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What You Need to Know About Uterine Fibroids, and Why

Medical advancements have made uterine fibroids a highly manageable condition. But lack of awareness means that some affected women may be missing out on treatment choices.

Uterine Fibroids

“Fibroids are benign growths that develop in the womb, or uterus. They are very common, affecting 30 to 40 per cent of women in reproductive age and 70 to 80 per cent of those near the menopause,” explains Mr Ertan Saridogan, consultant in gynaecology, reproductive medicine and minimal access surgery at University College London Hospitals (UCLH) and The Portland Hospital, London.

Often Asymptomatic

Typically, symptoms develop only in a relatively small number of affected women. They may include heavy menstrual bleeding, discomfort in the pelvic area, and pressure on the bladder or bowels that increases the need to go to the toilet. Some women may also have difficulties getting pregnant.

Many Treatment Options

Most uterine fibroids don’t need treatment. But this may be necessary if there are symptoms, and should be tailored to individual needs and family plans.

“Options may include medical treatments aimed at relieving symptoms, such as the contraceptive pill or a coil that releases the hormone progesterone into the womb, both of which reduce blood loss due to heavy periods,” says Mr Saridogan.

“If fibroids need to be removed, this can be done through the neck of the uterus and the vagina with a procedure called hysteroscopy. An abdominal operation, or myomectomy, may be needed if the fibroids are large. In this case, the fibroids are removed from the abdomen through either a single large incision, as in traditional open surgery, or multiple small cuts, with a minimally invasive operation called laparoscopic or keyhole surgery. A hysterectomy – the removal of the womb – may be a good option for women who have severe symptoms and are not planning to have children.”

Other, non-surgical options include uterine artery embolization, which involves blocking the blood supply to the fibroids causing them to shrink, and a new technique (high-intensity focused ultrasound) that uses high-energy waves to destroy fibroid tissue.

A novel drug with fibroid-shrinking effects is also available. Called ulipristal acetate, it can be particularly useful for managing symptoms in older women, until they reach the menopause, when fibroids begin to shrink naturally.

Low Awareness

The problem is that, despite uterine fibroids being common, public awareness is generally low.

Mr Saridogan says: “Not all women know about them, and not all medical professionals are aware of the many ways in which they can be managed. Hence, women with the condition may not be told about all the available treatment options.”

Greater awareness can increase the chances of all affected women receiving the most appropriate treatment and enjoying a better quality of life as a result.

You and Your Skin: Look After it From Within

Leading skincare experts are now advising that treating your skin from the inside-out, by including nutraceuticals in your daily skincare regime, is the best option for you and your skin.

Skin careIt’s important to take a comprehensive approach to your skincare regime; gone are the days of just reaching for the pot of cold cream on your bedside cabinet. Nowadays, in order to do the best for your skin, and achieve the results that you want, it’s important to combine a variety of specialised skincare products and sunscreen, whilst avoiding no-nos like smoking, but also think about treating your skin from within – this means learning about how nutraceuticals can also be used to improve the condition of your skin.

This isn’t just about anti-ageing or wrinkle removal that makes us, as women, feel like there is a clock ticking above our heads which chimes every year and rings out a sound screaming “you’re getting old” – this is about wanting our skin to look great for our age, for others to think we look healthy, well and natural – we want our skin to have vitality! With improved life expectancy, and people much more active than ever before into later life, feeling good also means looking good.

Nutraceuticals and Nutricosmetics

The term ‘nutraceuticals’ was first coined in the late 1980s. It describes the fusion between the words ‘nutrition’ and ‘pharmaceuticals’ as a name for products derived from food sources to promote health, prevent chronic diseases, delay the ageing process or support the structure and function of the body. Honing the definition yet further has seen the concept of ‘nutricosmetics’ appear in recent years – a hybrid between cosmeceuticals and nutraceuticals – which refers to orally taken products, generally derived from natural ingredients, which are aimed at combating oxidative stress and inflammation, caused by our environment and lifestyles, by supplementing nutrients within the body to promote healthy skin. The main products within the nutricosmetics sector are so-called collagen drinks.

We all know that a good diet helps us to have a healthy body, and the skin is no different, there are now dietary supplements available, in the form of collagen-based drinks, which can boost the health of our skin. And in some cases, they have even been shown to have a beneficial effect on hair and nails too, if they also contain a vitamin B complex.

With this in mind, more and more women are becoming aware of the benefits of an inside-out approach to their skincare regime. In fact, a report published by Global Industry Analysts in July 2013 stated that the global nutricosmetics market is forecast to reach $4.24 billion in 2017.

We know women want their skin to look great, we know that more and more are aware of nutraceuticals and nutricosmetics, and that the demand and market for products appears to be growing; but what about the scientific evidence?

Do Collagen Drinks Work?

It’s true to say that not all products are the same, so it’s worth doing some checking. However, more and more nutricosmetics are starting to show positive results from their use in studies and trials – so look for those. Some collagen-based drinks can be bought in high street chemists and some are only available through medical and cosmetic clinics or bespoke online retailers.

They may all contain collagen, but it’s worth checking which source it is derived from, how much of it is contained in the drink, and how large the molecule is as you need it to be small enough to be absorbed into your bloodstream to get to work, rather than being passed out of the body by your digestion if it’s too large, all of these factors will impact on how well a collagen drink works – types include bovine, marine or porcine. The choice is yours, but look for those with enough key active ingredients to do the job that they claim, or if you’re a vegetarian or have religious preferences then be aware of the animal source.

This may just sound like adding a multi-vitamin pill to your daily diet, but the key word here is collagen – this is the main building block of our skin and like any building, as it ages, the bricks get a little more worn and need some repair.

Adding a collagen-based supplement to your diet to assist with the reduction in healthy collagen could be seen as getting the handy-man to come round to repair and rebuild all the broken bricks which you’re not able to do on your own anymore. In fact, you could even go as far as to say that adding a nutraceutical product to your daily skincare routine is an important choice, and probably one that should be given considerable thought.

Evidence from clinical trials is showing a positive effect on skin hydration, the formation of new collagen and improvements in the overall collagen density in the skin following use of collagen-based drinks for 3 months or more – this means that nutricosmetics are re-building the ‘blocks’ to renewed, healthier and more youthful skin.

Making Strides in the Treatment of Women’s Health

Certain women’s health issues could benefit from recent advances says Dr David Richmond, President of the Royal College of Obstetricians and Gynaecologists.

Making Strides in Womens Health TreatmentThe Royal College of Obstetricians and Gynaecologists (RCOG) will celebrate International Women’s Day (IWD) on 4 March 2016 with the theme ‘Joining up care in maternal mental health’. Expert speakers will provide insights into the challenges experienced in providing effective, joined-up maternal mental health care and we will also hear from women who have experienced maternal mental healthcare problems.

Mental health illness during pregnancy and following delivery are sadly very common with between 12 per cent and 20 per cent of women experiencing anxiety and/or depression during pregnancy and within the first year of childbirth. It is also desperately upsetting that around one quarter of all maternal deaths between six weeks and a year after childbirth are related to mental health problems with one in seven of the women who die in this period committing suicide.

It is therefore vital that women receive the right support and at the right time. Greater integration between primary and secondary care is needed to ensure that women with significant medical and psychiatric conditions are assessed before becoming pregnant and referred to specialist care in a timely manner to ensure that the right support is provided throughout a woman’s pregnancy and beyond. These are themes that will be will also be discussed at the IWD event.

The RCOG has welcomed the news that non-invasive prenatal testing has been recommended for high-risk women on the NHS. This test is the most accurate and safest way of detecting diseases that may have potentially serious consequences, both enhancing the information available to pregnant women and reducing unnecessary invasive procedures. Should the test be rolled out, resources and training for healthcare professionals offering the test will be necessary, in particular around communication and counselling expectant parents about the implications of the test results.

The publication of the NICE menopause guideline at the end of last year was a milestone for both healthcare professionals and women alike. It will help ensure that the best possible care is provided in the diagnosis and treatment of the menopause, a biological stage that every woman experiences to some extent in their lives.

Treatment

For some women, menopausal symptoms such as hot flushes, night sweats, mood swings and depression as well as a loss of interest in having sex can be extremely debilitating and have a significant impact on a woman’s physical and psychological health, career, social life and relationships. Unfortunately, many women still suffer in silence.

Our hope is that the guideline will not only support healthcare professionals but also provide women with the necessary information to empower them to make informed decisions about their choice of treatment. We also welcome the Chief Medical Officer’s efforts to ensure that employers are also able to offer support and working time flexibility to women through this time. Women feeling able to talk openly to healthcare professionals, their employers, friends and families about their symptoms is key to removing stigma around the menopause.

Fibroids are non-cancerous growths that develop in or around the womb (uterus). They can range in size from larger than a melon to as small as a coin. Around 1 in 3 women of childbearing age have uterine fibroids and while many women do not experience any problems, symptoms can be severe enough to require treatment. In rare cases, further complications caused by fibroids can affect pregnancy or cause infertility.

We strongly encourage women to visit their GP if they have persistent symptoms of fibroids, which can include heavy and prolonged menstrual periods, low back or leg pain, pelvic pain or pressure, pain during sexual intercourse, pressure on the bladder which leads to a constant desire to urinate, pressure on the bowel which can lead to constipation and/or bloating or an enlarged abdomen which may be mistaken for weight gain or pregnancy.

An ultrasound scan is usually able to confirm the diagnosis and medication can help to relieve the symptoms. There are also other medical treatments available to help shrink fibroids. If these prove ineffective, surgical removal or other less invasive procedures may be recommended. Great surgical advances have been made to preserve fertility in the treatment of even the most severe fibroids.

Nowadays there are many complex assisted reproductive technology (ART) options for infertile couples, including gamete/embryo donation, egg/sperm sharing, surrogacy, adoption and fertility preservation. Understanding the current legal and regulatory situation regarding these options, as well as important considerations, such as the welfare of the child or children when surrogacy and adoption are considered, can be overwhelming.

A review published in the The Royal College of Obstetricians & Gynaecologists last year talked about how the psychological impact and private agony of infertility must be carefully considered by healthcare professionals. The review identified infertility as a complex state and life crisis setting out the dangers of neglecting the emotional impact of involuntary childlessness and viewing it solely in biological or medical terms. The authors recommended that counselling practitioners can play a critical role in explaining some or all of the options available to patients and in ensuring that they are well informed before making any treatment choices.

A Long Healthy Life is Possible if You Take Care of Yourself

“People are being kept alive with medical breakthroughs but can have a poor quality of life with chronic conditions such as diabetes, osteoarthritis, kidney failure and other problems,” says Dr Sarah Jarvis, GP and clinical consultant to Patient.co.uk.

Dr Sarah Jarvis
Dr Sarah Jarvis, GP and clinical consultant, Patient

Dr Jarvis has been a GP for 23 years, with a practice in Shepherd’s Bush, West London. She is passionate about educating the public about health through radio, television, magazines and books.

“Ironically, we are victims of our own success,” she says. “Medical innovations are keeping people alive. Death rates from heart disease have more than halved in the UK in the last 20 years. Consequently people are living longer with conditions we can’t cure.

“No matter what condition you’ve got, the management of that condition is down to you. You will only have a few hours every year with a medical professional; the rest of the time requires self-management. People have to be engaged in their own care.

“No matter what condition you’ve got, the management of that condition is down to you… People have to be engaged in their own care”
“But prevention is so much better than cure and GP’s have now doubled their role. Once we saw people who were ill and we sorted them out. But these days we also do health promotion and disease prevention.

“Obesity is the biggest cause of health problems. It has escalated in the last eight years and 90 per cent of people who get Type 2 diabetes are obese. The rise in cancer is linked to obesity and alcohol and every unit of alcohol you drink a day increases your risk of cancer by 7 to 11 per cent.” Obesity impacts fertility, according to Dr Jarvis. “The more overweight you are, the more trouble you will have conceiving. And women are trying to get pregnant much later. We may believe we are independent and equal but when it comes to fertility we are not.”

If you are too young, you are more likely to have problems with pregnancy, both medical and psychological, or if you are too old, you can have difficulty conceiving. Fertility starts to drop quite steeply from the age of 35. Women cannot assume that pregnancy will happen after the age of 35. Then there are urinary incontinence issues, which affect as many as 1 in 3 women after childbirth — and 40 per cent of women going through the menopause.

“Menopause has become a problem in last 10 years because studies such as the Million Women Study and the Women’s Health Initiative have suggested that HRT may do more harm than good.” She adds: “Women are at greater risk of depression because our brain hemispheres are more connected which allows women to multi-task and not switch off. And, whether it’s nature or upbringing and society or a combination, women tend to be nurturers and worry about everyone else and neglect themselves.”

Dr Jarvis has advice for women of all ages. “It’s not rocket science. All the common sense messages apply. They may be dull but they are true; eat a healthy, balanced diet, don’t eat more calories than you expend, don’t drink alcohol to excess and be free not to drink alcohol at all if you don’t want to. Use reliable contraception, exercise regularly and be nice to yourself!

“It can seem daunting, but working out where you’re doing well and how you can target areas for improvement can make all the difference.

Using a web tool like the Patient.co.uk ‘my health tool’ can help you introduce changes that could make all the difference to your long term quality of life.”