Ovulation

Your eggs were formed before you were born, when you were in your mother's womb. They have been resting in your ovaries since then. A hormone, Follicle Stimulating Hormone (FSH) is produced in an organ called the Pituitary, a gland that sits at the base of your brain. FSH reaches the ovary through the circulation and recruits some of these eggs. Fluid forms round the chosen eggs and a small natural cyst forms called a Follicle. That follicle grows during the first 2 weeks of your cycle, reaching about 2 cm in diameter.



Periods

The uterus (womb) has a lining called the endometrium. It is a special layer that thickens to be ready for an embryo (fertilised egg) to implant. The fimbrial end of one of the fallopian tubes usually collects the egg, released from the ovary. Fertilisation occurs in the outer third of the tube and the embryo makes its way along the remaining distance to the uterus. If the embryo implants the hormones of pregnancy supports the continued to growth of the lining. If pregnancy does not occur, the lining peels off about two weeks after ovulation.

When the endometrium peels off and is shed, there is some bleeding from the raw surface. These are the constituents of the period (menstrual flow). A period therefore occurs two weeks after an ovulation that does not result in pregnancy. Periods on the pill are not due to ovulation.

Normal periods usually occur at regular predictable frequency. The cycle (the number of days from the beginning of one period to the beginning of the next) is usually 28 days but may vary by a few days.



Period Problems

Periods generally occur as a result of the hormone secretions associated with ovulation. So irregularities in the cycle are reflecting irregularities in ovulation. If the periods are heavy it may be due to a problem with the uterus (polyp, fibroid, adenomyosis). However it is quite likely that there is nothing to find on investigation. If you are worried then discuss your problem with your general practitioner. It may be that he/she can resolve the problem. However, if referral is required, the degree to which it requires investigation can be assessed when you come for consultation. When you come to see Mr Shaw it is useful if you have the dates on which your last few periods started.

The sorts of problems that may be found include irregularities in the surface of the uterus due to polyps or fibroids. If a particular problem is found, it can be explained to you in more detail. Treatment will of course depend on the cause but it is easy to think that hysterectomy is the only answer - it isn't in most cases. Drug treatments can be considered - and they aren't always hormone treatments. If surgery is required then it may be possible to undertake conservative treatment. A laser can be used to stop the roots of the endometrium regenerating. This Endometrial Laser Ablation technique enables day case surgery to be undertaken with 80% of patients' periods returning to normal with no cuts on the abdomen. When the investigation of your periods has been completed it may be that Endometrial Laser Ablation will be one of the choices offered to you. More information is available at that time.

Fibroids

A fibroid forms when some of the muscle cells in the womb start to multiply. This is a process that would naturally occur throughout the womb in response to the increasing hormones of pregnancy - after all it does have to expand to accommodate the baby. In the case of a fibroid a few cells are multiplying on their own in the absence of pregnancy. The blood supply of course is normal and has not increased as in pregnancy. So the expanding muscle soon loses its muscular state and regresses to low energy fibrous "gristle", a fibroid. It appears as a hard nodule on the uterus. More than 10% of women develop fibroids but most are like fibroid A in the diagram and cause no symptoms. Symptoms may result from the size or the position of the lump. So fibroid B might cause heavy periods with some spotting after the end of the period. Fibroid C could, if big enough, cause pressure on the bladder or bowel. So not all fibroids need to be treated. That is a decision you can make when you have discussed the choices of treatment.



The classic treatment of fibroids is hysterectomy as it removes the fibroids along with the source of future fibroids, the uterus.

However there may be some who wish to conserve the womb. In that case there may be a way of dealing with the fibroid and conserve the womb, albeit with a defect at the site of the removed fibroid. Myomectomy is the traditional way of conserving the womb. As a procedure that cuts into the muscle and excises the fibroid it can cause more bleeding than a hysterectomy. So it should not be taken on lightly. Myolysis is a keyhole surgery technique that applies heat with a diathermy or laser to the centre of the fibroid to kill the cells in that area. The fibroid should then reduce in size due to the contraction of the lasered tissue. These keyhole surgery techniques are dependent on the site and size of the fibroid. The other way of achieving the same effect is by Embolisation. A tube is passed through the arteries in the groin to apply tiny polyvinyl pellets to the artery supplying the uterus. These then clog the smaller vessels including those of the fibroid cutting off the blood supply. Some drugs reduce the size of fibroids but the effect stops soon after the drug stops. Some of these choices may not be appropriate for your fibroid. Mr Shaw can discuss the choices with you in greater detail. Fibroids reduce in size in the years after the menopause. The average age of the menopause is 51.