Fibroids

Uterine Fibroids - Topic Overview- from WebMd

What are uterine fibroids?

Uterine fibroids are lumps that grow on your uterus. You can have fibroids on the inside , on the outside , or in the wall of your uterus.

Your doctor may call them fibroid tumors, leiomyomas, or myomas. But fibroids are not cancer. You do not need to do anything about them unless they are causing problems.

Fibroids are very common in women in their 30s and 40s. But fibroids usually do not cause problems. Many women never even know they have them.

What causes uterine fibroids?

Doctors are not sure what causes fibroids. But the female hormones estrogen andprogesterone seem to make them grow. Your body makes the highest levels of these hormones during the years when you have periods.

Your body makes less of these hormones after you stop having periods (menopause). Fibroids usually shrink after menopause and stop causing symptoms.

What are the symptoms?

Often fibroids do not cause symptoms. Or the symptoms may be mild, like periods that are a little heavier than normal. If the fibroids bleed or press on your organs, the symptoms may make it hard for you to enjoy life. Fibroids make some women have:

• Long, gushing periods and cramping.
• Fullness or pressure in their belly.
• Low back pain.
• Pain during sex.
• An urge to urinate often.

Heavy bleeding during your periods can lead to anemia. Anemia can make you feel weak and tired.

Sometimes fibroids can make it harder to get pregnant. Or they may cause problems during pregnancy, such as going into early labor or losing the baby (miscarriage).

How are uterine fibroids diagnosed?

To find out if you have fibroids, your doctor will ask you about your symptoms. He or she will do a pelvic exam to check the size of your uterus.

Your doctor may send you to have an ultrasound or another type of test that shows pictures of your uterus. These help your doctor see how large your fibroids are and where they are growing.

Your doctor may also do blood tests to look for anemia or other problems.

How are they treated?

If your fibroids are not bothering you, you do not need to do anything about them. Your doctor will check them during your regular visits to see if they have gotten bigger.

If your main symptoms are pain and heavy bleeding, try an over-the-counter pain medicine like ibuprofen, and ask your doctor about birth control pills. These can help you feel better and make your periods lighter. If you have anemia, take iron pills and eat foods that are high in iron, like meats, beans, and leafy green vegetables.

If your symptoms bother you a lot, you may want to think about surgery. Most of the time fibroids grow slowly, so you can take time to consider your choices.

There are two main types of surgery for fibroids. Which is better for you depends on how big your fibroids are, where they are, and whether you want to have children.

• Surgery to take out the fibroids is called myomectomy. Your doctor may suggest it if you hope to get pregnant or just want to keep your uterus. It may improve your chances of having a baby. But it does not always work, and fibroids may grow back.
• Surgery to take out your uterus is called hysterectomy. This is the most common surgery for fibroids. And it is the only way to make sure that fibroids will not come back. Your symptoms will go away, but you will not be able to get pregnant.

It is normal to have mixed feelings about hysterectomy. Some women are sad to lose part of what makes them a woman. Other women just want their symptoms to go away. If you are thinking about hysterectomy, learn all you can about it. This will help you make the choice that is right for you.

There are a number of other ways to treat fibroids. One treatment is called uterine fibroid embolization. It can shrink fibroids. It may be a choice if you do not plan to have children but want to keep your uterus. It is not a surgery, so most women feel better soon. But fibroids may grow back.

If you are near menopause, you might try medicines to treat your symptoms. Heavy periods will stop after menopause.

HPV

HPV and Cervical Cancer from WebMd

Nearly two decades ago, experts discovered a relationship between infection with HPV (human papillomavirus) and cervical cancer. Since then, these experts have learned much more about how HPV can lead to cervical cancer.

Here, what every woman and girl should know about HPV and cervical cancer.

About the HPV Virus

There are more than 100 types of HPV. About 30 or so types can cause genital infections. Some can cause genital warts; other types can cause cervical or other genital cancers. (The other 70 or so HPV types can cause infections and warts elsewhere on the body, such as on the hands.)

Most sexually active women and men will contract HPV at some point in their lifetime. Most will never even know it. Usually, this virus does not cause any symptoms and doesn't cause disease. Often, the body can clear HPV infection on its own within two years or less.

Some types of HPV, typically HPV 6 and HPV 11, cause genital warts. The warts are rarely associated with cervical cancers. They are considered "low-risk" HPV.

HPV and Cervical Cancer

Certain HPV types are classified as "high-risk" because they lead to abnormal cell changes and can cause genital cancers: cervical cancer as well as cancer of the vulva, anus, and penis. In fact, researchers say that virtually all cervical cancers -- more than 99% -- are caused by these high-risk HPV viruses. The most common of the high-risk strains of HPV are types 16 and 18, which cause about 70% of all cervical cancers.

If the body clears the infection, the cervical cells return to normal. But if the body doesn't clear the infection, the cells in the cervix can continue to change abnormally. This can lead to precancerous changes or cervical cancer.

Rates of Cervical Cancer

Actual cervical cancer is rare in the U.S. because most women get Pap tests and have abnormal cells removed before they turn into cancer. The American Cancer Society predicts that about 11,070 women will find out they have cervical cancer in the U.S. this year. They also say that roughly 3,870 women will die of the disease the same year.

How HPV Is Spread

HPV types associated with genital infections are transmitted sexually, primarily through skin-to-skin contact during sexual activity. HPV can also be spread through oral sex. The chance of getting HPV rises with certain risk factors:

• Number of lifetime sexual partners (risk increases with more partners)
• Young age: Women aged 20 to 24 are most likely to be infected, but they usually clear the HPV infection with no problems.
• Women who are sexually active with men who have other partners at the same time.

Symptoms of High-Risk HPV Infection and Tests

When infection with high-risk HPV types occurs, there usually are no symptoms. Often, the first clue is a Pap test result that is abnormal. In a Pap test, the doctor takes a swab of cervical cells and has them analyzed in a laboratory. If the Pap test results are unclear, the doctor may order a HPV test to check the DNA type of the virus. This analysis can identify 13 of the high-risk HPV types associated with cervical cancer. It does not identify cancer. But it tells the woman and her doctor if she has a type of HPV capable of causing cancer.

Treatment of HPV Infection

A positive HPV test may not mean a woman needs treatment, at least not immediately. Having a positive test puts a woman in the "high-risk" class, alerting the doctor that she is at higher risk for cervical tissue changes and may need close evaluation.

To watch for further tissue changes, the doctor may order frequent Pap tests. Or the doctor may perform a colposcopy, in which a lighted magnifying device is used to closely examine cervical tissues.

Researchers have discovered that high-risk HPV viruses produce certain proteins. These proteins interfere with the cell functions that limit excessive cell growth.

If abnormal cervical tissue changes progress, treatment of the HPV infection may be needed. Among the options are surgery, laser treatment, and freezing.

Pregnant women, or women considering pregnancy, should consult closely with their doctor. The risk of passing HPV on to the baby is very low. But HPV treatments can affect pregnancy, so doctors may want to delay treatment until after childbirth.

How to Prevent HPV Infection

There's only one sure way to eliminate any chance of HPV infection: Avoid all genital contact with another person. To reduce risk, it's best to have a mutually monogamous sexual relationship with an uninfected partner. But keep in mind, many people don't know if they're infected. Using condoms can help prevent HPV transmission but are not foolproof. The virus can be transmitted to genital areas not covered by the condom.

A vaccine, Gardasil, was approved in 2006 for use in girls and women aged 9 to 26. It is also approved for use in females and males (also aged 9 to 26) to prevent genital warts and anal cancer.

Another vaccine, Cervarix, may be approved by the FDA in 2007. Over time, widespread vaccination will help prevent transmission of the HPV types covered by the vaccines.

The Gardasil HPV vaccine protects against several high-risk strains of HPV, including HPV types 16 and 18, which account for 70% of cervical cancers. It also protects against HPV 6 and 11, which account for about 90% of genital warts. Cervarix, if approved, would protect against HPV types 16, 81, 31, and 45 -- all of which can cause cervical cancer.

Hysterectomy recovery

Hysterectomy Recovery: What Can You Expect?-from WebMD

After a hysterectomy, you will have a brief recovery time in the hospital. Your recovery time at home -- before you can get back to all your regular activities -- will vary depending on the procedure you had.

Abdominal hysterectomy. Most women go home three days after this surgery, but complete recovery takes from six to eight weeks. During this time, you need to rest at home. You should not be doing housework. There should be no lifting for the first two weeks. Walking is encouraged, but not heavy lifting. After six weeks, you can get back to your regular activities, including having sex.

Vaginal or laparoscopically assisted vaginal hysterectomy (LVAH). A vaginal hysterectomy is less surgically invasive than an abdominal procedure, and recovery can be as short as two weeks. Walking is encouraged, but not heavy lifting.
Laparoscopic supracervical hysterectomy (LSH). This procedure is the least invasive and can have a recovery period as short as six days to two weeks. Walking is encouraged, but not heavy lifting.

Call your doctor if you have any of these symptoms:
Fever or chills
Heavy bleeding or vaginal discharge
Severe pain
Redness or discharge from incisions
Problems urinating or having a bowel movement
Shortness of breath or chest pain

Your Hysterectomy Recovery
For most women, life without a uterus means relief from the symptoms that caused them to have a hysterectomy -- bleeding, pelvic pain, and abdominal bloating. With relief from those symptoms, women may have better sex -- with greater libido, frequency, and enjoyment.
Yet if the ovaries were removed, there are a few more challenges ahead. If you had not gone through menopause before your hysterectomy, you probably will begin having symptoms of menopause -- hot flashes and mood swings. Your body is adjusting to changes in hormone levels. You may also have some changes in sexual desire and enjoyment, and vaginal dryness.
You may feel a sense of loss. You may grieve over the loss of your uterus and your ability to have children. If you had surgery because of illness or cancer, you may feel depressed. These feelings are normal. Talk to your doctor and a mental health therapist about them.

Treating Side Effects of Hysterectomy
You may want to consider hormone replacement therapy (HRT) to ease some symptoms. Your age, medical history, and whether you have had ovaries removed are factors to consider when deciding on HRT. Talk the issues over with your doctor. If you have had breast cancer, HRT is not appropriate for you.
There are non-hormonal treatments that can help. Effexor (an antidepressant), Clonidine (a blood pressure medication), and Neurontin (prescribed for seizures and chronic pain) have been found to be effective in treating hot flashes.
Some women experience pain during intercourse after a hysterectomy. It helps to try different positions and lubricants (like K-Y oils or Replens). A low-dose vaginal estrogen cream or ring can also help relieve vaginal dryness.
Pelvic weakness sometimes develops after a hysterectomy. If you had some pelvic weakness before surgery, it may get worse afterward -- leading to bladder or bowel problems. Kegel exercises can help strengthen pelvic muscles to help control urinary incontinence problems. For some women, corrective surgery is necessary.

Hysterectomy information

Hysterectomy- from WebMD
A hysterectomy is an operation to remove a woman's uterus. A woman may have a hysterectomy for different reasons, including:

Uterine fibroids that cause pain, bleeding, or other problems
Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
Cancer of the uterus, cervix, or ovaries
Endometriosis
Abnormal vaginal bleeding
Chronic pelvic pain
Adenomyosis, or a thickening of the uterus

Hysterectomy is usually considered only after all other treatment approaches have been tried without success.

Types of Hysterectomy
Depending on the reason for the hysterectomy, a surgeon may choose to remove all or only part of the uterus. Patients and health care providers sometimes use these terms inexactly, so it is important to clarify if the cervix and/or ovaries are removed:
In a supracervial or subtotal hysterectomy, a surgeon removes only the upper part of the uterus, keeping the cervix in place.
A total hysterectomy removes the whole uterus and cervix.
In a radical hysterectomy, a surgeon removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina. Radical hysterectomy is generally only done when cancer is present.
The ovaries may also be removed -- a procedure called oopherectomy -- or may be left in place.

• Surgical Techniques for Hysterectomy
  Surgeons use different approaches for hysterectomy, depending on the surgeon’s experience, the reason for the hysterectomy, and a woman's overall health. The hysterectomy technique will partly determine healing time and the kind of scar, if any, that remains after the operation.
  There are two approaches to surgery – a traditional or open surgery and surgery using a minimally invasive procedure or MIP.
  
  Open Surgery Hysterectomy
  An abdominal hysterectomy is an open surgery. This is the most common approach to hysterectomy, accounting for about 70% of all procedures.
  To perform an abdominal hysterectomy, a surgeon makes a 5 to 7 inch incision, either up-and-down or side-to-side, across the belly. The surgeon then removes the uterus through this incision.
  On average, a woman spends more than three days in the hospital following an abdominal hysterectomy. There is also, after healing, a visible scar at the location of the incision.
• 
  MIP Hysterectomy
  There are several approaches that can be used for an MIP hysterectomy:
  Vaginal hysterectomy: The surgeon makes a cut in the vagina and removes the uterus through this incision. The incision is closed, leaving no visible scar.
  Laparoscopic hysterectomy: This surgery is done using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the belly. The surgeon performs the hysterectomy from outside the body, viewing the operation on a video screen.
  Laparoscopic-assisted vaginal hysterectomy: Using laparoscopic surgical tools, a surgeon removes the uterus through an incision in the vagina.
  Robot-assisted laparoscopic hysterectomy, but the surgeon controls a sophisticated robotic system of surgical tools from outside the body. Advanced technology allows the surgeon to use natural wrist movements and view the hysterectomy on a three-dimensional screen.

Comparison of MIP Hysterectomy and Abdominal Hysterectomy
Using an MIP approach to remove the uterus offers a number of benefits when compared to the more traditional open surgery used for an abdominal hysterectomy. In general, an MIP allows for faster recovery, shorter hospital stays, less pain and scarring, and a lower chance of infection than does an abdominal hysterectomy.
With an MIP, women are generally able to resume their normal activity within an average of three to four weeks compared to four to six weeks for an abdominal hysterectomy. And the costs associated with an MIP are considerably lower than the costs associated with open surgery. There is also less risk of incisional hernias with an MIP.

Not every woman is a good candidate for a minimally invasive procedure. The presence of scar tissue from previous surgeries, obesity, and health status can all affect whether or not an MIP is advisable. You should talk with your doctor about whether you might be a candidate for an MIP.

Risks of Hysterectomy
Hysterectomy is a low-risk surgery. Most women who undergo hysterectomy have no serious problems or complications from the surgery. However, as with any surgery, hysterectomy can result in complications for a small minority of women. Those complications include:

Urinary incontinence
Vaginal prolapse (part of the vagina coming out of the body)
Fistula formation (an abnormal connection that forms between the vagina and bladder)
Chronic pain
Other risks from hysterectomy include wound infections and blood clots, although these are uncommon.

What to Expect After Hysterectomy
After a hysterectomy, if the ovaries were also removed, a woman will enter menopause. If the ovaries were not removed, a woman will likely enter menopause at an earlier age than she would have otherwise.
Most women are told to abstain from sex and avoid lifting heavy objects for six weeks after hysterectomy.
After a hysterectomy, the vast majority of women surveyed feel the operation was successful at improving or curing their main problem (for example, pain or heavy periods).