PRACTICAL MANUAL ON UTERINE FIBROIDS

UTERINE FIBROIDS

Uterine fibroids, also called leiomyomas, fibromyomas or simply myomas are benign disorders, very widespread among women, and only rarely they can progress toward a malignant form

into invasive cancer. However, in most cases they have involve important symptoms that may have a serious impact on the quality of life.

There are many questions and doubts linked to uterine fibroids even if most of theme are false myths, mainly due to a low knowledge. For what it concerns the different treatment options to date, it is worth to mention that a more conservative approach prevails, especially when it is necessary to safeguard the reproductive health. This conservative approach bases on a follow-up aimed to monitor the fibroid development thus preveting the possible consequences for the well-being and quality of life of women it might trigger.

In general, the treatment of uterine fibroids should always be customized taking into account the symptoms, size and anatomical localization, the age, and the desire of childbearing.

Uterine fibroid is a common and disabling pathology, but it can be cured. Avoiding surgery is possible in most cases, and this is an important step to preserve woman’s feminity.

SILENTPATOLOGY

very abundant

menstrual cycle

pain in the lower

belly

sense of tiredness, demeanion

embarrassment related to physical

discomfortpain during

intimate intercourse

inability to do

physical activity

emotional discomfort

made of fears, taboos and

inconveniences

fear of surgery

Prevalence

Age

Distribution

Prevalence varies between 20 and80% of the female population

All women of reproductive age areaffected, especially in the 30-40 agegroup. The average age at diagnosis is35 years old.

30-40 5520

20% 80%

24M3M24 Million women are affected in Europe;3 million cases out of them are in Italy.

Prevalence varies between 20 and 80% of the female population.Highest prevalence is reported in afro-american women.

All women of reproductive age are affected, especially in the 30-40 age group. The average age at diagnosis is 35 years old.

“FIBROMA”It can develop in every part of the body even if the areas of most frequent interest are the intestines, stomach, bones, skin and uterus.

Concerning the uterus the term fibroid is improperly used as this benign tumor form is characterized by the proliferation of smooth muscle cells of myometrium and not by fibroblasts.Uterine fibroid therefore also takes the name of “myoma” and represents the most frequent female benign tumor: it is estimated that about one in 4 women between 30 and 50 years old has carrying at least one uterine fibroid that sometimes does not show any symptom, while sometimes it can present some symptoms and signs such as heavy bleeding and anemia, pelvic pain and infertility.

It is always essential to do not underestimate the problem and pay attention already from the first alarming symptoms, such as abnormal uterine bleeding or frequent or too abundant menstrual cycles.

Uterine fibroids can be single or multiple, and the diameter ranges from few millimeters to centimeters, until taking up nearly the whole uterus. Generally they have a rather slow evolution however in women of childbearing age they tendto increase in size more quickly due to increased estrogen secretion occurring at this stage, as well as they tend to regress during the menopause period or even disappear completely in some cases.

in medicine refers to a benignneoformation generated by fibroblasts.

INTRAMURAL FIBROIDS

The most common type, which affects about half of the women affected by this problem. They arise in the uterine muscle wall (myometrium). Once formed they can increase in volume and distort the shape of the uterus.

What problems do intramural fibroids give?

Intramural fibroids can give hemorrhagic symptoms when they emerge at submucosal level. Moreover, if they grow a lot in volume, they can create problems of infertility, as well as triggering consequences for pregnancy and childbirth.

1 2 3SUBSEROSAL FIBROIDS

They are quite frequent fibroids (35% of cases) that develop in the outer wall of the uterus and grow outwards, protruding into the pelvis.

What are the symptoms of subserosal fibroids?

Subserosal fibroids can remain silent for a long time and reach even large sizes (6-7 cm) if woman does not undergo regular gynecological visits at least once a year, it is possible she doesn’t note any symptom. In particular, if they grow on the front of the uterus they press on the bladder and the woman has weight sense on the pelvis, more frequent urinations, night awakenings to go to the bathroom several times (nycturia). If instead they grow is in the back of the uterus, there may be typical symptoms of constipation or pain during sexual intercourse.

SUBMUCOSAL FIBROIDS

They represent about 5% of all uterine fibroids, therefore the least common type. They develop within the endometrium and are the ones causing the most serious ailments. There are two types of submucosal fibroids: those growing just under the uterine lining, and peduculate that can instead arise inside or outside the uterus.

What are the characteristic symptoms of submucous fibroid?

Fibroid that grows just under the uterine lining, even if it is smaller than one centimeter, it can give important hemorrhages, while pedunculate can cause severe menstrual pain. In general, the abundant or hemorrhagic cycle has as its main consequence sideropenic anemia, which in turn causes several symptoms: severe asthenia, risk of doubled depression, loss of sexual desire, difficulty concentrating and attention, lower pain threshold and infertility.

WHICH ARE THE RISK FACTORS IN THE DEVELOPMENT OF FIBROIDS? WHICH IS THE ROLE OF HORMONES?

Age: They develop more frequently as they age during the final stage of reproductive age until menopause is reached in fact a significant increase appears after 40 years.

Ethnicity: The incidence is 2-3 times higher among women of African ethnicity and tend to be even more voluminous and numerous.

Obesity: Overweight women present a higher risk that seems to increase significantly in women with a BMI>25 since there are greater hormonal changes associated with obesity. The main cause of this disorder, but also often concomitant metabolic syndrome and dyslipidemia, an additional cause of the onset of uterine fibroids.

Genetic factors: The incidence is higher in women who have a family member such as their mother or sister who have had the same problem. Such familiarity presupposes the involvement of some genes in the development of fibroids.

Hormonal factors: Certainly sex hormones play a main role as it has been shown that estrogen and progesterone, which are responsible for stimulating the growth of the uterine lining every month in preparation for a possible pregnancy, induce and regulate its formation and growth. In fact fibroid cells have a higher concentration of estrogen and progesterone receptors than normal myometrium cells.

Hypertension or risk of heart disease: Arterial hypertension is associated with an increased risk of developing fibroids, even if being treated pharmacologically with hypertensive drugs.

Vitamin D deficiency: Low levels of vitamin D increase the risk of developing uterine fibroids.

Toxins: Changes in cytokine levels are the basis of the onset of uterine fibroids, suggesting involvement of the immune system and regulation of inflammation. Considering the ability of toxins to influence chronic low-grade inflammation, environmental pollution is one of the causes that induce the growth of uterine myomas.

Diet: Eating a lot of poor-quality beef and pork meat is linked to a higher risk of fibroids.

Hypothyroidism: Manifest hypothyroidism has been associated with the presence of fibroids.

Early menstruation: Women who had their first menstruation before the age of 10 have a higher risk of fibroids than women who had them later.

WHEN CAN MENSTRUAL FLOW BE CONSIDERED ABUNDANT/ABNORMAL?

When menstrual loss exceeds 80 ml of blood per cycle. A normal fully soaked pad contains 5 ml of blood. The loss is excessive if: it is necessary to change the pad every two hours or less; more than 20 pads per cycle are consumed; the flow lasts more than 7 days; there are clots.

The anemizing effects of the abundant cycle are enhanced if: the diet is low in iron or if the latter is absorbed little by co-existing food intolerances to gluten or lactose; if there are other losses, e.g. gum or hemorrhoidal; if there is irritable colon syndrome, with diarrhea.

Usual blood analysis are sufficient to diagnosis iron deficiency. They include dosage of ferritin (iron reserves), transferrin (how much is transported into the cells), sideremia (iron in the blood) and hemochrome (red blood cell count and hemoglobin level).

DO UTERINE FIBROIDS AFFECT THE WOMAN’S EMOTIONAL SPHERE?

The impact of uterine fibroids on personal, professional and academic life is very heavy, from the choice of wardrobe to the use of bulky tampons, to the fear of finding oneself in embarrassing situations with the consequent reduction in travel, sport, outings with friends, and for problems with concentration, memory, asthenia, thus resulting in lower performance potential, with repercussions also on the career, heavy conditioning during university examinations or work commitments and loss of working days.

IS IRON DEFICIENCY ANAEMIA A TRULY DISABLING CONDITION FOR WOMEN?

Absolutely: it is widespread throughout the world and almost completely overlooked. 15-30% of women of childbearing age suffer from it, and haemorrhages from uterine fibroids are a major cause.Iron is a trace element that acts as an important cofactor of various proteins needed for oxygen and energy metabolism. But it is also found in the central nervous system.The tiredness experienced by anaemic women is not so much linked to having fewer red blood cells and therefore less oxygen transported to the tissues, but to the role played by iron in the synthesis of dopamine in the brain.Also not to be overlooked is the heavy impact on fertility: 40% of women begin pregnancy with low iron stores. And, since the need for it increases threefold during gestation, this quickly leads to anaemia, a condition that doubles the risk of premature birth and triples the baby’s risk of low birth weight.

WHAT IS THE IMPACT, IN EVERYDAY LIFE, ON COUPLES’ LIVES AND SEXUALITY?

Uterine fibroids can affect a woman’s and a couple’s sexuality in several areas: sexual identity, with a greater impact the younger the woman; femininity and the sense of motherhood if the fibroids cause infertility; the quality of the relationship if the woman suffers from depression. In the case of anaemic women, they are twice as likely to experience this condition.

HOW DOES THE DIAGNOSIS OF A FIBROID TAKE PLACE? WHY IS IT OFTEN LATE?

A gynaecological examination plays a crucial role in the diagnosis of uterine fibroid, as awareness of the disease often only comes when symptoms begin to appear.Performing a routine gynaecological examination can instead be useful in detecting its presence before symptoms start appearing.

IF THE FIBROIDS ARE ASYMPTOMATIC, If they remain stable in shape, localization, size, if they are small in number and if they do not impede the pregnancy, in these cases it might not be necessary to remove them; thus, periodic gynecological follow-ups will be advised. Follow-ups, consisting in gynecological examinations, aim at checking, by ultrasound, whether fibroids are changing in shape, volume, size, and number, being these potential alarming bell for other possible approaches to take into account.

The problem in this condition called “wait and see” in which no therapy is adopted to prevent the growth of fibroids is often an oscillation between minimising the problem, especially if the woman makes regular gynaecological visits and the fibroid is small (“Let’s see how it goes in a year”), and then, given the degeneration of the disorder, drastic urgency (“We must remove them all and immediately”).

IF THE FIBROIDS ARE SYMPTOMATIC, In these cases it is necessary to start a treatment, which can be either pharmacological or surgical.1. Among the instrumental examinations, ultrasound is undoubtedly the most widely used means of making a correct diagnosis of uterine fibroid. Transabdominal pelvic ultrasound can clarify the location, size and number of fibroids, while transvaginal ultrasound is useful for more precisely defining their morphology of the fibroid.2. Other secondary imaging techniques, such as MRI and CT scan, may be required by the specialist to assess specific situations. 3. In certain cases, hysteroscopy is used for a precise and definitive diagnosis, particularly useful for submucous fibroids.

WHY ARE EARLY DIAGNOSIS AND APPROPRIATE THERAPY ESSENTIAL?

First and foremost, restoring the woman’s health and well-being, and

thus improving her quality of life, which is severely compromised by her symptoms. Early diagnosis also makes it possible to intervene with a

pharmacological approach when the fibroids are small, to the benefit of effective results and procreative health. Keeping the uterus in good condition also helps younger women not to worry about the risk of fibromatosis jeopardising their chances of becoming mothers. This is an important consideration in a country like Italy, where the average age at first pregnancy is among the highest in Europe (31.3 years) and the highest percentage of first children in the world is after the age of 40 (6%).

HOW IMPORTANT IS IT TO LISTEN TO YOUR BODY?

This is essential. The menstrual cycle usually becomes progressively

more haemorrhagic: if the duration increases from the usual 4 days to 6 or more, if the need to change the pad during the day increases or if there is

intra-menstrual bleeding, it is a good idea to talk to your gynaecologist. If you feel tired, teetotal, weak or depressed, it is better not to wait for it to “pass”, but to

talk to your family doctor and assess your blood tests, the CBC and ferritin, to check for possible anaemia.Before the age of 50, getting up several times at night to go to the toilet or having a sudden loss of urine is not physiological: it could be a symptom of compression due to a fibroid. Pain on deep penetration during sexual intercourse is also a warning sign that should be listened to.

The aim of current treatments for fibroids is:

1. TO ALLEVIATE ITS SYMPTOMS (BLEEDING, PAIN) 2. TO REDUCE ITS SIZE3. TO ALLOW ITS REMOVAL BY SURGICAL PROCEDURE.Gynaecologists consider several factors when prescribing the most suitable treatment: the severity of the symptoms, the size of the fibroids and their localization, the age of the patient and her desire to preserve the uterus and fertility. These factors play a key role in choosing the best treatment option.Taking them into consideration, the types of fibroid treatment can be natural, pharmacological, surgical and non-surgical.

WHAT IS THE GOAL OF FIBROID TREATMENT? WHAT ARE THE TREATMENT OPTIONS?

PHARMACOLOGICAL TREATMENTSThe drugs used are effective on menstrual disorders, but are not able to stop the growth of fibroids and most often have a temporary effectiveness:

Estro/progestin contraceptive pill, natural progesterone or progestin drugs: these drugs are not able to eliminate fibroids but they can hinder their growth and especially reduce the amount of menstrual flow. Hormonal contraceptives prevent ovulation, i.e. the release of an egg cell by the ovaries, and usually reduce the intensity of the menstrual cycle. Selective progesterone receptor modulators (SPRM) are oral drugs that modify the activity of the hormone progesterone.

Ulipristal acetate is the SPRM indicated for pre-operative treatment of moderate to severe symptoms of uterine fibroids, acting by controlling bleeding and reducing the size of the fibroid. However, the European Medicines Agency (EMA) has recommended restricting the use of drugs containing ulipristal acetate 5 mg (Esmya and generics) indicated for the treatment of uterine fibroids following several cases of severe liver damage. These drugs can therefore now only be used to treat uterine fibroids in pre-menopausal women for whom surgery is inadequate or has not proved effective. Finally, there are levonorgestrel-releasing intrauterine devices (IUS), which are inserted directly into the uterus and release the hormone levonorgestrel, a progestin that causes the inner lining of the uterine wall to atrophy and the cervical mucus to thicken, preventing sperm from reaching the egg cell.

GnRh analogue drugs: gonadotropin-releasing hormone agonists can reduce oestrogen production. They are most useful when used preoperatively to reduce the volume of the fibroid and uterus, making the operation more technically feasible and reducing blood loss during surgery. By blocking the production of female hormones, they create a transient menopause that cancels out metrorrhagic symptoms and can lead to some reduction in the size of the fibroid. In general, these drugs should not be used for long-term treatment, because they can cause rebound growth to the pre-treatment size within 6 months, and demineralisation of the bone. To avoid bone demineralisation when these drugs are used long-term, physicians should give patients additional oestrogen (add-back therapy), such as a low-dose oestrogen-progestin combination.

Non-steroidal anti-inflammatory drugs (NSAIDs): can be used to treat pain, but are unlikely to decrease bleeding.

Tranexamic acid: this is an antifibrinolytic drug that can reduce uterine bleeding by up to 40%. The dosage is 1300 mg every 8 hours for up to 5 days. Its role is constantly evolving

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When to operate? Surgery is used when fibroids are large, symptomatic and/or rapidly increasing in volume. Surgical treatment is aimed to removing the fibroids. Depending on the type, size and number of fibroids to be removed, different surgical techniques can be used:

LAPAROSCOPYThe surgical and optical instruments to perform the operation are inserted into the ab dominal cavity through small incisions, one below the navel, the others in the lower abdomen.

LAPAROTOMYThe operation is performed through a large incision in the abdominal wall.

HYSTEROSCOPYThe operation is carried out by introducing the surgical instruments into the uterine cavity, through the vagina. This technique allows endocavitary fibroids to be removed.

MAGNETIC RESONANCE-GUIDED FOCUSED ULTRASOUND (MRGFUS)This is a non-invasive procedure used in women who do not wish to have a child. MRgFUS uses high-energy, high-frequency focused ultrasound to destroy fibroids one at a time, heating them until they coagulate.

MYOLYSISIt is a procedure that uses focused energy to destroy fibroids in the uterus by contracting and closing the blood vessels, thus destroying the fibroid by cutting off its blood supply. It can be performed during a laparoscopic procedure, but can only target one fibroid at a time. As it can affect fertility, it should not be used if you wish to have a child in the future.

EMBOLISATION OF THE UTERINE ARTERYThis is a radiological technique through which the artery ‘feeding’ the fibroid is identified and occluded, so that the fibroid no longer receiving blood tends to progressively regress in size and, in many cases, definitive disappearance occurs. The manoeuvre leads to a progressive reduction in the volume of the fibroid itself without the need for surgery.

SURGICAL PROCEDURES NON-SURGICAL PROCEDURES

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NATURAL REMEDIES FOR FIBROIDS

FEEDING

USE ESSENTIAL OILS

DRINKGREEN TEA

PACK WITH THE OIL

AVOID EXPOSURETO ENVIRONMENTAL

TOXINS

SLEEP

SPORT

FEEDING

ALCOHOL Excessive alcohol consumption can contribu-te to increased inflammation throughout the body. It also reduces immune function; it can promote weight gain and encourages hormo-nal imbalances. By reducing or eliminating al-cohol, you can help get your hormones back on track and try to manage existing fibroids.

HIGH-FAT AND PROCESSED MEATS Foods rich in unhealthy fats, such as non-organic/processed meats or trans fats can increase inflammation levels. Limit the amount of meat you eat by also including vegetable proteins in your diet. When eating beef, always try to opt for grass-fed beef.

CONVENTIONAL DAIRY Non-organic dairy products can be rich in steroids, hormones and other chemicals that can alter hormone levels if taken in large quantities, which favors the development and growth of fibroids.

REFINED SUGAR The consumption of a lot of refined sugar can promote inflammation and lead to weight gain. It can also increase pain and reduce immune defense. There is an association between wei-ght gain and hormonal imbalance, and these two factors can foster the development of fi-broids.

REFINED CARBOHYDRATES Hormone management involves not only the elimination of sugars from the diet, but refined carbohydrates as well.

CAFFEIN Too much caffeine is damaging to your body, especially to your liver. When you give your liver more work to do than it can handle, it won’t keep your hormones in check. The more you can curb your alcohol and caffeine consumption, the easier it is for your liver to detoxify your body and keep your hormones in a proper fibroid-discouraging balance.

WE CAN REDUCE UTERINE FIBROIDS RISK AVOIDING

The consumption of predominantly organic foods can help handle fibroids since they are grown and produced without the use of chemical presticides.

They have many anti-inflammatory effects and so manage the growth of fibroids in a woman’s body. These vegetables are also foods rich in vitamin K, as an aid in blood clotting and helps control menstrual bleeding.

Support liver detoxification and help balance estrogen levels. A plant-based diet with a higher intake of cruciferous vegetables can control the incidence of uterine fibroids in women due to their high content of antioxidants and fiber.

A protective role of vitamin D on uterine fibroids has emerged. It has been reported that it controls their growth and their volume when the disorder is already developed, as well as their characteristic symptoms. In fact, a lower concentration of vitamin D has been seen in women with fibroids than in unsused women. Vitamin D is found in fatty fish from cold seas and fish liver oils, mainly. Small amounts of vitamin D are also found in beef liver, cheeses and egg yolk. Enriched foods also provide a satisfactory amount of vitamin D.

Upon digestion, the human body converts beta-carotene into vitamin A, which promotes the growth and repair of healthy tissue, which can be very useful in treating fibroids. Some foods rich in beta-carotene include carrots, sweet potatoes, kale and spinach.

To replace excessive iron loss due to increased bleeding, iron can be taken from both animal and plant sources. Iron from animal sources is known as heme iron. Iron found in plants is known as non-heme iron and is found in vegetables, cereals and legumes; the former tends to be better absorbed by the body than non-heme iron. A well-planned vegetarian diet does not increase the risk of anaemia, which is the case if the diet is improvised.To increase the absorption of non-heme iron, it is particularly useful to consume it together with foods rich in vitamin C, such as juices and fruit/vegetables such as broccoli, kiwi, green leafy vegetables, melons, oranges, peppers, strawberries and tomatoes.Lastly, in the case of a vegan diet, it is imperative to take vitamin B12 in the form of supplements.

Flaxseed can help balance oestrogen levels in the body, which in turn can work to control fibroids. You should aim for at least 2 tablespoons a day if you already have fibroids. You can sprinkle flaxseed on oatmeal, in your smoothies or simply on its own.

Instead of eating refined grains, opt for healthier whole grains such as millet, spelt, brown rice, buckwheat, rye and oats. These are higher in fibre, contain more minerals and tend to be much less processed, but most importantly they have a strong effect on blood pressure balance and therefore reduce the risk of insulin resistance which contributes to the hormonal imbalance underlying uterine fibroids.

MANAGE UTERINE FIBROIDS EATING

ORGANIC FOODS IRON-RICH FOODS

FLAXSEEDS

WHOLE GRAINS

GREEN LEAFY VEGETABLES

CRUCIFEROUS VEGETABLES

FOODS RICH IN VITAMIN D

FOODS RICH IN BETA CAROTENE

USEESSENTIAL OILS

PACK WITH THE OIL

Thyme, sage sclarea and incense are the best essential oils for the natural treatment of fibroids because can help balance hormones naturally. Researchers have also shown that sage oil sclarea might have antidepressant effects. To use these essential oils, you can rub 2 drops of each oil on the lower abdomen twice a day (combine it with a carrier oil such as coconut oil if you have sensitive skin). Also, useful to put 2 drops of incense oil on the palate twice a day.

Applying castor oil compresses to the abdomen increases circulation in the lymphatic and circulatory systems and lymphocytes cells in the human body responsible for acquired immunity, i.e., to fight off any different antigens that attack it, including toxins. Thanks to its known calming effect, Castor oil has been reported beneficial for uterine contraction management.

DRINK GREEN TEA

AVOID EXPOSURE TO ENVIRONMENTAL

TOXINS

Infusions can help calm symptoms by reducing inflammation and balancing certain hormones.Several studies have shown that green tea contains several antioxidants, one of which, epigallocatechin gallate, may help control fibroid growth, thus improving also the related symptoms such as bleeding and pain.

It is good to stay away from the following chemicals to improve your hormonal health, as well as your general health: pesticides, herbicides, synthetic fertilisers, bleach, food preservatives, harmful detergents (even some eco-cleaners) and food colouring.You should also opt for natural feminine care products, as well as organic body care products and cosmetics.There is a link between environmental pollution and female infertility in women of reproductive age. Recent findings suggest that a negative negative association between environment PM concentration and ovarian reserve exists, highlighting the potential adverse impact of air pollution on women’s fertility.

SLEEP

Sleeping well seems to have beneficial effects not only on mood but also on the effectiveness of the immune system in fighting infections.Sleep, along with nutrition, physical activity and stress management, is one of the pillars of your well-being. It would not be right to put these four factors in order of importance, because, in addition to being all indispensable, they are also closely linked to each other.

In fact, if you sleep badly, it’s easier for you to be attracted to unhealthy foods, to have less desire to exercise, and for your stress levels to be higher.

Take care of your sleep, do not underestimate its importance for your physical and mental well-being, because it is during sleep that toxins are eliminated, cells regenerate and the immune system strengthens. That is why sleeping, and especially sleeping well, is so important.

How sleep affects nutrition

Tiredness due to sleep deprivation affects your diet because it leads you to look for sweet, sugar-rich foods as an energy source, to cheer you up. The problem is that the increase in energy caused by sugar is rapid, but short-lived. After a short time then it is normal to feel on the ground again and look for more sugar to return energetic and efficient.

This leads to an endless cycle of rising and rapidly collapsing energy, which causes people to consume large amounts of sugar, sweets, candies, and sugary drinks. Sugar, however, is a highly inflammatory substance and therefore harmful to health and the enemy of the best physical form. Do you know that lack of sleep also stimulates the production of ghrelin, the appetite hormone? On the contrary, a good night rest promotes the release of leptin, the satiety hormone. So basically if you sleep well you will feel less hungry during the day.

The link between sleep and physical activity

In addition to nutrition, sleep is also closely linked to physical activity, which as we know is another pillar of well-being. First, when you are rested, you train more willingly and consequently the quality of training benefits. Do not forget then that just while sleeping the muscle fibers regenerate after the efforts made during training. Without proper rest, it is difficult to achieve physical improvements and that is why professional athletes take care of training and rest with the same attention.

THE BEST MEDICINE? SOMETIMES IT CAN BE SLEEP.

How stress affects sleep quality

Restlessness and stress are closely related and feed each other. When you don’t sleep well and wake up tired, it makes it harder to face the day with a smile and to keep stress under control. At the same time, when you arrive in the evening stressed out, it is unlikely that you will get quality rest. It is therefore important to get a good night’s sleep in order to be less stressed during the day and to learn how to reduce stress in order to sleep better at night.

Stress is an enemy of health because it stimulates the release of cortisol, known as the stress hormone. Cortisol is useful for dealing with sudden dangerous situations, known as ‘fight or flight’. It becomes harmful when it is constantly circulating, as happens in chronic stress situations. It is therefore chronic stress that should be avoided, because cortisol encourages the release of blood sugar and consequently the pancreas is forced to produce large amounts of insulin.

This situation favours the onset of metabolic diseases such as insulin resistance, obesity, metabolic syndrome and type 2 diabetes. A lifestyle that is attentive to physical and mental wellbeing therefore also means giving due importance to sleep. For this reason, it is important to put in place the right strategies to get a truly restful night’s sleep.

IMPROVE YOUR SLEEP WITH 5 STRATEGIESTry to not have dinner too late in the evening and especially avoid bingeing. It is important to

not be so hungry before having dinner and never miss the vegetables, which satiate without

weighing down too much. Ongoing digestion does not help sleep.

Do not consume coffee, tea and even chocolate after 2 pm, because they contain exciting

substances, which interfere with sleep.

Turn off all electronic devices at least one hour before bedtime. Mobile phones, PCs and TVs

emit a light, the so-called blue light, which the brain confuses with that of the sun’s rays. The

luminous stimulus inhibits the release of melatonin, the hormone that promotes deep sleep.

Worry about creating an environment in the evening that promotes rest. Do not keep the

room temperature too high, change the air before bedtime and try to avoid discussions and

negative news.

Before going to sleep, devote at least ten minutes to meditation or even simply breathing, to

free the mind and throw out the tensions accumulated throughout the day.

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Exercises recommended for those suffering from uterine fibroids?

Although there is no direct correlation, stress can increase weight and stimulate cortisol production, two conditions that favour fibroid formation. If you live a very stressful life, find a way to slow down and relax to improve your overall health.

The most suitable exercise in the presence of a fibroid is that requiring gentle movement so as not to cause additional pain. High impact sports and high strength training are extremely difficult for most women with fibroids; even swimming becomes an impossible activity to be performed in the presence of profuse bleeding.

It must be pleasant, otherwise it will soon be interrupted.

YOGA AND PILATES since they are based on gentle movements and some postures can work on the abdominal area without causing pain.

MEDITATION AND DEEP BREATHING TECHNIQUE 15-20 minutes a day of this activity relaxes the mind and reduces stress.

WALKINGProceed at your own pace and stay outdoors in all seasons.

PHYSICAL ACTIVITY

IMPROVES INSULIN

SENSITIVITY

CONTROLSBLOOD

PRESSURE

BODY WEIGHT

CONTROL

CONTRIBUTES TO HORMONAL

BALANCE

I’M ON MY PERIOD, HOW DO I DRESS UP?Who said that when a woman has her period she has to give up her style? Today fashion allows you to feel comfortable and beautiful even on those days, so you can live your daily life without worries.

Jumpsuits, for example, have become a trendy item and instead of wearing the classic models in plush or chenille, you can find really original jumpsuits. If you don’t want to give up the classic dress instead, you’ll prefer models with an A-shaped figure, or those in empire style, which widen from the waist down, leaving free the belly area that in those days is the weakest point.

Always in step with the trends, there are also gypsy effect long skirts, a bit ‘70s, to be worn perhaps with German sandals a bit ‘bright, with crystal inserts or metallic textures.For the loversl of the pants, put away the tight jeans and choose high-waisted cotton models, which are more breathable.

The important thing in the end is to wear something that will make you smile and that’ll make us ourself.

It is not uncommon during pregnancy to discover the presence of a fibroid or myoma: during the first twenty weeks of pregnancy, due to hormonal changes, their size tends to increase and often their volume doubles, then growth stops. In order to determine whether a caesarean is necessary, the characteristics of the fibroid must be assessed on a case-by-case basis through a gynaecological examination and a transvaginal ultrasound. The operation is necessary in cases where the size and position of the myoma can obstruct the passage of the baby through the birth canal. This rarely happens in reality, generally when the fibroma exceeds five centimetres, if it is previo (located near the cervix) and submucosal (i.e. on the internal surface of the organ) or intramural (develops in the thickness of the wall). Conversely, subserous formations, i.e. those that face the external surface of the organ, create less of an obstacle. In the event of a caesarean section, the fibroid can rarely be removed during the same operation, because the pregnant uterus is very vascularised and there is a risk of major blood loss. What about contractions? A fibroid can lead to two other problems: firstly, it can increase the risk of uterine contractions, either if the fibroid is small or if there are multiple myomas, and secondly, if the fibroid is growing very quickly, parts of the fibrous tissue can become ischaemic and soft. This triggers a painful inflammatory reaction that can, in turn, cause contractions. In both cases it is necessary to rest and, if necessary, to take tocolytic drugs to reduce contractile activity.

Fibroid uterine discovered during pregnancy.Can it obstruct my delivery? Will I necessarily have to have a caesarean section?

Genetic predisposition is one of the possible causes of fibroids, but IT IS NOT a crucial factor. Fibroids are most likely caused by a number of potentially interacting factors.

My mother used to suffer from uterine fibroids.Am I at risk?

Fibroids can cause infertility and therefore be the primary cause of an unsuccessful pregnancy, especially those involving the uterine cavity or those of the wall, especially if they are large, can be a barrier to implantation of the fertilised egg. In many cases, on the other hand, it is possible to conceive and carry a pregnancy to term. However, although it is possible for pregnancy and fibroids to coexist, it is advisable to rely on the advice of one’s gynaecologist: every patient is different and only a personalised approach can manage the clinical situation in the best possible way. However, in some cases it can reduce fetal growth or cause uterine contractions, premature birth, breech presentation (requiring a caesarean section) and in some cases cause repeated miscarriage. Today, given the age at which women decide to carry out their plans for motherhood, time is a key factor. Surgery to remove uterine fibroids not only takes longer but is also associated with a high risk of damage to the uterus. Thanks to drug therapy, which does not affect the ovarian reserve, it is possible to shorten the time because it is possible to get pregnant a few months after stopping the drug.

Can I get pregnant with a uterine fibroid?

QUESTION & ANSWERS

Medical treatments, aimed at suspending ovarian activity and reducing estrogen production, may be indicated in women who will reach climacteric within a period of no more than a couple of years.When menopause is further away, uterine removal is the treatment option associated with the highest degree of patient satisfaction.Many women fear that uterine removal will result in unfavorable consequences on sexual, bladder, and bowel function and the risk of genital prolapse. However, several studies have shown that none of these fears are well-founded. In particular, sexual function generally remains unchanged from pre-operative conditions, and partners do not experience different sensations during intercourse. In addition, women should be reassured that no climacteric symptoms will occur after hysterectomy if the ovaries are preserved, since gonadal function will not be altered and will terminate according to one’s “biological clock”.

When should a uterine fibroid be removed? What consequences does the surgery have?

A fibroid may cause anaemia and weakness, backache and other pains, frequent urination and physical ailments during sexual intercourses. All these symptoms may have serious repercussions on daily life, therefore negatively affecting mood as well.

The several types of fibroids develop very slowly and tend not to become malignant lesions, sometimes actually causing no symptoms at all. However, should they be detected, a detailed analysis of their nature is to be conducted, in order to rule out the rare possibility of a degeneration.

Can fibroids develop into something more serious, such as a malignant tumour?

I frequently have mood swings and I am often irritable. Could fibroids be the cause?

Roughly 30% of women suffer from them at some stage, hence it’s true: uterine fibroids are frequent. Frequency increases with age, therefore it is necessary to screen regularly, on a yearly basis, to check the health of the uterus. It is very useful to monitor symptoms, in particular a heavier menstrual flow, which is one of the major symptoms of uterine fibroids.

My GP keeps on telling me that uterine fibroids are a rather common pathology, yet nobody I know suffers from them.

Are they really so widespread?

QUESTION & ANSWERS

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