At our recent Fibroid Focus conference an interesting question was raised: “Has anyone used the Mooncup?” There were a few blank stares, which came from us too, and then an attendee answered: “Yes, and it is so much better than tampons and pads.”

This little exchange got us thinking.

Many women with fibroids experience heavy prolonged periods meaning they use large quantities of pads and tampons. Over the last few years there has been quite a bit of focus on the chemicals in these products and this has raised concerns about possible health effects. This led to the formation of a number of companies who now manufacture organic feminine hygiene products to give women a natural alternative.

But are women with fibroids aware of all the options available when it comes to feminine hygiene products and are they aware of alternatives like the Mooncup (a menstrual cup made by Mooncup Ltd)? This is particularly important for women with fibroids, who are likely to need to use large quantities of pads and tampons, and may be concerned about their prolonged exposure to the chemicals in these products.

In this blog series we are going to introduce you to a selection of feminine hygiene products starting with the menstrual cup today.

What is a Menstrual Cup?

A menstrual cup is a small flexible cup usually made of silicone, but can also be made of rubber, that is inserted into the vagina and collects menstrual blood. Depending on the amount of flow the cup is removed every 4-8 hours, emptied, washed and reinserted. At the end of a woman’s period the cup can be sterilised and the same cup used again every month. The shelf life of menstrual cups is fairly long with manufacturers recommending that they be replaced, on average, every 5 years.

Many companies make menstrual cups and these include:

• Mooncup Ltd
• DivaCup
• Lunette
• IrisCup
• MeLuna

Are Menstrual Cups New?

The menstrual cup was invented by Leona Chalmers in the 1930s and she patented her design in 1935. So the menstrual cup is over 80 years old and has been used for decades.

Is it Safe to Use?

Research has shown that the cup is safe to use with only a very small number of issues reported.

There has been just one case of toxic shock syndrome linked to the use of a menstrual cup, making this a very rare occurrence.  Additionally, one research paper reported that a woman may have developed adenomyosis and endometriosis  after using a menstrual cup for four years and the Endometriosis Research Centre in the US has called for more research to determine if there is link between the use of the menstrual cup and endometriosis.

Several studies have shown that, provided the cup is used properly and is kept clean, the risk of infection is low.  Also, for those worried about allergic reactions the majority of cups are made from medical grade silicone and silicone sensitivity is very rare. For those with a latex allergy they just need to ensure that they use a cup that is made entirely of silicone and does not contain rubber.

The Benefits

There are many benefits of using a menstrual cup. These include:

• Environmentally friendly – one cup can be used for 5 years which means there is less waste created than if tampons or pads are used
• Cost effective – menstrual cups costs about £20 and last for up to 5 years so this works out much cheaper than pads which are estimated to cost about £80 per year and tampons about £43 per year.
• No exposure to toxic chemicals – menstrual cups do not contain the bleaches, pesticides and other chemicals that the majority of pads and tampons contain
• Doesn’t cause dryness –tampons and pads can cause vaginal dryness because they are made of absorbent material, the cup simply collects fluid and isn’t drying
• Less leaks

The Drawbacks

There are some disadvantages associated with the menstrual cup:

• Inserting and removing the cup can be challenging
• Emptying the cup can be quite messy
• Women with certain conditions may not find a cup that fits properly. This has been reported for women with a dropped uterus and certain types of fibroids
• The cup needs to be kept clean to avoid infection so it requires some maintenance every month and needs to be sterilised after each cycle

Conclusion

If you’re looking for an alternative to tampons and pads a menstrual cup is an option you can explore. It may take some time to get used to it, but we recommend that you give it a few months before you make a judgement.

Saturday was a really exciting day for us as we hosted our first fibroids conference, Fibroid Focus. The theme of the conference was treatment and we aimed to provide an in-depth look at all treatment options including natural options.

The day started with an introduction by our founder, Abi Begho, who welcomed everyone, explained the aim of the day and briefly summarised the work we’ve been doing on fibroids. This work has included conducting a survey to understand the needs of black women with fibroids, forming an expert panel, developing a booklet and organising awareness events.

You can watch a clip of Abi talking about the event here

Exercise and Fibroids

We first heard from Lillian Lartey the founder and CEO of I Want My Body Back. Lillian discussed exercise and fibroids and we learnt that exercise has been shown to be beneficial in reducing the risk of developing a number of hormone-dependent conditions such as breast cancer and hence we expect that it will also be beneficial in preventing fibroids but also in improving symptoms as part of a healthy lifestyle. Lillian explained that stress is an important factor as any benefits of exercise are cancelled out if we are experiencing persistent stress in our lives. Finally, Lillian reminded us that we should be aiming for 30 minutes of moderate exercise a day and that we shouldn’t consistently take part in long bouts of exercise as this can put pressure on our body. Lillian ended with three suggestions on how to move forward:

• Check your lifestyle – how will exercise be a part of your life?
• Choose the right type of exercise for you and avoid stress-induced exercise
• Manage your stress – this is more than just resting but managing your thoughts.

You can watch a clip of Lillian’s talk here, download her presentation in the section below this blog piece, listen to her full presentation here and you can read our blog on fibroids and exercise here.

Diet and Fibroids

Next we heard from Leah Salmon, The Naturally You Coach, who spoke about diet and fibroids. Leah stressed that food is more than something that we eat three times a day because it tastes nice, food is medicinal. To reap the benefits of food and to fight disease we need to have a solid foundation of nutrients for our body to build on. To achieve this Leah advised that we make at least 50% of our diet unprocessed foods. Leah explained that fibroids have been linked to a number of nutritional deficiencies such as vitamin D, magnesium and essential fatty acids.  Leah stated that we can use our diet to prevent the deficiencies that lead to the fibroids or, if we have fibroids, use nutrition to re-balance the deficiencies, build and repair the body and stop the fibroid tumours from growing. Leah then recommended nine foods that can achieve this:

• Irish Moss and sea weed
• Bone broth and oily fish
• Evening Primrose Oil
• Molasses
• Tumeric
• Garlic
• Green smoothies and vitamin C rich food
• Vitamin D
• Water

Leah also warned us about six foods we should avoid:

• Xenoestrogens (growth hormones in commercially reared animals and can thus be found in red meat, poultry and eggs and also BPA, found in some plastics)
• Alcohol and caffeine
• White sugar
• Processed grains
• Trans and hydrogenated fats

Finally, Leah stated that success in this area is all about our mindset and we need the willingness to change, the stamina to commit to a healthy lifestyle and patience.

You can download Leah’s slides below this blog, watch clips of Leah’s talk here and here, listen to her full presentation here and you can read more about diet and fibroids here.

Medical Treatment and Fibroids

We also heard from Rajiv Varma, a consultant gynaecologist at the Nuffield Hospital, who presented on the medical management of fibroids.  Mr Varma first described some of the effects of fibroids such as challenges with fertility, problems during pregnancy and a number of symptoms that affect a woman’s quality of life, but he did stress that most women with fibroids do not experience these problems.

Mr Varma explained the treatment options available and these include:

• Doing nothing (watchful waiting)
• Drug treatments – mainly used to shrink fibroids before surgery or to relieve symptoms
• Procedures
  • Uterine Artery Embolisation (UAE) – cuts off blood supply to the fibroids
• Surgery – to remove the fibroids

Mr Varma then gave us some really good insight and advice on a number of issues:

 NHS treatment vs. private treatment:  He stated that in an ideal world there would be no difference between NHS and private treatment but unfortunately there can be some issues with NHS care such as: lack of choice, long waiting times and limited treatment options. There are a number of benefits though which include: the NHS is better equipped to deal with complex cases,  easy access to supportive services (such as blood transfusions and intensive care),  the consultant is present and other specialists are available.

Second opinions:  Mr Varma explained that we are entitled to get a second opinion and the situations where he would advise that a woman seeks a second opinion are: if you are unhappy with the treatment and management options that have been presented to you; if you lose confidence in your doctor; and if there is poor communication between yourself and your doctor.

Finding the right doctor: he stated that the most effective way of finding the right doctor is to have insider information and nurses are the best people to get information on who the best doctors are.

Herbal Remedies and Fibroids

Patricia Ferguson, a Medical Herbalist and a member of the College of Practitioners of Phytotherapy, then discussed herbal remedies that have been shown to be effective in treating fibroids. These remedies either contribute to shrinking the fibroid or are effective at managing some of the symptoms. They are as follows:

Vitex Berries (or agnus cactus) – act on the pituitary gland and depress oestrogen and progesterone (both of which can stimulate the growth of fibroids).
Shepherds Purse – can be effective in treating heavy menstrual bleeding
Red raspberry leaf – can help control heavy menstrual bleeding and can help shrink fibroids

Nettle leaves- can be effective in reducing heavy bleeding
Yarrow – helps to stop the growth of fibroids
Thuja  – helps to stop the growth of fibroids
Burdock  Root – can improve liver function and may inhibit the growth of fibroids
Milk Thistle – improves liver function and therefore can help the live control oestrogen levels

It was also noted that before taking any of these herbal preparations women should seek advice from a medical herbalist as some of the above shouldn’t be taken if a woman is pregnant or if she is on certain medication.

You can download a copy of the handouts to this presentation below this blog and read about some research on complementary and alternative medicine and fibroids here.

Managing the Emotional Impact of Fibroids

Finally, Olivia Haltman discussed the emotional impact of fibroids and how to manage this. Olivia explained that women may experience a number of emotions when going through their fibroid journey. This starts before the diagnosis with some women experiencing fear of the unknown due to symptoms. There can be a significant amount of anxiety whilst waiting for results and after receiving results, there can be a feeling of loss of control and hopelessness where you feel like you can’t control the outcome. Additionally, the vaginal examination can cause a significant amount of stress particularly for women who have had a traumatic sexual experience in the past.

Once a woman has received a confirmed diagnosis she may feel a fear of the growth of her fibroids and experience some unease about how her employers may respond, for example, missed days from work due to symptoms. Additionally, she may have anxiety over her fertility and then feel overwhelmed by the treatment decision.

The emotional impact may also include loss of focus, mood swings, panic attacks, lack of self-esteem, irrational emotions, fears regarding relationships and severe premenstrual syndrome.

So, fibroids can have a significant emotional impact on women which, in many cases, go unrecognised. These issues need to be addressed so that women can heal and move on.

Olivia provided some tips on how to start dealing with the emotional impact and these were:

• Educating yourself about fibroids – this can be empowering allowing you to make informed decisions about treatment
• Relaxation and breathing techniques
• Ground techniques
• Writing as therapy
• Positive thinking techniques
• Talking to your partner, friends and family
• Talking therapy
• Healthy eating
• Holistic lifestyle

Olivia finished by summarising tips from HysterSisters which were:

1. Don’t play the blame game
2. Don’t dwell on the what if’s
3. Don’t compare yourself to others
4. Give yourself time to heal emotionally as well as physically
5. Don’t underestimate how much your hormones affect your emotions
6. Don’t do it alone
7. Do move on

Conclusions

The event ended with a really good summary from The Lake Foundation’s trustee, Fadzai Marange, who shared a little of her personal experience with fibroids, summarised the talks and appealed to women to follow Leah Salmon’s advice regarding the watchful waiting option i.e. if you have been diagnosed with fibroids and your doctor says: ‘ let’s watch and wait’, don’t be passive during this time, act – adopt a healthy lifestyle and see what you can do naturally. Finally, Fadzai encouraged women to visit their doctor and check whether they have a vitamin D deficiency as this is strongly linked to fibroids.

The Exhibitors

At this event were a  number exhibitors including:

• Gedeon Ricther
• I Want My Body Back
• Nearer Nature
• Noire Wellness
• Pure Goodness
• The Naturally You Coach
• TOHETI
• Wisdom of Osun

Together they:

• Provided information on fibroids;
• Provided information on the support available for women affected by fibroids;
• Provided information on health and well-being programmes;
• Sold health and well-being books;
• Sold natural feminine hygiene products; and
• Sold natural hair and skin care products.

We also had ‘Meet the Exhibitor’ sessions on the agenda giving attendees the opportunity to hear organisations talk about their work.

Thank you

We had a great day and would like to thank everyone who attended, shared their story and for being a fantastic, engaged audience. We’d also like to thank all the speakers for their thought-provoking, informative presentations and all the exhibitors for attending and sharing their information, services, products and knowledge.

Finally, we’d like to thank Black History Walks, Natracare and Noire Wellness for their support.

There are several medical procedures used to treat fibroids.  Some of these result in infertility and because of this, as well as unease with these procedures, many women are seeking less invasive more “natural” options. But, are these effective?

One area that has been explored is the use of green tea extract which has been used for a variety of medical reasons with some success.

What research has been done?

 To explore this area we’ll be looking at a research paper published in the International Journal of Women’s Health in 2013 – ‘Treatment of symptomatic uterine fibroids with green tea extract: a pilot randomised controlled clinical study.’

Why green tea extract?

In the research paper, the investigators described why they decided to look at green tea extract.  They explained that green tea contains epigallocatechin gallate which has been shown to have useful biological effects. These include: anti-inflammatory, anti-proliferative (stops cells from growing) and antioxidant effects.

They stated that a study conducted by the US Department of Agriculture reported that great tea has an anti-cancer effect. Additionally, they quoted further research that showed that green tea stops the growth of tumours. From these studies, it is safe to conclude that as fibroids are benign tumours green tea extract may be an effective treatment.

Furthermore, at the time of conducting their research, there were no effective drug treatment  for fibroids. So there was a need to explore this area to explore the possibility of developing the first drug treatment.

The researchers had also conducted some preliminary work, not on humans but on fibroid cells grown in their lab and in a mouse model of fibroids. This was very promising with their experiments on the fibroid cells showing that green tea extract caused the cells to stop growing and die. Whilst in the mouse model they saw a significant amount of fibroid shrinkage.

What did they do?

The researchers conducted a small clinical study which included 33 women with fibroids.  Twenty-two women were given green tea extract and eleven women were not. To ensure the outcome of the study wasn’t compromised, the women taking part and the study staff didn’t know who was receiving the extract and who wasn’t (double blind study). The treatment lasted for four months and women were followed up monthly.

The aim of the study was to determine whether treatment with green tea extract could:

• reduce the size of a patient’s fibroids;
• reduce the severity of symptoms; and
• improve quality of life.

What were their findings?

When looking at those women who were given green tea extract the researchers determined that, on average, the size of their fibroids decreased  by 32.6%. Meanwhile those women who didn’t receive the extract actually experienced an average increase in the size of their fibroids of 24.2%.

The researchers then looked at the severity of symptoms and a similar trend was seen. In the women given green tea extract there was a significant decrease in the severity of their symptoms, but there was an increase in symptom severity in those not treated.

Next, the researchers analysed quality of life. They found that the  overall average increase in the quality of life score in women treated with green tea extract was 20.7 (i.e. their quality of life improved significantly). But in women not treated with green tree extract there was only a 2.19 increase in their quality of life score.

Finally, the study looked at menstrual bleeding and they were able to show that green tea extract caused a significant decline in average blood flow, there was no such effect seen in women not treated.

Conclusions

Based on their findings the researchers concluded that:

“… green tea extract has a significant positive effect on the reduction of uterine fibroid burden and symptoms severity. Thus, administration of green tea extract could possibly be an effective oral treatment.”

The Limitations of this Research

It is worth bearing in mind that this was a very small study with only 33 women taking part. This study needs to be repeated on a larger scale to confirm this finding and ensure its accuracy.

To find out more about this study you can read the full paper below.

Transforming Outcomes and Health Economics Through Imaging (TOHETI) is a three year Guy’s and St Thomas’ Charity funded programme. It includes NHS partners across Lambeth and Southwark who are developing a vision of imaging with patient experience at its core.

One of its  aims is to understand how they can better join up services to treat fibroids to offer the best care to their patients. As part of this work they conducted a focus group which identified that more needed to be done to empower, inform and support women with fibroids. Therefore they started a patient support group and this week we had the pleasure of being invited to attend.

TOHETI’s patient support group started in March 2016 and meets every two months. It is facilitated by a specialist nurse and aims to provide women with a safe, informal setting to share their experiences, ask questions, meet other women with fibroids, understand treatment options and learn about how best to manage their situation.

We attended the support group to learn more about TOHETI’s project and to understand how we could collaborate with them.

The women who attended the support group session told very similar stories to women we have met in the work that we’ve been doing. They explained that it took several years for them to be diagnosed and that they didn’t feel well-informed about fibroids or their treatment options. Additionally, attendees explained that fibroids significantly affect their quality of life, including their relationships and emotional wellbeing. They also felt that no one was listening to their concerns. We also briefly discussed diet with one attendee stating that when she adopted a healthy lifestyle  this significantly improved her symptoms but the challenge was maintaining this lifestyle.

Also in attendance were representatives from Gedeon Richter,  the pharmaceutical company that developed the drug ESMYA® which is used to treat fibroids. They were able to answer questions on treatment, particularly on ESMYA®, its benefits and how it works.

This was an interesting  session that highlighted the need for more support for women with fibrioids and we look forward to working with TOHETI to address this.

The next session will be on  Wednesday 5^thOctober at the McNair Centre at Guy’s Hospital. If you’d like to attend  please contact Yvonne Akande (yvonne.akande@kcl.ac.uk).

Back in March we worked with Black History Walks to organise a fibroids awareness event at the University of Westminster. This was a very well-attended event with over 150 women attending. Our speakers provided an overview of fibroids and its treatment, and shared personal stories of the effect of fibroids.

During the event we were absolutely delighted to meet Yvonne Akande, Senior Project Manager at Transforming Outcomes and Health Economics Through Imaging –TOHETI. It was wonderful to learn of all the great work they’ve been doing to raise awareness of fibroids and support women who have been affected.

TOHETI is a three year Guy’s and St Thomas’ Charity funded programme, working with NHS partners across Lambeth and Southwark to develop a vision of imaging with patient experience at its core. The programme has been working to understand how they can better join up services to treat fibroids to offer the best possible care to their patients.

In June 2015 they conducted a series of focus groups which helped identify how they could improve the information provided to patients. This resulted in the development of their new patient information leaflet and video.  You can download their leaflet here and view their video here.

Additionally, TOHETI has been hosting patient support groups and their next sessions will be held on Wednesday 13^thJuly and Wednesday 5^thOctober at the McNair Centre at Guy’s Hospital. If you’d like to attend one of these sessions please contact Yvonne Akande (yvonne.akande@kcl.ac.uk).

We’re really happy to see fibroids getting a lot more attention as this is an area that women, from our survey in 2013, felt needed a lot more focus.

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The Lake Foundation will be hosting a half day fibroids seminar on 30^thJuly 2016. At this event we will be focusing specifically on treatment including natural ways of managing symptoms. For more information and to book a place please click here

This week it was reported that Johnson and Johnson, the company that produces talcum powder, has lost a second court case where another woman has claimed that she developed ovarian cancer after using talcum powder for feminine hygiene reasons.

The company has been instructed by a jury to pay a settlement of $55M to the claimant. This case follows a case in February of this year where the family of a women who died from ovarian cancer was awarded $72M after it was claimed that she developed ovarian cancer after using talcum powder for many years.

Johnson and Johnson will be back in court and may face a long stretch of court appearance as it faces 1,200 lawsuits accusing the company of not adequately warning women of the risks associated with using talc-based products.

The question is: is there a risk of developing ovarian cancer from the use of talcum powder? The short answer is, we don’t know.

Cancer Research UK says the following:

“Scientists are trying to see if this is the case, but for now the evidence is still uncertain. However, even if there is a risk it is likely to be fairly small.

“Cosmetic body and talcum powders often contain a mineral compound called talc. Several studies have looked at talcum powder use and ovarian cancer. While on the whole the studies have seen a modest increase in the risk of ovarian cancer in women who use talc on their genitals, the evidence isn’t completely clear. So we can’t be sure whether or not talc itself could cause ovarian cancer”

The Chief Executive of the UK’s leading ovarian cancer charity, Ovarian Cancer Action,  has said the following on this issue:

“If you’re currently using talc, don’t panic. Given evidence is inconsistent we do advocate a ‘better safe than sorry’ attitude and advise that women using talc on their genitals stop doing so. But it’s important to remember that the suggested increased risk from using talcum powder is very small.

“While the relative increase of a third suggested by some studies sounds significant, the absolute risk of getting ovarian cancer still remains very low. We’re talking about the difference between a 2% risk and a risk of 2.5%.”

This sentiment about using talcum powder for personal hygiene reasons is echoed by the NHS who say:

“Most gynaecologists recommend using plain, unperfumed soaps to wash the area around the vagina (the vulva) gently every day, as opposed to talc or perfumed soaps, gels and antiseptics.” 

The take home message is that there isn’t yet clarity on whether talcum powder increases risk of ovarian cancer and while this uncertainty remains it’s probably better to avoid using talcum powder on the genital area.

The Christmas and New Year break are over and although I enjoyed it, I felt strangely relieved.  I think that’s because although it’s normally a really enjoyable time of year- it can also be highly stressful.  We know stress has an effect on general health. But how much do we know about how stress affects particular conditions associated with the Black community?  Black women have the highest risk of developing fibroids (non-cancerous growths in or around the womb). They can lead to heavy periods, period pain and pregnancy challenges (amongst other things). It is useful to know if stress plays a part in the existence of fibroids since we can control the way we handle stress.

A basic search of the literature doesn’t reveal many studies focused on the link between stress and fibroids.  One study did note that the increase in stress hormone cortisol can cause fluctuations in oestrogen and progestogen. Low levels of these hormones are linked to a reduction in fibroid growth.  This particular US study actually investigated the links between major-life event stress and fibroids in both Black and White women.  The authors reported  that the greater the number of ‘major life events’ the female experienced, the more likely she was to have fibroids. The pattern was evident among white women who had experienced all levels of stress yet only obvious  among  very highly stressed  Black women.  The authors of another study looked at 22,002 premenopausal  US Black women.  They reported that high levels of self-reported racism increased the risk of fibroids.  However, a study on Chinese women did not find any link between stress and the presence of fibroids. You can find out more about these studies here, here andhere.

Due to the small number of studies which investigate the link between fibroids and stress, it is difficult to say whether there is a true link- more work needs to be done in this area.  However, some people do find that they discover their fibroids after a period of stress in their lives. Have any of you had this experience?

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.

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.