Problems with the womb

Diseases and disorders affecting the womb and other reproductive organs such as the ovaries and Fallopian tubes can be particularly worrying. As well as causing considerable pain and discomfort which may sometimes interfere with your sex life, there is always the anxiety that they may prevent you from having a baby or make becoming pregnant more difficult.

Some women are reluctant to consult a doctor about these problems, perhaps because they are afraid he will dismiss their symptoms as being purely psychological.

But fibroids, prolapse and endometriosis – all fairly common disorders affecting the womb- have physical causes which can be treated, and even if these disorders cannot always be completely cured, many of the more unpleasant symptoms can be alleviated.

Fibroids

Fibroids are swellings in the wall of the womb consisting of muscle and fibrous tissue. They develop into lumps that can be smaller than a pea, or very rarely bigger than a football. They can protrude into the womb, or out into the pelvic region and then into the abdomen if they get very big. Apart from taking up space, they do no direct harm and the chances of them developing into cancer are very, very small. Around 20 per cent of all women have fibroids at some time in their lives, often without even knowing they have them, and only around a quarter have problems with them.

When do fibroids cause trouble?

When fibroids push into the womb, they enlarge it, stretching and indenting the endometrium, the lining of the womb that is shed every month during a period. So fibroids can cause heavier and longer periods.

Fibroids don’t usually prevent you becoming pregnant, but if there are several sitting under the womb lining, the fertilized egg may have trouble finding some healthy muscle in which to grow, and the risk of an early miscarriage is therefore increased, if the egg does succeed in becoming properly embedded, and you become pregnant, the baby may not be able to get into the ideal head-down position before birth because fibroids are in the way. In this case, a Caesarean delivery is sometimes neces- [treatment) Because no one knows how or why Tibroids grow, there are no drugs available at the moment which will effectively prevent or cure them, although some anti-oestrogen drugs may shrink them a little. If the fibroids are small, they are usually best left alone, but once they have made the womb large enough to be felt above the brim of the pelvis – about equivalent in size to a three months’ pregnancy- they are usually dealt with by surgery because they are beginning to get in the way.

Where just a single fibroid has deve-loped, one, say the size of a tennis ball hanging on the outside of the womb, it can easily be removed on its own by an operation called a myomectomy.

If, however, you have several fibroids so that removing them individually would involve a great deal of intricate surgery with the risk of considerable blood loss, doctors often recommend a hysterectomy, an operation to remove the whole of the womb. This not only gets rid of fibroids that have already developed, but ensures that any tiny seedling fibroids that are also present but difficult to detect will not have a chance to grow.

It also means you won’t be able to have children, so doctors won’t insist on a hysterectomy if you want to start or add to your family, unless the fibroids show signs of abnormal growth. This is extremely unlikely.