Monique Rainford

Dear Dr. Rainford,

My questions are, 'Are there bleeding fibroids?' and 'Can they be flushed out with medication?' I did a pelvic ultrasound two weeks ago and was told that I have some very, very tiny fibroids. I am spotting and was given medication. I did a Pap smear in March and it was ok. I did another Pap smear last November. Am I following the correct procedure and what do you think?

Dear Reader,

Fibroids can cause bleeding or spotting between periods. If a fibroid is located in the lining of the uterus (submucosal fibroid) bleeding can occur if there are ulcerations over the fibroid. However, fibroids can cause abnormal bleeding regardless of their location; the exact reasons are unknown. Fibroids cannot be flushed out with medication but certain medications can cause them to shrink. However, when these medications are stopped, the fibroids usually grow back.

Abnormal results on your Pap smear can be a cause of abnormal bleeding. Depending on your age, your doctor may decide to do further testing of your womb such as an ultrasound which injects fluid in the lining of your womb to examine it more closely or a biopsy or sampling of the tissue in the lining of the womb. I recommend that you continue to visit your doctor until the problem is solved.

Terrible pain

Dear Dr. Rainford,

Ever since I've been growing up, I have been having terrible pains. Every month I have to see a doctor for injection to ease the pain. Can you tell me what I can do or what diet I need to be on. I did surgery in 1996 for fibroids and I understand that they came back. Awaiting a response.

Dear Reader,

You have a condition known as dysmenorrhoea which is the medical term for painful periods. Since you had it from a younger age it is possible that you initially had primary dysmenorrhoea in which the pelvic organs were normal. However, as you got older, fibroids may have contributed to your menstrual pain and this is known as secondary dysmenorrhoea.

In a European study, women who ate more green vegetables had fewer fibroids than women who ate more beef and ham. Therefore, I recommend that you consider adjusting your diet accordingly. Also, being obese increases the risk of fibroids, therefore, I suggest that you maintain a healthy normal weight.

Why not emobolisation?

Dear Dr. Rainford,

After reading your answer to a young woman with fibroids regarding embolisation, my question to you is why would you not recommend this procedure? With myomectomy, isn't there a possibility that the fibroids will grow back? (See full text of letter in the Letters section.)

Dear Reader,

Although a small but growing number of women achieve pregnancy after uterine artery embolisation (UAE), there is still insufficient information to recommend the procedure to those who desire future pregnancy. A study performed in the United Kingdom showed that the women who did become pregnant after the procedure had a higher risk of having a caesarean section, miscarriage, delivery before full term and abnormally heavy bleeding after delivery.

However, these women had other characteristics such as older age that may also have increased their risks. Therefore fibroids may grow back after a myomectomy, based on current information, I still recommend it rather than UAE for women who want children. Otherwise it appears to be a good treatment option for some women.