A Quick Primer for Understanding Ovarian Cysts & Uterine Fibroids

WORDS LIM TECK CHOON

FEATURED EXPERTS
DR WONG YEN SHI
Consultant Obstetrician & Gynaecologist
Sunway Medical Centre Velocity
DR FARAH LEONG RAHMAN
Consultant Obstetrician & Gynaecologist and Fertility Specialist
Sunway Medical Centre Velocity
DR WONG YEN SHI ON UTERINE FIBROIDS
Click on image for a larger, clearer version.

AT A GLANCE
  • They are non-cancerous growths that form in the muscular layers of the uterus.
  • One can have a single fibroid or multiple fibroids.
  • Often found in women in their reproductive years—that is, the period of time when they are capable of conceiving.
  • We still don’t know what causes fibroids to develop in a woman. Dr Wong states that hormones and growth factors could be possible causes.
YOU MAY HAVE UTERINE FIBROID(S) IF YOU HAVE…
  • Irregular or painful period
  • Heavy bleeding during your period
  • Frequent urination or constipation
  • Abdominal distension or bloating
  • Back pain
  • Unexplained weight gain
  • Painful sexual intercourse

TREATMENT

  • Fibroids can be removed via surgery. Depending on the location and size of the fibroid(s) present in the uterus, this can be open surgery or laparoscopic surgery, the latter involving the use of a laparoscope to make fewer and smaller cuts in the body. Women that no longer want to have children can also opt to have their womb surgically removed.
  • Newer treatments such as uterine artery embolization (blocking the blood vessels that nourish the fibroid, thus causing it to shrink) and high intensity focused ultrasound (HIFU) surgery can be considered, but note that not every medical facility in Malaysia offer these treatments.
  • Medicines to relieve symptoms such as heavy menstrual bleeding and painful period
DR WONG YEN SHI & DR FARAH LEONG RAHMAN ON OVARIAN CYSTS
Click on the image above for a larger, clearer version.

AT A GLANCE
  • These are sacs that contain mostly fluid, sometimes with tissues or blood, which form within the ovaries or on its surface.
  • They are mostly benign, but can be cancerous on rare occasions–especially among women between 60 and 65.
  • Ultrasound and CA125 tumour marker test are used to tell whether an ovarian cyst is benign or cancerous.
  • Conditions such as pregnancy, pelvic infections, and endometriosis can increase the likelihood of developing ovarian cysts. A woman with a history of ovarian cysts is more likely to develop ovarian cysts in the future.
  • Yes, it’s possible to have both fibroids and ovarian cysts at the same time.
YOU MAY HAVE OVARIAN CYST(S) IF YOU HAVE…
  • Irregular or painful period
  • Frequent urination or constipation
  • Abdominal distension or bloating
  • Back pain
  • Unexplained weight change
  • Unexplained loss of appetite
  • Quick sense of fullness while eating
  • Painful sexual intercourse

TREATMENT

  • Smaller cysts usually don’t require treatment. Instead, the doctor will monitor the cyst for signs of growth and other changes. 
  • Larger cysts can be removed via open or laparoscopic surgery.
CAN UTERINE FIBROIDS & OVARIAN CYSTS AFFECT ONE’S CHANCES OF HAVING A BABY? DR FARAH EXPLAINS 
  • Most women with fibroids and cysts have no problems getting pregnant.
  • However, depending on the size and location, uterine fibroids may affect one’s fertility. For example, fibroids that form in the womb lining may block the fallopian tubes, keeping the egg from being fertilized by a sperm cell, or make the womb environment less conducive for a fertilized egg to attach to the womb for further development.
  • Fibroid developing during pregnancy may increase the risk of early delivery. “In some cases, it can cause severe pain when fibroids outgrow their blood supply. If the fibroid is large, it can cause the baby to be positioned wrongly, such as the baby’s head not turning down even at term,” explains Dr Farah.
  • Ovarian cysts forming during pregnancy is usually not a cause of concern, except when the cyst grows so big that it ruptures open.

DR FARAH’S ADVICE

  • Go for regular gynaecology check-up to detect the growths of uterine fibroids and ovarian cysts as well as to ensure that the rest of the reproductive system is in good condition and working order.
  • When you’re about to embark on your pregnancy journey, seek advice from your doctor if you have a history of uterine fibroids and/or ovarian cysts.
  • We still don’t have any evidence-based method to prevent the formation of uterine cysts or ovarian fibroids. However, practicing good health and maintaining a well-balanced diet will be good for your overall well-being and improve your chances of a safe and successful pregnancy.

Hoping for a Baby? These Multivitamins May Increase Your Odds of Success!

WORDS LIM TECK CHOON

Data from a recent study conducted by Singaporean researchers suggests that multivitamin supplements that contain folic acid and iodine may be beneficial to women that are planning and hoping to conceive a child.

WHAT THE STUDY DID

The investigators interviewed 908 women between 18 and 45 years old that were trying to conceive. These women were enrolled in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO).

As an aside, S-PRESTO is a large-scale study on the effects of nutrition, lifestyle, and maternal mood prior to and during pregnancy on the effects of the baby’s genetic materials and the presence clinically important outcomes of the pregnancy. This study is beyond the scope of this article, though!

Back to this study, the investigators were interested in 2 things:

  1. Fecundity, or the measure of the chances of successful pregnancy
  2. Time to pregnancy, or the time between the first moment when the woman tries to conceive and the time of successful conception
WHAT THE INVESTIGATORS FOUND
  1. Multivitamins containing folic acid and iodine improve the success rate of having a baby when compared to those that do not take these supplements.
  2. These multivitamins also are linked to shorter time to pregnancy.
  3. Vitamins D and E do not show any significant improvements to pregnancy success rate and time to pregnancy.
  4. On the other hand, consumption of evening primrose oil is linked to lower pregnancy success rate and slightly longer time to pregnancy, compared to those that do not take this supplement.
WHY FOLIC ACID?

Folic acid, or vitamin B9, plays a role in breaking down and reducing the levels of an amino acid called homocysteine in the body.

High levels of homocysteine can cause effects that can affect fertility, such as increasing the ageing rate of a woman’s eggs and triggering the death of trophoblasts, which are cells of the outer layer of the developing embryo that helps it to attach to the woman’s endometrium for further development, protect the embryo, and eventually form the placenta.

Hence, by reducing the effects of high levels of homocysteine, folic acid can help improve the chances of a successful pregnancy.

HOW ABOUT IODINE?

Past tests on animals suggested that iodine can help improve the regulation of ovulation, increase the odds of a successful fertilization of an egg by a sperm cell following sexual intercourse, and promote successful implantation of the fertilized egg into the endometrium of the woman for further development.

Iodine also plays an important role in the development of nerve and brain cells of the foetus.

HOWEVER, SOME POINTS TO NOTE BEFORE YOU RUSH TO THE PHARMACY!

The investigators noted that more research is needed before we can make any conclusive statements about the effects of folic acid and iodine on one’s hopes of a successful pregnancy.

For example, their study did not measure the exact amounts of these nutrients that will work best on a woman hoping to conceive, and more research would be needed to determine whether their results can be replicated.

However, they believed that women trying to conceive could potentially benefit from taking multivitamin supplements containing these two nutrients, when this is also done in conjunction with other beneficial lifestyle modifications such as being physically active and cutting down on smoking and alcohol intake.


Reference: Ku, C. W., Ku, C. O., Tay, L. P. C., Xing, H. K., Cheung, Y. B., Godfrey, K. M., Colega, M. T., Teo, C., Tan, K. M. L., Chong, Y. S., Shek, L. P., Tan, K. H., Chan, S. Y., Lim, S. X., Chong, M. F., Yap, F., Chan, J. K. Y., & Loy, S. L. (2022). Dietary supplement intake and fecundability in a Singapore preconception cohort study. Nutrients, 14(23), 5110. https://doi.org/10.3390/nu14235110

Diets & Exercise Tips to Regain Your Pre-Pregnancy Body Shape

WORDS DR VICKY KOH

FEATURED EXPERT
DR VICKY KOH
Medical Director
Clinic RX
WELL, READ THIS FIRST

Every woman’s body is unique. Therefore, the question of the ‘right option’ or ‘best option’ is something that each and every woman has to figure out on her own.

For example, mothers that breastfeed often experience rapid weight loss and may benefit from an increased intake of certain nutrients or supplements. Women that gave birth via caesarean section may need a longer time to recover. Existing health issues and lifestyle variables also need to be considered.

If you are interested to find out more about the topics discussed below, you should discuss the matter further with your doctor.

BREASTFEEDING CONSIDERATIONS

Postpartum weight loss averages about 4.5 to 5.5 kg in the first 6 weeks. Women often return to their pre-pregnancy weight within a year, though this time frame varies depending on how much weight was gained during their pregnancy.

Breastfeeding aids in weight loss since it consumes extra calories, resulting in a natural weight loss for many women.

Breastfeeding women should pay special attention to their diets at this time.

While experiencing weight loss after giving birth may seem like a good idea, doing so too quickly will actually hinder healing!

POST-PREGNANCY DIETARY RECOMMENDATIONS

Dietary recommendations should include a variety of fresh produce, whole grains, lean proteins, and healthy fats.

Breastfeeding mothers, in particular, should drink a lot of water (6-10 glasses daily). Try to stay away from sodas and other sugary drinks.

Meanwhile, for moms that had a C-section, they should focus on eating foods that are high in protein. Avoid junk foods and take vitamin supplements, especially if they are nursing.

Vitamin and mineral supplements are crucial for moms during and after pregnancy.

This is because nutrients such as calcium, iron, vitamin D, folic acid, zinc, and more are normally redirected from the mother’s bloodstream to the developing infant.

Furthermore, the delivery process as well as breastfeeding depletes the body of essential vitamins.

Hence, postnatal supplements such as calcium, vitamin D, B vitamins, docosahexaenoic acid (DHA), magnesium, selenium, iodine, and choline may be helpful in replenishing nutrients that were used up during pregnancy and after childbirth.

EXERCISE RECOMMENDATIONS

Regular exercise after childbirth will help strengthen and tone your muscles while increasing your energy levels and making you feel less weary.

It also aids in the loss of excess weight.

During the first 6 weeks, the uterus returns to its pre-pregnancy size, and some women may feel uterine cramping and discharge.

However, mothers are recommended to gradually resume their exercise habits, starting with less strenuous activities during the first few weeks after giving birth.

A few days after delivery, you can start doing gentle abdominal and pelvic floor exercises if they don’t cause you any pain.

Try to proceed at your own pace—you can gradually increase the duration and tempo of your workout of over time.

Swimming, cycling, yoga, pilates, mild weight training, and low-impact aerobics are all good alternatives after the first few weeks.

How Breast Ultrasound & Mammogram May Save Your Life

WORDS LIM TECK CHOON

FEATURED EXPERT
DR WINNIE NG NYEK PING
Consultant Clinical Oncologist
Subang Jaya Medical Centre
NO FAMILY HISTORY OF BREAST CANCER = NO PROBLEM? WELL, THINK AGAIN!

“Even if one has no known family history of cancer, external factors such as environmental exposures, prolonged exposure to female hormones and lifestyle features may contribute to an increased relative risk of breast cancer,” says Dr Winnie Ng, a consultant clinical oncologist.

“Aside from genetics, there are numerous underlying possible causes of breast cancer,” says Dr Ng
  • Alcohol intake
  • Smoking
  • Prolonged exposure to female reproductive hormones such as oestrogen, such as in women that reach menstruation at early age, women that have never been pregnant, women on oral contraceptive pills, women that experience menopause late, and woman that have their first full-term pregnancy at a later age
  • Postmenopausal women on hormone replacement therapy
  • Obesity

Therefore, even if you have no family history of breast cancer, Dr Ng recommends that still going for breast cancer screening.

“The easiest method of screening is by self-examination of the breast,” she adds.

How to perform a breast self-examination. Click on this image to view a larger version.
AS WE STILL DON’T HAVE A CURE FOR BREAST CANCER, SCREENING REMAINS THE MOST PRACTICAL SOLUTION TO DETECT BREAST CANCER EARLY

Dr Ng recommends that:

  • Women below 40 should undergo a breast ultrasound.
  • Women above 40 are advised to go for a mammogram.

You should consult your doctor about your risk factors and how often you should go for breast cancer screening.

“A breast cancer diagnosis is not a death sentence. Self-tests and regular screenings can save lives,” says Dr Winnie Ng.

A Free App for Women, Especially Marginalized Women

WORDS LIM TECK CHOON

The University of Nottingham Malaysia (UNM) and Hanai Jiwa Ibu Sdn Bhd have developed an app, called Jiwa Ibu, to provide localised and tailored information on mental, women’s, maternal, and children’s health.

This app, developed in collaboration of the two entities with St George’s University of London, Universiti Malaya and Universiti Malaysia Sabah, serves to reduce the great disparity in access to healthcare between those residing in urban and rural communities. This is because rural communities have limited access to quality medical centres and professionals, and residents of those communities have to travel further in search of quality healthcare.

AN APP FOR MARGINALISED WOMEN

“For years, we’ve wanted to shift our focus to the rural and marginalised communities of Malaysia. Since the idea began, our team of eight dedicated women have run focus groups involving doctors, nurses, midwives, community nurses and everyday women, to better learn what the ideal women and maternal healthcare pathway should look like,” explains Hanai Jiwa Ibu Founder and CEO, Shamala Hinrichsen. “We don’t expect to solve the world’s problems, of course, but one tiny step forward is better than no steps at all.”

UNM and Hanai Jiwa Ibu recently inked a Memorandum of Understanding (MoU) to allow for the copyrighting and trademarking of the app, ahead of plans to work alongside Selangkah, Selangor’s healthcare app, to embed part of Jiwa Ibu into the system.

“The Jiwa Ibu app is expected to benefit 15 million women across Malaysia. During its initial alpha-test, the app was downloaded by 3,000 women, with 75% returning to the app within the span of one month from downloading,” shares Associate Professor Dr Joanne Lim Bee Yin of the UNM School of Media Languages and Cultures. “Based on the surveys and interviews that we carried out, 95% of respondents also shared that they wanted the app.

MANY FUNCTIONS FOR EMPOWERMENT & HEALTH SELF-MANAGEMENT

Jiwa Ibu will include a directory for doctors and healthcare centres within the vicinity of the user and other important resources, such as those for violence against women cases.

Users can also store and track their own health records and seek medical assistance through the app.

In an effort to be more accessible, the app will be made available in Bahasa Melayu, English, and other native languages.

Click here to download the app (link opens in a new tab) in the Google Playstore. The app is free.