Café for a short break and some light refreshments before making our way back to Croydon through Chelsham,  New Addington, Addington and Addiscombe.

This was a really fun day out and in total, we cycled for  3 hours and 56 minutes,  covered 41.6km, burned over 500 calories and had an elevation gain of 354m (oh those hills!).

A big thank you to the Cycling Instructor for leading the session, to Croydon Council for funding this event and to everyone who attended.

We recently helped organised a fibroids awareness event and one issues that was raised at this event was that many women aren’t aware of the various treatment options available and in this week’s blogs we  provide an overview of treatment options.

It is first important to note that the treatments offered for fibroids depend on the size of a woman’s fibroids, the symptoms they are causing, and if they are likely to affect her fertility. Most women with fibroids will not have symptoms, or the symptoms may be very mild and therefore no treatment may be required.  However, a significant number of women with fibroids will need treatment because they have severe symptoms and/or their fibroids may interfere with pregnancy or fertility.

Treatment options for fibroids may include:
· Watchful waiting
· Medication to treat symptoms
· Medication to shrink fibroids
· Surgery or medical procedures

Watchful Waiting

A woman may not realise that she has fibroids until her doctor detects them after a routine pelvic exam. Therefore she may have no symptoms or very minor symptoms. Or her minor symptoms may have led her to visit her doctor who then went on to diagnose her fibroids. Either way, if a woman has no symptoms or mild symptoms that are not a major problem, her best option is ‘watchful waiting’. This may involve her:
· Keeping an eye on her symptoms and if they get worse or new symptoms develop then the next step will be a visit to her doctor.
· Being regularly monitored by her doctor. This may involve having regular (yearly) ultrasound scans to keep an eye on the size of the fibroids.

It is hard to predict if the fibroids will grow or whether symptoms will develop. It is only through watchful waiting that this can be determined. The benefit of watchful waiting is that unnecessary treatment can be avoided or delayed. Delaying treatment may allow a woman to start her family before having treatment which may affect her fertility.

Women nearing menopause may consider watchful waiting until after menopause as fibroids tend to shrink after menopause and symptoms may ease or disappear completely on their own after menopause.  If symptoms don’t improve after menopause then a woman can speak to her doctor about other options.

Medication to treat fibroid symptoms

Some of the symptoms of fibroids may be treated with over-the-counter or prescription drugs. Women should speak to their doctors before taking any medication, and make sure that they are aware of any side effects.

If fibroids are causing pelvic or abdominal pain, pain-killers may be an effective way to treat that. Or, if fibroids have caused severe period pain, anti-inflammatory drugs such as ibuprofen and mefanamic acid can be effective at easing period pain.

Sometimes fibroids can cause heavy flow during periods. If this is the case, a woman can speak to her doctor about the contraceptive pill.  This can make periods lighter and also ease period pain. An alternative to the pill for treating heavy periods is tranexamic acid, a drug that is used in many different conditions to control bleeding.

Medication to shrink fibroids

There are treatments available that may be effective at shrinking fibroids. These types of drugs are usually used before surgery, meaning that less extensive surgery may be required because they make it easier for fibroids to be removed.  These are hormonal drugs that reduce a woman’s hormone levels. This means that there will be less hormones available in a circulation to stimulate the growth of fibroids, causing them to shrink.

Drugs that can shrink fibroids include goserelin (Zoladex®) or leuprorelin acetate (Prostap® SR).  They reduce oestrogen levels, and can cause menopause symptoms, so sometimes patients are given Hormone Replacement Therapy (HRT) to combat any menopause symptoms. The patient will be started on a course of treatment three to four months before surgery.
Another drug that may be offered is ulipristal acetate (UPA or Esmya®), which lowers progesterone levels. Typically, if this drug is prescribed, it will be given to the patient before surgery and it can be taken for a maximum of up to three months.

Surgery or medical procedures

In many cases, women with symptoms will need some form of surgery or a medical procedure to treat their fibroids. The options here include:
· Hysteroscopic Resection
· Myomectomy
· Hysterectomy
·  Endometrial Ablation
·  Embolisation
·  MRI treatments

Hysteroscopic Resection

A hysteroscopic resection (transcervical resection of fibroids) is a procedure that removes fibroids that develop on the inside of the womb (submucosal/intracavity fibroids).  It is usually performed under general anaesthetic (where a woman is put to sleep for the entire procedure). A small device with a camera and a light on the end of it (a hysteroscope) is inserted through the vagina, past the cervix and into the womb. The camera allows the doctor to see the womb on a video screen. On the end of the hysteroscope is a device that allows the doctor to remove the fibroids.

A hysteroscopic resection takes 20 to 80 minutes and is likely to be a day-case or one that might require an overnight stay in the hospital. Recovery time will be 1 to 2 weeks. After-care advice is given to prevent infection, and to help with any pain that a patient may experience.  Within a couple of months, there should be improvements in the symptoms that were caused by the fibroids, such as heavy bleeding or irregular periods.

This procedure is a good option as it avoids the removal of the womb and allows a woman to preserve her fertility. As with any medical procedure, there is a small risk of complications

Myomectomy

A myomectomy is a surgical procedure used to remove fibroids without removing the womb, and therefore helps to preserve fertility. A myomectomy can be carried out in two ways; either via keyhole surgery (laparoscopic myomectomy) or an abdominal myomectomy (laparotomy).

Keyhole surgery is usually performed when you have one or two fibroids that are five centimetres or smaller that grow on the outside of the womb (pedunculatedand subserosalfibroids). It involves a small hole being made in or near the belly button and then a narrow tube with a camera (laparoscope) is inserted into the abdomen. Through this hole, and other holes in the abdomen, a surgeon is able to cut the fibroids into small pieces and then remove them through the holes.

The benefit of keyhole surgery is that because the operation occurs via the small holes, it is less invasive. This means that there is less blood loss and pain, and recovery is quicker than a full-blown operation – 1 to 2 weeks. It also requires minimal stay in the hospital (either a day case or for one night).

Despite this, there is a small risk of developing complications. These include: excessive bleeding, an adverse reaction to the anaesthetic, a puncture to the womb, blood clots and infection. And, there is a 40% chance that fibroids will re-grow within five years of the keyhole surgery.

An abdominal myomectomy is performed under general anaesthetic. A surgeon will make a fairly large incision in a woman’s abdomen in order to gain access to the womb and will then remove the fibroids. This procedure is used to remove large fibroids from the wall of the womb and may require a 2 to 4 day stay in hospital and takes anywhere from 4 to 6 weeks to recover.  There is a small risk of complications which include infection, damage to internal organs like the bowel, and weakening of the womb. There is also a 10 to 50% chance that fibroids will re-grow.

Hysterectomy

A hysterectomy is a surgical procedure to remove the womb. It is performed under general anaesthetic and is a permanent solution to resolving any symptoms which are caused by fibroids. Removal of the womb means that a woman will not be able to have children, making this option best for women who have completed their families. If the ovaries are also removed during the hysterectomy, a woman will go through menopause immediately. But if the ovaries are not removed, then a woman may go through the menopause within five years of having her womb removed.

Depending on the size of the fibroids, a hysterectomy can be conducted in three different ways. Smaller fibroids can be removed by a vaginal hysterectomy (the womb is removed through the vagina via a small cut at the top of the vagina), or by a laparoscopic hysterectomy (where the womb is removed through small holes in the abdomen). Alternatively, for larger fibroids, an abdominal hysterectomy can be performed where a fairly large incision is made in the abdomen and the womb is removed through the incision.

A hysterectomy is considered to be major surgery and as such takes longer to recover from than other procedures. It takes about 6 to 8 weeks and requires about 1 to 7 days stay in hospital depending on the way in which the hysterectomy was performed.

A woman will be given an after-care plan on how to care for her wounds and will have a follow up appointment to ensure that she is healing properly.
As with any surgical procedure there is a small risk of complications

Endometrial Ablation

Endometrial ablation is a procedure that is used to address heavy menstrual bleeding caused by fibroids or to remove small fibroids (less than 5cm) that have formed in the lining of the womb. This procedure removes the lining of the womb using either a laser beam, radiofrequency waves, microwaves, hot saline, electrical current or freezing.
A small device with a camera and a light on the end of it (a hysteroscope) is inserted through the vagina, past the cervix and into the womb. The camera allows a doctor to see the womb on a video screen. The doctor will then use specialist instruments to remove the lining of the womb by one of the methods described above (i.e. either laser beam, radiofrequency waves etc.).
Because the lining of the womb is removed it is highly unlikely that a woman will be able to get pregnant after this procedure. However, even if her periods stop, there is a small chance that she may become pregnant. And, because of the removal of the lining of her womb, her pregnancy is likely to be a risky one for both her and her baby, and she will probably be advised to use birth control after her endometrial ablation.

An endometrial ablation takes 20 to 45 minutes to perform, and is performed either under local or general anaesthetic. Patients are usually discharged from hospital on the same day and take about 2 weeks to fully recover.

There is a small risk of complications, these include: burns to the womb and surface of the bowel, fluid build-up in the lungs, tearing of the cervix, a womb puncture and a blockage of the major blood vessel in the lung (pulmonary embolism).

Embolisation

Embolisation, or Uterine Artery Embolisation (UAE), is a procedure that blocks the blood vessels (uterine arteries) to the fibroids, starving them of oxygen and therefore causing them to shrink.  This procedure is carried out by an interventional radiologist who makes a small cut in the groin area and then inserts a tube (catheter) through the cut, using live x-ray images on a monitor to guide the tube into the uterine arteries. Tiny plastic beads (the size of fine sand particles) are then injected into the artery supplying the fibroid and these tiny embolic particles block the artery.  Over the next few hours, the fibroids ‘die’ and then shrink over the next few months and years.

An embolisation is carried out under local anaesthetic and patients will have to stay in hospital for 1 night and recovery will take 1 to 2 weeks.

Complications from embolisation are rare and tend to be fairly minor, for example: bruising, pain, fever and vaginal discharge.  Submucosal and particularly intra cavity fibroids can become detached. These can either pass through the cervix and vagina on their own or, if they get stuck, can rarely require a hysteroscopic removal by a Gynaecologist.

Fertility after embolisation has been maintained in many women, and premature menopause is very rare. Recurrence rates are low, being around 15% by 5 to 10 years.

UAE can be used in combination with various forms of myomectomy to get the best of both treatments and maintain fertility.

MRI Treatments

There are two fairly new procedures that may be considered to treat fibroids which make use of MRI (magnetic resonance imaging).  These are:

• MRI-guided percutaneous laser ablation
• MRI-guided transcutaneous focused ultrasound

These treatments are not widely available in the UK and only a handful of specialist centres perform these procedures.

In MRI-guided percutaneous laser ablation, an MRI scan is used to locate the exact location of fibroids and fine needles are inserted through the skin and into the fibroid. A cable is then passed through the needle and light is targeted at the fibroids. The heat from the light shrinks or destroys the fibroids. MRI-guided transcutaneous focused ultrasound also uses MRI to find fibroids, but uses ultrasound energy to target them.

Both of these procedures take 3 to 4 hours to perform and requires only about a two hour stay in hospital after the treatment. Recovery should take a few days during which the patient may experience some pain and nausea.  There are rarely any complications in the short-term. However, the long-term effects and risks are unknown, as are the effects on fertility.

Conculsion

We hope that above has been useful to providing a summary of the various treatments that are available for fibroids. Again, it’s important to note that the treatment a woman receive will depend on various factors. We encourage women who have to have treatment for their fibroids to have an informed discussion with their doctor.

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This blog is based on our fibroids booklet which was reviewed by experts in the field.

On 30^th September we teamed up with Black History Walks to help organise a Queen Nzingha Lecture on fibroids.  The Queen Nzingha lecture series is a regular event developed by Black history Walks and is a series  of lectures  delivered by black women  with expertise in a particular topic. It aims to achieve three things: give black professional women a platform to discuss their area of expertise;  give audiences the opportunity to learn about a specific topic; and provide a forum to debate topical issues.

We were delighted to be asked to help organise the most recent event which focused on fibroids. This was a great opportunity to raise awareness and also give women affected by fibroids the opportunity to learn more about this condition, share their experiences and meet other women with fibroids.

On the day we were delighted to have an interesting agenda which included an overview of fibroids by Abi Begho of The Lake Foundation, a really inspiring presentation by Amanda Epe on her personal experience of fibroids and finally a presentation by Dr Sydney Dillard on treatment options.

Lifestyle, this word brings thought to mind of daily tasks, particularly professional and pastimes, hobbies, activities or lack of them. As a former Cabin Crew member the work had a strong influence and was my lifestyle. I was a long haul stewardess, which entailed trips to far distance lands for a few days at a time or a week. My whole life activities were based on where I was going and for how long. I had wonderful opportunities for sight seeing, exploration, shopping or relaxation.  At times though, my peers and I weren’t motivated to go out or it was mundane to re-visit some locations. It became standard to stay in the hotel and meet for a drink or two with my peers. I had to keep myself motivated to use the gym and spa facilities, which were the perks of lodging in five star hotels. My health had deteriorated as A Fly Girl and prior to leaving the job I had a surgical removal of a uterine fibroid.

I had uterine fibroids since I was in my early twenties, prior to working in the airline, and have no history of fibroids in the family. I was also raised on a diet which was balanced and healthy; minimal dairy and red meat. During my twenties my lifestyle had changed and when I reflect back to this I can pick out the decline in a totally healthy lifestyle, it was not drastic however it may have been significant to the cause.

Some key points that I should mention are that in my twenties, and since childhood, I craved sugar and water was not a friend of mine. Until recently I admit water isn’t medicine, but in my twenties instead of water I increased my daily dinner red wine with red meat.

During my youth my menstruation was a curse on my well-being. It came with severe dysmenorrhea, nausea and occasional vomiting. No matter what pain killing medication the doctor prescribed, nothing worked, my stomach looked enlarged on my small and athletic frame. The appearance was a minor, the pain was major.

Although my fibroid was present before being a cabin crew member, my new lifestyle fed the fibroids, my symptoms worsened and my distended stomach gave me the appearance of a second trimester pregnancy.

In my memoir, A Fly Girl, there are many incidences in my tales that reflect on the toxic lifestyle.

Just before leaving the airline I had a myomectomy, the surgical removal of fibroid through an intense operation. It was intense compared to today’s procedure as I had an incision whereas technology now uses laser surgery. It was done privately as I had waited for this operation since my initial diagnosis on the NHS for several years.

I was driven to have the operation because of various new symptoms which accompanied my period; the abdomen swelling was severe and I suffered with menorrhea, the haemorrhaging  would leave me extremely weak and anaemic. I felt quite emotional after surgery however I recovered well and speedily. I became fully conscious from then as to what triggers fibroid growth from a holistic perspective, nutrition, spiritual and physical.

I began to write poetry as a means of self- expression, my diet improved and water became my friend again. I eliminated a lot of foods and it was a turning point in building self-esteem and self-expression. Spiritually I was more expressive as the true me, and being a writer has aided this. I engaged in a lot more exercise, road running, and for a year I was training in Thai boxing to release anger, energy and develop mental strength and finally relaxation in the spa with sauna and steam to eliminate further toxins. I started to enjoy being a creative cook so that my dinners where healthy and whole.

The complete change, spiritual, nutritional and physical was agreeing with me and my body was in balance with no extraordinary monthly pain. Over the years and I started to slip, unconsciously, old habits die-hard and gradually unsavoury patterns took hold. Many years later the fibroid growth returned with vengeance, it came with not just swelling of the abdomen but when menstruating many parts of my body would swell including my face and eyelids. I also experienced restless leg syndrome. I was haemorrhaging and clotting heavily and it had an affect on my work life, I couldn’t commit my presence at work, neither guarantee attending social events and I was fully exhausted because of anaemia. It got to the point where I was emotionally drained and hit rock bottom. I had tried again over the last few years several remedies of natural treatments and some therapies had adverse affects. However determined not to give up, neither to go back to the medical approach, I had a vision that the pain at least should be over and started a six month change programme this year.

I worked on the spiritual and nutritional aspect alone, and I am currently getting back into the physical component. It was a worthy sacrifice to officially eliminate specific foods in my diet for the last six months and gradually experiment with herbs that balance the hormones and strengthen the womb. It has been the best introduction to well being adding herbal remedies to a wholesome diet. Also the spiritual freedom of expression this year has given me joy as I spoke from the heart being part of a national book tour. Having a 90% reduction of symptoms that over the years have accompanied my menstruation and now have disappeared is an amazing testimony, it verifies that there are options for healing in this earth, one must have resilience to overcome and to know that healing isn’t a linear progression.

I am thankful for my diverse experiences in life and I can say that having the fibroid has been a catalyst for my behaviour change. To focus on holistic health can be one of the most self-loving expressions a human can do.

I will update my progress in another six months with the inclusion of physical activity, and this can be found on my blog at www.msroseblossom.org

My experience in treating and healing fibroids or to prevent the onset of them begins with living a spiritual fulfilled life, and includes ways to balance health holistically, along with help from experts and support networks.

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Amanda Epe is a health promotion coach and author.

The Lake Foundation would like to thank Amanda for helping us raise awareness of fibroids and its challenges by sharing her story through this blog piece.