I was thinking over the weekend about the presidential race. I was talking to someone at work about how we don't feel that Obama has really reached out for our support and that stuck with me. Why do I feel this way and what would it take to change it.

I thought about all the news and commentary I've been reading, about how in some regards Obama and McCain's policy directions and positions aren't always that far apart. So I thought some more... what did I care about as a woman? What would make me feel more excited about Obama and his "pro-woman" agenda? Here's what I came up with:

Work with Congress to pass the late Stephanie Tubbs-Jones Fibroid Research and Education Act. This has been stalled out in committee for years and yet it is so needed. Fibroids affecting between 25-80% of all women (and their families), and a disproportionate amount of women of African-American descent. This would be great for women and it would also be a nice gesture in remembrance of Tubbs-Jones legacy.

Work to better support women who want to breastfeed
Breastfeeding and working is a hard deal, not impossible but surely challenging for the best of us. Greater flexibility in working arrangements, possibly thought family leave, could help more women be able to offer their children this best start in life. Since Obama says he's for preventative health care, this is the best preventative care option around. (see the Breastfeeding Promotion Act)

Provide mandatory access to optional supplementary insurance plans to cover infertility treatments
After trying so long for my own child, I was lucky enough that my particular condition (fibroids) fell within the purview of my health insurance coverage. Also, I was able to conceive on my own after a good stint of work with alternative care providers. Many couples aren't so lucky and for them assisted reproduction is the best path towards achieving a successful pregnancy yet most health insurance plans don't cover these treatments. The plans themselves would be optional and supplementary, sort of like how you can get a catastrophic plan in case of disability/dismemberment. Since insurance is currently handled on a state by state basis, federal plans would have to be put in place to incentivize the creation of these plans. See Family Building Act of 2007

Expand support for small businesses to offer childcare benefits
I looked into it for our business and there is a federal tax break for offering a childcare benefit but it wasn't that comprehensive. Perhaps the tax break is enough but additional support for how to structure the benefits could go a long way to helping more families out. (see Employer-Supported Child Care and Starting Early Starting Right Act)

How about increasing support for HeadStart programming?

Expanding surviving widows to claim a greater portion of their deceased husband social security?

I'm going to keep thinking of other things that might fall on my women's agenda. Add your ideas as well -- what can the government do to help you meet your priorities?

Fibroids and Endometriosis?

In response to Deb's question about endometriosis testing on my post about infant potty training, no, I haven't specifically had tests for endo. But I did have two HSGs and have been opened up twice -- once for my myo and once for the c-section and nothing was mentioned -- not even on my medical records. Some of my other online fibroid sisters have had endo and fibroids though -- so it is a possibility. In the book The Infertility Cure both conditions are dealt with in the same chapter -- so similar can their causes be.

I've had painful ovulations before, the first one that I recall was back in 1996 when I was just about doubled over in pain at work -- a stressful computer start-up -- and I ended up going to the emergency room just to make sure I didn't have appendicitis. Wanna know where that pain was? The same location as my fibroid showed up years later. I had an ultrasound at the time and it came back clean. After all the acupuncture I've had done I think that partially the pain comes from some form of blood stagnation in that area -- and too much stress will divert the blood flow from your reproductive organs so it it possible that its all related.

Since my c-section I've occassionally felt a few jabs of pain in that area -- which is where Twyla, my new big fibroid is located. It's not too bad so I'm hopeful that she's not going to be an issue.

Lately I've thought, as people respond in surprise when my partner and I mention that we're planning on starting to TTC again later this year, that another factor besides it taking so long and the miscarriages, that also the fibroids I have are another consideration. One good thing for the moment now though is that breastfeeding suppresses estrogen production so it is possible that my fibroids will shrink substantially until my period shows up again. The reduction in estrogen also causes me to have dry skin, so dry I have hives on my upper arms, and it also dries out the girly bits so that sex is a bit uncomfortable. There's no winning.

What's a Castor Oil Pack?

A castor oil pack is a piece of cloth soaked in castor oil that you heat up and place on your belly then cover it with a piece of plastic and then put a heating pad or hot water bottle on top of that. You usually do it for 15-20 minutes once a day, at night before bed most typically. It is supposed to improve blood circulation and increase the white blood cell count locally.

What it definately will do is get you to slow down and relax. Disadvantages are that you end up with an oily belly right before bed and heating it up if you don't have a microwave (which I don't) can be a pain.

My naturopath had me do castor oil packs for a while. I found them to be a pain and they didn't seem to change anything -- my fibroid didn't get smaller, my cycles didn't get more normal, my basel temps stayed where they were -- I'm skeptical.

The book Sex, Lies and the Truth About Uterine Fibroids mentions castor oil packs, and that there aren't any studies showing that they work. There are studies showing they increase white blood cells in the skin area that is treated but nothing more than that. Evidently it is a traditional treatment used in many cultures.

My acu asked me to do them this Spring and I wasn't into it -- I just would use my hot water bottle to apply heat directly to my lower abdomen to keep the blood flow active in the area and left it at that.

Extended birth control use issues that could affect fertility and health

There was a discussion on Ovusoft so I looked up some references based on things that I had read here and there. Studies supposedly show that upwards of 80% of women will return to "normal" cycles upon discontinuation of the Pill. It really does matter how they did those studies though, as cycles before and after hormonal contraceptive use might differ wildly so normal isn't really as normal as you might have been if you hadn't used the Pill.

I never used the Pill, it wasn't anything other than a philosophical position -- it didn't seem right to me to introduce prolonged hormonal manipulation to my body just for the sake of more assurance against unwanted pregnancy. I was careful in my selection of partners, there were few as well that I crossed that line of intimacy with, I was willing to be diligent in my use of condoms and I knew I was open to dealing with any unfortunate outcomes of my approach. Still I ended up with fibroids and heavy period and anemia and who knows if BCPs might not have carved out a different reality for me. My sister on the other hand used all sorts of birth control including Depo and she ended up with 6 fibroids combined to the size of a grapefruit (the size mine was when it was removed after I became pregnant) and that was a good 6-7 years ahead of when I got to that point when you factor in our age difference.

Here are some mentions of the pill that might interest you.

After the pill, the copper IUD, superovulation-stimulating drugs (Clomid, etc.) or previous childbirth, the copper may be over-high and the zinc, and possibly also magnesium and manganese, may be too low. It is vital to adjust this before embarking on the next pregnancy, to avoid the risk of miscarriage or premature birth.
From: Foresight, Preparing for Pregnancy

14 women with a history of taking a combined oral contraceptive (norethynodrel plus mestranol) were studied and were found to have vaginal candidosis which commenced after an average period of 9 months from start of contraceptive therapy. 4 sexual contacts (men) of those women taking the pill were also discovered to have vaginal candidosis; they had presented with candidal balanoposthitis. 4 other men had clinical manifestations suggestive of balanoposthitis caused by hypersensitivity to the candidosis of their sexual partners. Nystatin was a satisfactory treatment in most cases; however, 2 women had to stop using the pill because of frequent relapses of yeast infections.

From: Candida albicans and the contraceptive pill.

Nutrients that can be reduced by the use of Oral Contraceptives (OC):

Folic Acid (Folate). Birth control pills tend to cause folic acid depletion and increase the risk of cervical dysplasia and vascular thrombosis, stroke, and possibly megaloblastic anemia.

B-vitamins. As several B-vitamins are affected negatively by birth control pill use, a B-complex supplement is suggested, especially vitamin B6 if depression is present.

Vitamin C (Ascorbic Acid). Levels are lowered by OC use which interferes with the metabolism of ascorbic acid. Insufficient intake of ascorbate is also associated with an increased risk of cervical dysplasia.

Selenium. Selenium absorption may be reduced. Selenium is an important nutrient for cancer prevention.

From: Birth Control Pill Issues

Also since the affect of the pill cause changes in the hypothalmus-pituitary-ovarian axis isn't it possible that prolonged use actually can cause some potential atrophy of this system in how it is normally meant to function? Using a contrasting situation, if you shot up someone who was healthy with insulin for years, even at a low dose, wouldn't it affect the function of the pancreas long-term? (]more about how the Pill works here)

The pill may cause permant sex drive loss

BOSTON, May 26 (UPI) -- Women who take contraceptive pills may suffer reduced sex drive for the rest of their lives, University of Boston researchers say.

It has been long known that oral contraceptives lower levels of testosterone, and thus sex drive, and increase levels of sex hormone binding globulin, or SHBG.

While it was thought that the pill's adverse effects could be reversed, the University of Boston research shows they may be permanent, the London Daily Mail reported Thursday...

Women taking the pill had SHBG levels that were seven times higher than women who had never taken oral contraceptives.

Women who quit taking the pill still registered SHBG levels that were four times as great as non-contraceptive users.

Hysterosalpingogram (HSG)

An HSG is a hysterosalpingogram, an x-ray of the interior space of the uterus and fallopian tubes using a contrast dye. It can be used to look for uterine abnormalities and adhesions, determine how much infringement fibroids are making into the interior of the uterus (to some degree), and identify if your tubes are open (referred to by docs as "patent"). Some docs do it standard a few months after a myomectomy, mine did not. The dye does have what my RE referred to as a "voodoo effect", where there is some slight increase in pregnancies after the procedure, speculated to be caused by the dye perhaps causing the little hairs (cilia) in the tubes to function better.

It can be done by your doctor in a radiology facility or by a radiologist -- mine was done by my RE and she was a lot more comfortable with the procedure than the radiologist I could tell.

They insert a catheter to insert the contrast dye through your cervix; a good cough evidently will open up the cervix so it is less painful. The dye feels like pressure going in, and it can cause a drop in blood pressure. It's generally uncomfortable and causes some cramping. My RE tried to manipulate my uterus for the xray shots using the special speculum and I found that to be very uncomfortable with my 6-7cm (at the time) fibroid.

Here is an link detailing Guidelines for the Performance of HSG - it advises taking 1000 mg of NSAIDs prior to the procedure.

Rarely it can cause infection, and some people are allergic to the contrast medium. Some docs give antibiotics preventatively ahead of time, they also might have you take a heavy dose of Tylenol an hour beforehand.

Here are some links to sites showing images from HSGs:

HSG Link 1

HSG Link 2
HSG Link 3

I should go pick up my x-ray film from the University of Washington Radiology Department, where I brought it when I consulted about UAE a couple years ago. I'd like to scan it and and post it here so you can see what my distorted uterus looked like.

About Degenerated or Infected Fibroids

Here are some links I've found which deal with fibroid degeneration or the very rare condition, pyomyoma, where fibroids can become infected.

DEGENERATION
Unusual Appearances of Uterine Leiomyomas: MR Imaging Findings and Their Histopathologic Backgrounds
Lots of images of fibroids with degeneration and other changes

An Unsuspected Case of a Degenerating Leiomyoma
requires free registration

Photo of a fibroid that has undergone degenerative change

Thrombophlebitis (aka Deep Vein Thrombosis)
Can be associated with red degeneration; general risk to women with fibroids and possible post surgery complication

PYOMYOMA - INFECTED FIBROIDS

Streptococcus agalactiae Endocarditis and Giant Pyomyoma Simulating Ovarian Cancer
Medical article looking at one case in particular and reviewing other cases since 1945


Uterine Pyomyoma as a Complication of Pregnancy in an Intravenous Drug User
JOSEPH A. PRAHLOW, MD, JAMES O. CAPPELLARI, MD, and SCOTT A. WASHBURN, MD, Winston-Salem, NC (1996)

To someone who is wondering whether or not to have a myo

Lots of women get pg with fibroids in place, it is an elective procedure however so in part you get to decide when it is right for you. Some considerations I've noted about when it is a good time to have fibroid surgery:

• you feel like you have exhausted all other possible treatment options
  
• you are feeling pain and discomfort, even some of the time. This can include back pain, pelvic pain, leg pain, etc.
  
• you are having bleeding problems (really heavy periods, or periods that don't seem to stop -- this can lead to problems with anemia which can impair fertility and put you at risk for other health problems such as clotting)
  
• you have had trouble conceiving or have had miscarriage/s
  
• you are wanting to try hormonal fertility treatments and your fibroids are already a good size
  
• you are having difficulty urinating or are having to pee all the time or you are developing urinary tract infections
  
• you can't stand the thought of having fibroids inside of you and want to get rid of them
  
• you fibroids are compromising the interior space of the uterus
  

Since you are already dealing with TTC with one tube I can see that it doesn't feel like a straight shot decision for you at all. There is a risk of adhesions after any abdominal surgery, but whether or not these will cause problems is another question.

The surgery is a big deal in that it can be quite invasive and most of us haven't had that much physical trauma before. It is also one that you will recover from quickly. An abdominal myo is very similar to a c-section and loads of women have those operations every day.

Have you read What Your Doctor May Not Tell You About Fibroids yet? It is a super book that really helped me to feel empowered about my body and my fibroids. It describes in detail about the various procedure options and includes info about fertility success rates post-op.

So, over the past couple of years I noted that a couple times a year I was in a lot of pain around ovulation. At first I thought it was my fibroid causing it, actually it was partially due to this pain that my fibroid was diagnosed. It it focalized on the right side and if I press on the area it feels worse. In the past I've noted that ibuprofen wouldn't help the pain at all.

When I had u/s to check it out after the fact and always they have seen that I have ovulated on the opposite side (which was opposite from my fibroid as well) and that there was some fluid in my cul de sac consistent with ovulation, but nothing else.

Last night I was in so much pain that I couldn't sleep and I finally broke down and took some percocet I had left over from my surgery in November. I fell asleep around 3am. This morning I still have dull pain, but it is a lot less intense then last night. I put a call into the REs office for advisement, it seems like I should at least ask since it was painful enough to keep me up.

Part of me wonders if it was an ovarian cyst rupturing and not just a regular follicle. I didn't have such a great ovulation last cycle -- hardly any EWCM, and dry generally -- I wonder if I didn't actually ovulate or else just had a cyst. Still, the u/s when I've had this pain before showed just a single ruptured follicle on the other side.

Fibroid Research Study

I sent my blood sample in to this study last summer; my sister and I are both doing it. If you know any sisters with fibroids please tell them about the study.

What: The Center for Uterine Fibroids is currently enrolling families in the "Finding Genes for Fibroids" study. This is a clinical research study, aimed at identifying the causes of uterine fibroids. This study has been reviewed and approved by the Human Research Committee at Brigham and Women's Hospital.

Why: We hope that information gained from the study will provide future generations of women with non-surgical treatment options. This is not a treatment study. We hope that your generous efforts will make a meaningful difference in the future treatment of fibroids.

Who: In order to be eligible for this study, your family must have at least two women who are full sisters and have uterine fibroids. Sisters with a past history of uterine fibroids are also eligible. The sisters may be you and your sister, your mother and her sister, two cousins who are sisters, or any other sisters in your family. Once your family meets this minimum requirement, we encourage other family members with or without fibroids to participate. This includes men. The more family members who take part, the more powerful our data will be.

How: You can participate from anywhere in the world; all study procedures are completed through the mail at no cost to you or your family. The study involves filling out a consent form and a survey and sending us a small one-time blood sample. The consent form discusses the risks and benefits of the study. We ask you to read and sign the consent form and fill out a medical records release form. We request only medical records having to do with fibroid diagnosis and treatment. The survey can take from 15 to 45 minutes to complete, depending upon your medical history. Once these forms are sent back, we send all participants a blood sample kit. The kit contains directions about how to get your blood sample drawn and reimbursement procedures. Once this sample is returned to us, your participation in the study is complete.

Anemia & Iron Rich Foods

Here are some links to pages with information about iron rich foods and some others about anemia generally. B vitamins are also important in healty blood production so make sure you eat a balanced diet with enough B vitamins.

Rules about iron include - take it with vitamin C, don't overcook foods (steaming is best), antacids, calcium (dairy products) and caffeine all block absorption so definately don't take at the same time. Iron from red meat and liver (heme iron) is more easily absorbed than from plant sources (non-heme) though taking non-heme foods at the same time as heme foods can improve iron absorption.

Here's a great link about iron absorption

Also, since some of the iron supplements are hard on people's stomachs I though I would share what I'm taking which hasn't caused me any difficulty (although if you are severely anemic this probably isn't strong enough) -- Nutrition Now Chewable Iron (25 mg of elemental iron per tab -- though they recently changed their formulation to ferric pyrophosphate and I don't recommend it anymore. Others I've met online have had good luck with Slow FE or Floradix.

"Which forms of supplemental iron are best?
All iron supplements are not the same. Ferrous iron (e.g. ferrous sulfate) is much better absorbed than ferric iron (e.g. ferric citrate).13 14 The most common form of iron supplement is ferrous sulfate, but it is known to produce intestinal side effects (such as constipation, nausea, and bloating) in many users. Some forms of ferrous sulfate are enteric-coated to delay tablet dissolving and prevent some side effects,16 but enteric-coated iron may not absorb as well as iron from standard supplements. Other forms of iron supplements, such as ferrous fumarate, ferrous gluconate, heme iron concentrate, and iron glycine amino acid chelate are readily absorbed and less likely to cause intestinal side effects."
From: Vitacost's Iron Information page


What foods contain high amounts of iron?

Eat Iron-Rich Foods

Iron: Vegan Society

Menorrhagia Diet

Iron

How much iron do certain foods contain?

Iron deficiency anemia in pregnancy: a short account

Iron Deficiency Anemia

Iron Balance - explains iron intake, losses and affects of iron
deficiency in women

Anemia and Fatigue

Iron Deficiency

and kind of unrelated but interesting information:

Workshop on Maintaining Iron Balance in Women Blood Donors of Child-Bearing Age

Why we have bleeding problems... Links/References

At the beginning of the year I posted some links about dysfunctional uterine bleeding (DUB) and one list member (on the fibroid group) asked if I would look into why women tend to have flooding first thing in the morning. Most of you probably know this phenomena whether or not you have DUB -- its when you are sound asleep and suddenly awaken because a big gush of blood is coming out all at once and you run to the bathroom if you can though sometimes you wake up too late and the sheets, your underwear and your nightclothes all need washing.

I wish I had a hematologist to confer with but doctors tend to keep to themselves or just don't overlap with my software oriented social network. I've got a few references here some mechanical and some physiological to causes for bleeding. Since excess estrogen/low progesterone is one theory of part of the cause of fibroids it is interesting to see that the same conditions also set the stage for bleeding problems. Also, I couldn't find references to early morning menstrual bleeding but there was a reference to there being early morning changes in the blood which might be related, at least in action.

"Most very heavy menstrual bleeding does not mean that a woman is shedding substantially more endometrium. The endometrial slough is determined by the size of the uterus and the hormonally induced endometrial thickness. The uterus has large blood vessels that come through the myometrium to feed and supply the endometrium. Really heavy bleeding occurs when the uterine muscle cannot do its job of contracting around these vessels. This is important because after the endometrium is passed out, the basilis layer may be very thin, which could expose the raw muscle surface. This means that the large
vessels can pump blood directly into the uterine cavity if the muscle cannot contract well."
http://www.centerforendo.com/news/adenomyosis/adenomyosis.htm

"what frequently happens when excessive amounts of estrogen are secreted. Parts of the endometrium outgrow their blood supply and are discarded but not simultaneously. While the one part recovers another part is discarded and the bleeding continue for prolonged periods. In the illustrations the bleeding might decrease while the one area heals before the the other area starts bleeding."

"Fibroids usually cause excessive cyclic bleeding. The amount of blood loss is increased and /or the duration of the bleeding is increased. The mechanism is probably due to enlargement of the womb, thus increasing the surface area of the endometrium."
http://www.femalehealthmadesimple.com/FileTwelveFinal.html

"The plasminogen (fibrinolytic) system (Figure 1 ) comprises an inactive proenzyme, plasminogen, that can be converted to the active enzyme, plasmin, that degrades fibrin and that activates matrix metalloproteinases (MMPs), which in turn degrade extracellular matrix(ECM)"
"There is a clear correlation between the circadian variation in the time of onset of myocardial infarction, with the highest incidence at about 8 a.m., and the circadian rhythm of plasma PAI-1 activity, which is also highest early in the morning."
http://www.asheducationbook.org/cgi/content/full/2001/1/1

"PGE2 --> vasodilation; PGF2a --> vasoconstriction; progesterone is necessary to increase ararchidonic acid, the precursor to PGF2a. With decreased progesterone there is a decreased PGF2a/PGE2 ratio. Since vasoconstriction is promoted by PGF2a, which is less abundant due to the decrease in progesterone, vasodilation results thereby promoting AUB [Abnormal Uterine Bleeding]"
http://www.unmc.edu/Olson/PowerPoint/36 (no longer available)

4+ Weeks Post Myo

Another report on how I'm recovering -- hopefully this helps people who are considering the procedure.

I retured to work part-time one week ago. I got tired and sore by the afternoon and was sure to go home. During the rest of the week I noticed that day by day I had more stamina and less pain -- it seems that the pain picks up if my body needs a rest. I was able to work almost a full day on Friday without any problem and then my uterus where I had the incision started aching so I headed home. In contrast, my first shopping trip 8 days post-op I felt lightheaded and really tired after a couple hours out of the house. My second shopping trip 18 days post op I was out for a few hours on my own and got really tired and flushed feeling -- that's when you know you need to head home.

Saturday I took it easy, just doing light housework and cooking plus lots of knitting. Yesterday I went shopping for several hours and it was only after I tried on a bunch of different pants (after having been out for some time) that I started feeling achy. I handed over the items I was going to purchase to my partner to carry and then went home. I was feeling a little tired but I wanted to get a tree for Christmas so I drove out to do that and just had the staff carry and load it for me in to the car. I took a rest when I got home and finished stringing popcorn for the tree and then after making dinner I decorated the tree and vacuumed downstairs (I had my partner bring the vacuum downstairs for me).

Every day I'm feeling more and more myself. The pain from the adhesions behind my incision in my skin seem to be breaking up a little bit and I think my skin might be adapting/growing to that situation as well. I still haven't had my period but hopefully this week. When I had my d&c for my miscarriage in July it took 50 days to get my period, I think my body tends to take it slowly and get everything back in alignment before it continues.

I had sex once so far and it wasn't bad at all -- we did it spooning, on our sides which takes all pressure off of my belly. The only reason we've only had the one go is because our sleep schedules are different so I'm tired when he's just getting interested (sound familiar anyone?).

14+ days post op

So I had my post-op visit yesterday morning and everything was good, she said I looked great. She said removing my retained POC was very difficult because of the fibroid and that there was no way for my uterus to expel the tissue on its own based on how the fibroid was positioned filling the interior of the uterus. So my prospects for a normal vaginal delivery were probably slim to none since my uterus couldn't contract well, or at least I would have had a complicated delivery. I was sooooo uncomfortable when I was pg with the rapid fibroid growth and the pregnancy having to grow off to the side because that was the only way my uterus would move, next time should be a lot better.

My doc also said that my uterus will be enlarged for a while, shrinking back some but that it would never be the size of a normal unpregnant uterus since the fibroid made the muscle wall have to grow larger. Maybe I'll be extra fertile now though, the interior of my uterus will be one vast space with lots of room for an embryo to settle in.

She said I could remove the steri strips in the shower or bath, I just pulled them off carefully when they were dry, the adhesive was already starting to go. Uncovering the incision though made it burn more, I think this is partly due to my nerves regrowing right now --
they have to cut through some in the skin there and they may or may
not grow back completely. I had to take the 600mg ibuprofen and after an hour that wasn't helping so I took a percocet and it really helped take the edge off the pain. My father said he had that same burning sensation as he healed from his triple by-pass a few years ago. The incision looks great and I don't think that it will show that much at all in a few months.



She agreed that starting trying to conceive (TTC) again in February
sounded like a good idea and that we should try for a few months on
our own before going back for any more fertility consultations. After having way too much medical attention over the past 6 months (due mostly to the pregnancy/miscarriage) and way, way too many blood draws for my liking, now I'm in a holding pattern and it feels so strange to be told that I'm healthy and back on my own. Not that I liked being not well but you do sort of get adapted to fitting in the medical care when things go wrong. Yeah to be healthy again though!

Oh and I guess it was around 11 days post op that I started to feel
more myself and I've been less fatigued and able to do more around
the house, tidying up, cooking, light cleaning, etc.

Fibroids and pregnancy

Welcome to the club. I've met some women here who have successfully carried babies to term with fibroids in place, with some fibroid growth. I've also heard women report that they have had excrutiating pain from degenerating fibroids and the babies were fine but the pregnancy was rough on the mother. There are also a lot of women who have had miscarriages, which may or many not have to do with their fibroids -- myself included.

Doctors don't really know which fibroids will cause problems and which ones won't -- at least not beyond just normal clinical experience, the studies just haven't been done yet on a lot of topics. Some tiny fibroids can become really large during pregnancy. Large fibroids might experience some growth but not cause too many problems, or vice versas. I learned of one woman recently who had her fibroid removed during a c-section to deliver her baby -- the fibroids and the baby weighed the same. What you want to find out is where is/are the fibroid/s, what type are they (submucosal, intramural, subserosal)

The Babycenter.com fibroid message board has lots of posts from women who are trying to conceive with fibroids in place or post myomectomy (surgery to remove fibroids), as well as women having to deal with fibroids during their pregnancies.

Just because you have fibroids doesn't mean that you can't conceive and carry a healthy child to term, but it can make the journey a little less smooth.

I've posted a bunch of interesting articles about fibroids and fertility in the Links area of the NUFF uterinefibroids message group. Do check them out (subscription required).

Go out to the bookstore and buy: What Your Doctor May Not Tell You About Uterine Fibroids, and Sex, Lies and the Truth About Uterine Fibroids.

Oh, and I would seek the assistance of an RE (reproductive endocrinologist) if you have a diagnosis of uterine fibroids. They are more knowledgeable about hormone imbalances and specialize in fertility issues -- they are ob/gyns with advanced training -- and if you haven't had any luck with well-timed intercourse after a year the you should go for a consult anyway. They might try to push you for surgery and fertility drugs but it is up to you what you want to have done.

What happens when you are having a myo

I'm on bed rest one week and two days post abdominal myo and I'm feeling great. Tired but healing quickly. Since you were curious about the before and after...

Pre-op consult -- they take your blood pressure, weight, check your blood to make sure you aren't anemic and get your blood type if they don't have it on record. You meet with your doc and ask last minute questions and sign a few forms. Sometime you will get to meet with the anesthesiologist at this time but I didn't. They give you instructions on when to stop eating and drinking prior to surgery.

Day of surgery -- check in 2 hours beforehand. I brought knitting to keep my hands busy and mind calm. The hospital seems to make you keep signing forms that say the same thing (whatever). My surgery was delayed by more than an hour so we went home for an hour and I did some last minute housecleaning.

When it is your turn they take you into an area with a gurney and give you a hospital gown to change into. My partner was allowed to be with me until they were ready to take me into the operating room (my doc said -- be sure to ask yours ahead of time about this). They hook you up to an IV and the anesthesiologist asks you questions about your previous experiences with anaesthesia. You have the option of asking for an epidural with sedation if you prefer, it is up to you and the anesthesiologist. I did the general and it was fine. They take your bag and you say goodbye and then they wheel you in to a freezing cold room. They hook you up to a blood pressure cuff and the oxygen monitor (little finger cuff) and then put a blanket over you. The anesthesiologist puts a mask on your face and tells you to breathe in oxygen and the next thing you know you are waking up in recovery.

They keep taking your blood pressure alot post-op and you are groggy and have a hard time opening your eyes. You are hooked up to a PCA, where you are able to dose yourself with painkillers as needed -- don't hold back because staying on top of the pain at first will help you a lot. After about an hour they wheel you to your room. They put some pressure stocking on your legs and some cuffs that compress/decompress automatically to help prevent blood clots. My wound was covered with a bandage so I couldn't see the incision -- thankfully. I had a catheter in for not even a full day, but know that the first pee can be really difficult. The nurse gave me warm water to run over my vagina while on the toilet and that helped get things moving. I recommend drinking unsweetened grape or cranberry juice for a week afterwards to help ward off a urinary tract infection -- it helps prevent bacteria from adhering to the lining of your bladder, etc.

They will have you up and walking less than a day after surgery, take it slow and roll onto your side slightly, then drop your legs off the bed and use those side muscles to lift you up. The first few times you get up will be very awkward and painful. Stay on top of the pain meds and breathe a lot and you will do fine. The pain isn't excruciating, I ranked the worst at 5 on a scale of 1-10 but it was mostly around 3-4.

And then do as I've been advised from other post myo gals -- take it easy and don't push yourself. Even though my incision looks great I can't see my uterus and it has a lot more healing to do than my skin.

Extreme Makeover: Uterus Edition

"We converted this cramped two bedroom bungalow into a special open floor layout and removed some earlier renovations which were gettingin the way…"

So, I'm home from the hospital as of yesterday afternoon and I'm well on my way to a full recovery. I'm really tired still and reading is kind of hard, I just start falling asleep so I'm going to make this post and then you'll probably hear more from me later in the week.

My entire surgical team was comprised of women. From the two REs and the anesthesiologist to the nursing team – how very cool to know that competent women were working hard to help heal me. I wore my purple fuzzy socks of courage and even got compliments on them from the nurses. I opted for the general anesthesia and other than a sore throat on Saturday it was totally fine.

It took as long to remove the remaining tissue from my miscarriage as it did to remove my fibroid, but already my bleeding has slowed. I had been bleeding for the 4 weeks prior to my surgery and was a little anemic as a result. They didn't need to give me a transfusion and they commented on how little blood was lost – I went for an acupuncture treatment the day before and that can help lessen blood loss. One of the REs said she was a firm believer in acupuncture and wasn't surprised that it would help out.

The fibroid made it impossible to use the hysteroscope to view the retained tissue but they believe they got it all out of there. My fibroid was described as being the size of a grapefruit, and was removed via a single incision about 3 or so inches long. It was growing right up against the endometrium, but it was not engaged withthe endometrium – what a blessing. So, while they had to cut all the way through the muscle wall to get it out there was no disturbance of the interior of my uterus so I've got the most surface area possible to help catch fertilized eggs.

Over the course of the two procedures my bladder was manipulated and traumatized quite a bit. Between that and the catheter the most difficult part so far has been trying to urinate; I have to sit for along time and try to relax and let got of any part I can think of. I also had blood tinged urine but the doctors said it was as a resultof the trauma. I'm drinking cranberry juice and lots of water and am under strict orders to urinate every 2 hours. They weren't sure if my bladder was enlarged from the fibroid or now, or if I'm just one of those women who can't empty her bladder completely (it happens they say) but we sure as heck don't want me to have a bladder infection so I'm going to stay on top of it.

My incision on my swollen belly is a good 5 inches long, I imagine that it will decrease over time. The gum, the walking, the sleeping mask, ear plugs, robe, slippers, granny knickers and my own pads all came in handy. The doctors and nursing staff were amazed at how well prepared I was for the hospital – I gave the fibroid ladies all the credit. They are truly the best group of women on the web.

My myomectomy scar - Day 3


Oh, and the baby making department… my RE said that the way the fibroid was positioned that she didn't think that I would have beenable to carry to term even if we didn't have a blighted ovum and that she expected that I would have continued having miscarriages. She thinks we have a great chance now and said we could try as soon as two months from now, though I think we will wait until February is over.

My partner is exhausted; I think the emotional stress of the weekend has gotten to him. He held me in the hallway last night and hugged me and said he felt so relieved that it was all done now. Poor guy; he was nice and helped watch over me the first hours after my surgery on Friday, massaging my feet and making sure they got me situated into a good room.

So, I'm feeling all right and my abs aren't too sore – they didn't clamp me, just pushed and pulled them a bit. Other than the incision site being sore and my uterus as well in the two spots they worked the rest of my body feels fine – I'm just incredible tired.

I can't believe that I'm through with the worst of it and now I've just got to heal. No regrets on my part for delaying the surgery, I know it was the right thing for me. Thank you for your prayers on Friday – I felt like I was in a warm cloud, so relaxed and comforted the entire time.

[See also: Preparing for surgery posts]

Fibroid leaving on a metal tray (sung to the tune of Leaving on an Airplane)

So my bag is packed, I'm ready to go
I'm sitting here, making another post
Already I'm looking forward to the change
So cut me and dissect me
Tell me that how much better I'll be
Help me get back on the fertility road

My fibroid is leaving on a metal tray
Don't expect to see it ever again
Oh 'Roid its time to go.

So, anyway... Friday is my big day, I've got gum and granny knickers, a maternity belt, arnice pellets, purple socks of courage etc., etc. -- all courtesy of the generous sharing of info by the fibroid ladies on the NUFF group. I'm feeling pretty relaxed and this will all be over and I'll be on my way to recovery within the next 24 hours.

I don't need to take phosphosoda or any laxative so that is good. And my doc thinks the d&C and myo should only take 2 hours. My RE will be assisted by another RE, a fellow, so I'm in good hands. I check in at the hospital at 1:30 tomorrow and the surgery is scheduled for 3:30.

Please send good thoughts and prayers if you can tomorrow.

Contribute $ to fibroid research/ what do we need studied?

So what if you want to help give money to support firbroid research? Here are some ideas based on my research.

Brigham and Women's Hospital Fibroid Research Center is a possibility, they are doing the sister study and many others -- exciting stuff. I gave money last year to a specific researcher at the University of Toronto, Galene Pron, Ph.D., who is studying fibroid embolization and fertility.

I did a search on Yahoo of the words "fibroid research" and got some interesting results as well. You also can search through the PubMed site or anywhere online and see what research has been done and contact the researchers directly if they provide email addresses.

Also the March of Dimes is doing a push again premature delivery of infants but they aren't talking about fibroids. We might be able to help drive the point home by sending comments and cash at them.

Oh, by the way, this reminds me that I was in touch with the Women's Clinical Research Center here in Seattle and suggested some study ideas to them. They evidently are only doing pharmaceutical industry funded studies which irked me. Here is a list of the things I sent to them:

What happens to fibroids after menopause? Anecdotally they are supposed to shrink but there is no research evidence to refer to.

I would love to see a study that would help get women in for a routine ultrasound at age 25 and then 30-32 to help catch fibroids early since pelvic exams are often useless.

How about diet/dietary changes and how that affects growth? I think that stress and restrictive eating contributed to my fibroid growth.

What hormonal profiles and body types are linked with fibroid growth.

What about pain from fibroids – I have it but it isn't my fibroid that is hurting me, it is adjacent. I'd love to see imaging that would demonstrate what exactly is hurting. Lots of doctors dismiss this type of pain.

What about a comparison of waiting until menopause for symptoms to recede versus having a hysterectomy on quality of life.

In reading this study report, Myomectomy: a retrospective study to examine reproductive performance before and after surgery (http://humrep.oupjournals.org/cgi/content/full/14/7/1735),
I noted the following mentions of incomplete research
on the topic:

"Many reports have considered intramural fibroids and subserosal fibroids as a single group, and little attempt has been made to analyse the two groups separately. However, it is possible that the impact of intramural fibroids on reproductive outcome is quite different to that of subserosal fibroids."

"few studies have considered the reproductive performance prior to myomectomy, including the presence of infertility and miscarriage, and hence have not examined how myomectomy alters the reproductive performance."

"there are no prospective data to suggest whether or not intramural or subserosal fibroids increase the rate of pregnancy loss, and to what extent they are the cause of recurrent miscarriage"

"The value of myomectomy for subserosal fibroid is a particularly controversial issue. Our series included 10 cases whose outcome appeared encouraging (conception rate, 80%). However, its effect upon the rate of pregnancy loss requires a much larger observational or randomized control study."

"In our study the reproductive outcomes before and after myomectomy were compared and the subjects did not undergo myomectomy as part of a prospective randomized controlled trial. So far, no such trial has examined reproductive outcome following myomectomy. Until a multicentre study has been carried out, the only available, retrospective, data suggest that myomectomy may improve reproductive outcome."


As a patient I have been told, though I have been unable to find research that backs up these assertions, that:

* c-section will be required post myomectomy

* doctor would be unwilling to work with me as a fertility patient unless I have a myomectomy

Between a fibroid and a hard place

I've been on this long journey over the past 2 1/2 years. I went from not being ready to get pregnant, panicked about the thought of it, to where I am today which is still recovering emotionally from the loss of my first pregnancy.

Along the way it hasn't been easy, I found out I have a large tumor in my uterus which is called a fibroid. It is benign but they don't really go away on their own. It may be compromising my fertility but the only treatment offered to me was to have major abdominal surgery to have it out which could cause pelvic adhesions which could really compromise my fertility. I'm damned if I do and I'm damned if I don't (I'm beginning to notice that theme in my life...hmmmm...)

My fibroid and I are having our second anniversary this week since we first met. Maybe I'll bake a cake. I have not named my fibroid though I know women who have. And I only have the one, I'm monogamous when it comes to uterine fibroids.

At any rate I've done a lot of research into male and female fertility, hormones, supplements, diet, lifestyle, and a ton about fibroids and other gynecological conditions and I'd like to share with you what I have learned. I do think there is more than one way to skin this cat and I hope you find my research worthwhile.

(This was my very first post here.)

Other Causes of Pelvic Pain Besides Fibroid Degeneration

A common complain of women with fibroids is abdominal Pain. This pelvic pain can come from from fibroid degeneration, when the fibroid outgrows its blood supply and dies, but that's fairly rare and there are other possible causes of pelvic pain including (an incomplete list):

Appendicitis

Constipation

Adenomyosis -- endometrial tissue grows into the wall of the uterus and can form pockets that bleed each month

Endometriosis -- endometrial tissue grows on other pelvic structures outside of the interior of the uterus and swell and bleed with the hormones produced as a part of your menstrual cycle

Ovarian Cysts -- mature follicle that does not rupture and can grow pretty large, if they rupture they can be quite painful. Some cysts are normal and most of the time they are just reabsorbed. There are other forms of cyst which require medical intervention such as dermoid cysts, endometrioma, and sometimes chocolate cysts.

Ovulation -- mittelshmerz is pain that is felt around ovulation, perhaps from the release of the egg or perhaps from irritation from fluid released from the follicle

Pelvic Inflammatory Disease -- bacterial vaginosis, gonorrhea, and chlamidia can all cause infections in the pelvic cavity

Pelvic Adhesions from prior abdominal surgery or infection -- a d&c or IUD can sometime result in an infection as well

Fibroid Pressing on blood vessels or other abdominal structure

Cystitis -- bladder infection

Kidney infection

There is also a diagnosis in traditional chinese medicine/acupuncture called blood stagnation which can cause pelvic pain and is generally associated with gynecological conditions such as fibroids. Liver stagnation is usually part of the diagnosis as well, the liver being the major detox organ in the body and one that is also associated with emotion and grief in chinese medicine. I've found acupuncture to be helpful in managing my pelvic pain, as well as breathing exercises that promote movement in the abdomen. Here's a link about blood stagnation that you might find useful.

All About Blood Stagnation
http://www.acupuncture.com/Herbology/bloodstag.htm

If your doctor checks you out and you are still having problems then
you might consider the blood stagnation possibility.