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May 6th 2015

Endometriosis and fibroids

Dear Dr Mitchell,

For a patient who has endometriosis and fibroids and had surgery to take them out, what diet must she be on and must she expect the fibroids to return?

Endometriosis is a condition where tissues similar to that which lines the cavity of the uterus are present outside the actual lining of the uterus. It may be found in the muscles of the uterus (adenomyosis) around the Fallopian tubes, on the surface of the bowel, bladder, peritoneal surfaces in the abdomen and pelvis, and sometimes rarely in the vagina and lungs. These deposits shed over the influence of the hormones produced by the ovaries (oestrogen and progesterone) in a similar fashion to the shedding of the lining of the uterus during the menstrual period. This results in bleeding at the various sites causing scarring or adhesions to form.

Endometriosis commonly presents with pain, abnormal bleeding and infertility. It can be treated by cutting away the deposits or burning them. Medical treatment may also be undertaken to prevent the deposits from bleeding and hence prevent damage to the structures from adhesions. The only permanent cure for endometriosis is to remove the ovaries or if the menopause sets in.

Uterine fibroids are abnormal growths in the muscles of the uterus. Both fibroids and endometriosis will grow or thrive in the presence of oestrogen. Fibroids tend to shrink after the menopause due to the lack of oestrogen. Theoretically, oestrogen-containing foods or preparations can cause fibroids to grow and also cause endometriosis to worsen. It is actually a myth that eating red meat or chicken will cause fibroids and endometriosis to worsen. Women who have had fibroids removed and have changed to a strict vegetarian diet still have regrowth of their fibroids. There is an inherent or familial tendency for some women to develop endometriosis and fibroids. Black women tend to grow significantly larger fibroids than white women.

It is always a good practice to eat healthy and avoid high-calorie and fatty foods. A good exercise regimen will also help to reduce body fat.

Fibroids will usually grow back within about five years of doing surgery to remove them. In some cases they do not grow back at all.

The combination of fibroids and endometriosis is seen at the time of surgery in women who did not know that they had endometriosis. The presence of both significantly reduces the chance of becoming pregnant. Once surgery has been done to treat both endometriosis and fibroids you should try to become pregnant as soon as possible -- we usually say off the operating table and try right away! A long delay will increase the chance of regrowth of fibroids and recurrence of endometriosis which can significantly reduce your chance of becoming pregnant.

If there is no suitable partner and no option for conception in the short term, then medical treatment to suppress endometriosis while waiting is the way to go, while ensuring that you keep your weight under control by eating healthy and doing regular exercise.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver. com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax 968-2025. Dr Mitchell cannot provide personal responses.

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