A bladder infection may complicate matters, causing a feeling of scalding when urine is passed, a feeling of wanting to pass urine frequently or pain. The doctor will send a specimen of urine for laboratory examination and will prescribe an appropriate antibiotic to clear the bladder of any infection that is found.

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• Submucosal fibroids grow on the inside of the womb and extend into the uterine cavity.

• Intramural fibroids grow within the uterine wall.

• Subserol fibroids grow on the outside of the womb, in the lining between the uterus and the pelvic cavity.

The main symptoms of fibroids are extremely heavy periods. If the fibroid is submucosal, then the mechanism that stops menstrual flow may not operate effectively. Menstrual flow is stopped by muscular contractions of the womb and fibroids can interfere with this.

Diagnosis

Fibroids can be diagnosed in several ways. Often they are picked up on a simple internal examination. If the fibroids are small, then a pelvic ultrasound can be used and this is often done to confirm the diagnosis from the internal examination.

Medical Treatment

If the fibroids are preventing pregnancy and they are not too large, they can be removed surgically, leaving the womb intact (myomectomy).

Recently, a new technique has been developed called arterial embolisation. Fibroids have their own blood supply and the theory is that, if that blood supply is cut off, the fibroids will stop growing and may even shrink. Embolisation is performed with a laser and it can make some fibroids shrink to one-third of their original size.

Natural Treatment

The natural treatment for fibroids is the same as that for PCOS and endometriosis

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Acupuncture

Acupuncture is an ancient Chinese treatment which is thought to restore energy flows in the body, thereby alleviating pain and allowing healing.

Acupuncture usually involves placing fine, sterile, stainless steel needles in specific locations on the body depending on the site of the pain. The needles may then be manipulated and rotated by hand or stimulated electrically.

The depth of the needle penetration, the number of points on your body that are stimulated and the duration of treatment will vary according to the symptoms.

Acupuncture is a simple and safe procedure if practiced by a properly qualified medical practitioner.

There may be a little discomfort during the treatment and you may experience slight bruising where the needles have been inserted.

Many doctors practicing acupuncture now use single or disposable needles to eliminate the risk of infection.

Some women suffering from endometriosis have gained significant relief from their pain with the use of acupuncture.

Acupressure

Acupressure originated in China as a first aid technique. It is based on the same principles as acupuncture but the acupuncture points are stimulated by finger pressure instead of needles.

Acupressure is easy to learn and can be performed by yourself or by a friend. It can be used for the relief of symptoms such as menstrual cramps and can also be a means of strengthening and balancing your body’s deep energies for the well-being of your body and mind.

Shiatsu

Shiatsu is a form of acupressure. It is an ancient Japanese art of applying pressure to acupuncture points and is combined with oriental massage. With regular use it is believed to improve your health by increasing the flow of energy through the body.

Shiatsu should be pleasurable, not painful. Once the correct technique has been learnt from a qualified person it is possible to have a friend give you a massage or even to do it yourself.

Reflexology

Reflexology is again similar to acupressure and is derived from the belief that discomfort and pain arises from blockings of the body’s vital energy.

It is believed that every organ of the body has a corresponding point on the foot. To treat problems affecting a particular part of the body, the appropriate point is located on the foot and then manipulated and massaged. This massage results in a stimulation and improvement of the energy flow to the affected organ and therefore brings about pain relief.

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At the beginning of puberty, the ovaries start to produce oestrogen in response to gonadal stimulating hormones produced by the pituitary gland, which in its turn has been stimulated by the hypothalamic region of the brain. The age of puberty varies from nine to fifteen, or more. What turns the process on is unknown, but an early onset tends to run in families. Climate influences it, as do emotional state, body weight, and regular sleep. Puberty is signalled by a spurt in growth and breast enlargement. The uterus, vulva and vagina enlarge, and hair appears on various areas of the body.

At a variable time after this, ovulation (release of an egg or ovum) occurs, and progesterone, the second hormone, is produced, which, with oestrogen, is responsible for menstruation. Each month ovulation followed by periods is the normal process in a woman’s life, the normal menstrual cycle. The pituitary gland produces follicule-stimulating hormone, which causes the ovarian-follicles (sites where the eggs develop) to ripen and release oestrogen. One egg follicle goes on to mature in about two weeks, but the remainder do not usually develop. The pituitary then puts out a second hormone, or luteinising hormone (LH), and the egg is released. The egg passes down the fallopian tube to the uterus, leaving behind the ruptured egg follicle, which develops into the corpus luteum and produces progesterone. The lining of the uterus has been built up by the oestrogen ready to receive a fertilised egg, but if it is not fertilised, the lining is shed and menstruation results.

At menopause, ovarian production fails, and menstruation no longer occurs. A few years before the menopause, however, ovarian function has been reduced and no progesterone is produced, so regular periods become irregular, and they may be light or heavy.

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Headaches not previously experienced occurred in nearly half the women in two of our surveys.4,5 Others who had been subject to migraines showed some increase. This is, after all, nothing new. Headaches experienced before a period are thought to be due in part to the fall in oestrogen at this time. Headaches experienced in the pill-free week when taking an oral contraceptive are also felt to be due to this factor. They can, of course, be due to many other causes. They may be a sign of disturbance in almost any system in the body. I am only mentioning them here as they are sometimes relieved when oestrogen replacement is administered, but I am certainly not suggesting that oestrogen is the first line of treatment for headaches at this time of life.

Vertigo, which is described as an odd sort of dizziness or motion sickness, may also occur at this period.

Muscle and joint pains

These are common at the menopause and are probably due to a relaxing muscle tone and osteoarthritis which often occurs first at the menopause. Osteoarthritis is also more common in women than in men. An everyday exercise programme (see chapter often helps, and many arthritis specialists agree that oestrogen replacement often helps to alleviate pains in the joints when they first appear at the menopause. This seems to be supported by recent reports that one of the advantages of the oral contraceptive pill is the reduction of arthritis in pill users. Some patients report relief of symptoms when on the oral contraceptive pill, and also during pregnancy, when circulating hormone levels are high.

Prolapse and laxness of the pelvic floor

There is a general reduction in muscle tone at the time of the menopause, and this of course is most noticeable in the pelvis. In addition, prolapse, which occurs after childbirth, becomes more evident. Prolapse – where the uterus descends into the vagina because its normal supports have weakened – may be helped by a regular exercise programme and by avoiding constipation.

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Exercises Women should contract their pelvic floor several times each day. Simply tighten and draw up the genital region. You can do this while waiting on the telephone or stopped at traffic lights. A simple bladder sphincter exercise is to stop and start while urinating. These exercises will help prevent trouble from starting and will also help in mild cases of laxness.

Surgery If the laxness is marked, surgery may be the only solution. You must weigh up the problems it causes you and decide for yourself whether it is bad enough to warrant a surgical operation.

Preventing urinary tract infection A simple method of helping to prevent urinary tract infection is to urinate immediately after intercourse. This action flushes out the urethra and is a preventive measure at any time of life, particularly when intercourse is first started.

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Oestrogen is given continuously, and progestogen is added every month for ten days. A bleed may occur in the week following the completion of the progestogen course. Any bleeding at any other time must be reported to the patients doctor.

Although some writers believe that the production of periods has a psychologically beneficial effect on the patient, it was initially found difficult to persuade our group. Few Australian women wish to return to menstrual periods; however, since the publicity on the increase of cancer of the uterus with long-term oestrogen therapy alone, this attitude has altered.

I emphasise that women can choose when to have the bleed. If they have a heavy social programme or family commitments one week, they may have their bleed before or after this. They take the progestogen pills at the time they wish and a period usually follows within a week. If no bleed occurs, it simply means there is not enough build-up in the lining of the uterus to come away.

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As an aid to prediction we hope to install a bone mineral analyser at Prince Henry’s Hospital. The forearm is placed in the machine, and an analysis is made which gives some idea of the calcium content of the forearm and to some degree reflects the general state of the bones. It will be a simple procedure for your doctor to refer you for this test so that your bones may be monitored against the fracture rate for your age group.

Many patients say to me ‘My symptoms are gone but what about my bones?’ Many more will in the future as this is becoming a well-documented problem that isn’t receiving the attention it deserves. In the United Kingdom last year it was calculated that the government spent £48m on orthopaedic beds for women with osteoporosis. Still higher figures exist in the United States.

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The cervix usually acts to hold the sac containing the foetus, until it is time to dilate and let it out (labour). If the cervix is weakened, it may open early and the pregnancy can, in effect, fall out. If this happens the dilation of the cervix is usually painless (unlike labour, in which much of the pain is from the cervix dilating).

If the cervix is prematurely dilating there may be spotting, or a sticky vaginal discharge, and possibly a watery discharge if the membranes of the sac rupture (‘waters breaking’).

Many women who have this condition are born with a tendency for a weakened cervix (congenital cervical incompetence). Others may have had damage to their cervix at some time which has affected its strength. Some examples of this include having had a very rapid labour and delivery, or delivery through a cervix which is not fully dilated. Another potential cause is damage to the cervix during a gynaecological procedure. The process of dilatation and curettage (D and C), used for abortions, gynaecological investigations, and after miscarriage, has long been thought to be a potential hazard for rhe cervix. More recent research has shown that with modem techniques, and experienced operators, the risk to the cervix from a routine procedure is minimal. Aggressive or rapid dilation, or dilation greater than that necessary for a twelve- to fourteen-week termination of pregnancy may carry more risk. Extensive cone biopsies of the cervix may increase the risk of cervical incompetence, but in most cases the amount of tissue taken does not interfere with the structure and function of the cervix.

If the problem is identified before a miscarriage has taken place, attempts may be made to treat a woman’s incompetent cervix. At between fourteen and twenty weeks, a non-dissolving stitch can be inserted into the cervix under general anaesthetic. This stitch can be cut when the pregnancy has progressed (after thirty-six weeks), and it is safer to go into labour.

Another, or additional, treatment is rest in bed, so that gravity has less of an effect on the contents of the uterus.

Success rates in the treatment of incompetent cervices vary with individual circumstances, but have been quoted as between 40 and 90 per cent.

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Statistics on the long-term psychological effects of abortion are difficult to get, and very difficult to interpret, as theft are individual personalities, situations and reasons involved with each abortion. The opportunity to work through your options and feelings carefully before having an abortion can help to minimize or prevent problems later.

There is no ‘right’ way to react to having an abortion. A woman may have mixed feelings, even when she is certain that abortion was the right option for her. Feeling sad or emotionally fragile for a short while are common reactions, and does not mean a woman has done the wrong thing. The hormones associated with pregnancy are known to have effects on emotional reactions, and may be playing a part.

For most women, having an abortion does not interfere with living a normal life, or with normal fertility.

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