But although uterine fibroids are extremely common, especially in women of reproductive age, in actuality, this disease may not be as difficult to cure as is generally feared or assumed.

Benign uterine growths or tumours can be in the form of a polyp, or can be a fibroid muscle tissue mass (it may have a stalk or stem-like base), that develops in the muscular wall of the uterus, and can protrude into the uterus itself, as well. This can occur in women of any age, even in younger women, but is most common in women of reproductive age.

Generally speaking, any woman is capable of developing a uterine fibroid, as, again, it is something that can affect women of all ages.

Abnormal vaginal bleeding or discharge is a primary symptoms of uterine fibroids. The kinds of symptoms experienced by patients depend on the location and the size of the tumour. Other common symptoms include pain in the lower abdomen or pelvis, heavy menstrual pain requiring pain medication or pain to the point of being unable to work or function normally, and bladder pressure leading to a frequent urge to urinate. These are all warning signs for which to watch; however, some women may not experience any symptoms or indications whatsoever.

The exact cause of uterine fibroids is still unclear, as it is generally observed that these types of tumours can occur at any time. It does, however, seem that there are some factors contributing to the development of fibroids in the uterus, and one of these is hormones. The female sex hormone, oestrogen, appears to promote the growth of these kinds of tumours, which explains why they occur more frequently in women of reproductive age.

In some cases, if left untreated, uterine fibroids can cause heavy bleeding and possibly infertility.

Currently, the standard treatment option is what is known as a hysteroscopy procedure, during which a hysteroscope, equipped with a miniature camera and light at the end of a tube, only about two millimetres in diameter, is inserted into the vagina in order to examine the cervix and the inside of the uterus. If larger growths are found, a larger diameter camera with a thin electric wire loop attached may then be inserted and an electric current is used to cut the fibroid or polyp into small pieces that can then be removed through the cervix without affecting any other parts of the body.

Treatment of uterine fibroids by using a far safer and more convenient option is the primary benefit. Patients experience minimal pain, and, importantly, a shorter recovery period.

The recuperation period after this type of surgery is just one to days, after which the patient can return to work as usual. Minimally invasive surgery is, therefore, a favoured solution that meets the needs of today’s women who have greater responsibilities, both in the workplace and at home.

For women planning to have children, the issue of uterine fibroids is not one to be complacent about or to leave unattended. Women should undergo regular annual health check-ups, as uterine fibroids can develop at any time.

Annual health check-ups will help to catch and treat this disease in time, and are the best means of prevention. Now that we are more aware of the dangers and treatments of uterine fibroids, we can clearly see that, they need not be as great a source of fear or concern as was once thought.

If or when uterine fibroids occur, medical science is now able to remedy the problem more easily and safely than ever before.

DR SOSAKUL BUNYAVIROCH is an Oncology and Gynaecologic Endoscopic Surgeon attached to the Women’s Health Centre of Samitivej Sukhumvit Hospital. Call (02) 022 2555-6.

About one in four adults has trouble sleeping, while more than 10 per cent say their sleep frequently or even persistently isn’t restful, according to Germany’s central body for biomedicine, the Berlin-based Robert Koch Institute.

But there are remedies. We asked the sleep experts the questions going through sleepless minds.

What is a sleep disorder?

There are various kinds of sleep disorders with diverse causes, according to Hans-Guenter Weess of the German Sleep Society (DGSM).

“What is commonly referred to as ‘sleep disorder’ is actually insomnia, which is a difficulty falling and/or staying asleep,” he says.

Many people will also regularly experience the problem of not being able to sleep through the night, says Jens Wagenknecht, executive board member of the German Association of General Practitioners.

What causes sleep disorders?

The causes are often very complex. They could be physical, psychological or behavioural in nature. A sleep disorder might be a side effect of a medication, and not infrequently it’s a result of another illness.

“Awakening very early often occurs in cases of depression,” Weess says, although multiple factors may play a role.

Someone with a herniated disc, for example, experiences pain in a lying position, wakes up every two or three hours at night and might then start brooding over personal problems, Weess explains. “That leads to tension, making it impossible to sleep.”

When should someone with trouble sleeping see a doctor?

If you sleep poorly at least three nights a week over a period of a month and are impaired during the day, then you should seek medical help, Weess says.

Impairment can take various forms: tiredness or exhaustion, difficulty concentrating, irritability and moodiness, as well as physical symptoms such as headaches or gastrointestinal problems.

To treat a sleep disorder it’s important to find its cause. Treatment options include a change to sleep habits, cognitive behavioural therapy and medication. However sleeping tablets are recommended only in exceptional cases and for no longer than two weeks.

To what sort of doctor should one turn?

If you don’t have access to a sleep specialist, you should see your family physician, who can determine whether the underlying problem is physical, Weess advises.

What can a poor sleeper do to get a good night’s rest?

There are quite a lot of things you can do, according to Weess. People suffering from restlessness at night are advised to go to bed and get up at regular times, while also avoiding lying awake in bed too long, napping during the day, drinking alcohol and watching television or using devices in bed.

Having a clock in the bedroom is also a bad idea, Weess says, since this can lead to counting the hours before it’s time to get up.

When is a sleep study called for?

Physicians will often recommend an examination for a sleep study in cases of snoring with breathing stoppages (sleep apnea), abnormal daytime fatigue or sleepwalking, says Dr Ingo Fietze, director of the Interdisciplinary Centre for Sleep Medicine at Berlin’s Charite hospital. It can also be used to find the reason a patient can’t stay asleep.

During the examination, patients hooked up to electrodes that measure things like electrical brain and heart activity, muscle activity and eye movements, before going to bed at the usual time.

Besides the electrodes the patient is fitted with a chest belt to measure respiration, a device attached to the nose to measure |breathing rate and changes in inhalation and exhalation, and a pulse oximeter on a finger to measure blood oxygen saturation levels. The person is also observed by a camera suspended from the ceiling while they sleep.

The bleeding occurs in the oesophagus, stomach or duodenum, the first part of the small intestine, and is often caused by stress ulcers or gastritis as a result of the child suffering from a severe illness. In short, when a child’s body is put under stress due to illness, it releases an acid that can lead to bleeding in the stomach. Stress ulcers resulting in UGIB are common among children in the Neonatal Intensive Care Unit (NICU) or the Paediatric Care Unit (PICU)

Another cause, especially in older children, is a peptic ulcer. Symptoms of peptic ulcer include abdominal pain and vomiting up blood.

Other reasons for the bleeding include multiple episodes of severe vomiting which can cause a tear or an inflammation in the oesophagus; food allergies, haemorrhagic disease, liver dysfunction; vascular malformation and variceal bleeding. In the past vitamin K deficiency was also to blame though this is no longer one of the most common causes of UGIB due to vitamin injections every newborn must receive.

It should be noted that sometimes a child might appear to have UGIB, but other factors are at play. For example, a child may swallow some of their mother’s blood during breastfeeding, causing the child to have a bloody mouth. Mothers will often be alarmed, thinking the blood is coming from the child.

Before rushing to the hospital, the mother should check if her nipples are cracked and/or bleeding.

One obvious symptom of gastrointestinal bleeding is vomiting blood. Other symptoms may include fatigue, pale skin, shortness of breath, and abdominal pain that is more painful than usual. Some children may show no signs of UGIB. In severe cases, one of the signs of UGIB is black stool.

UGIB can be detected through a blood test showing whether or not someone has a low level of haemoconcentration. If left untreated, gastrointestinal bleeding can be fatal, so detecting it as early as possible is of utmost importance.

Take your child to the doctor immediately if he/she is vomiting blood or black material that looks like coffee grounds or has black and tarry or maroon stools. Early detection is key: the sooner gastrointestinal bleeding is diagnosed or ruled out, the sooner your child’s condition can improve rapidly, allowing for a happy, healthy life.

Most commonly, a physical exam will be performed. In some cases, the doctor may perform a gastroscopy in which a small tube inserted through the mouth to determine the source of the bleeding and evaluate its severity.

An abdominal and rectal examination may also be performed to determine the cause of the bleeding. Other tests are carried out to determine the complete blood count, the patient’s liver function, and the blood’s ability to clot (coagulation test).

Treatment depends on the condition your child has, and how much bleeding has taken place. The following are some of the treatments your child’s doctor may perform:

• Administering medicine to reduce stomach acid in the cases of peptic ulcers or stress ulcers
• Removing certain foods from your child if he or she has food allergies
• Therapeutic endoscope to stop the bleeding in more severe cases
• Vitamin injections
• Direct treatment of the wounds inside the child’s stomach

DR AMORNPHUN GAENSAN is a specialist in Paediatric Gastroenterology and Hepatology at the Samitivej International Children’s Hospital, Sukhumvit Campus. Call (02) 022 2236-7.

Endometriosis, often referred to as chocolate cysts, is a condition that most commonly affects women during their reproductive years. One theory for endometriosis is that they are caused by retrograde menstruation, where menstrual blood flows back through the fallopian tubes and deposits the tissue in various locations, such as the ovaries, fallopian tubes, bladder, intestines, or other tissues attached to the uterus.

At first, there may be no indication or noticeable pain, but over time, the surrounding tissue can become inflamed or swollen, which may then develop into lesions or growths. If the displaced endometrial tissue becomes lodged on the ovaries, blood during the menstrual cycle becomes trapped and has nowhere to go, thus accumulating more and more until it forms cysts. As blood that collects over time thickens, it becomes a dark blood colour, thus earning the name “chocolate cysts”.

While this explanation seems reasonable, in truth no clear medical conclusion has been reached regarding the cause of this disease. As far as the symptoms are concerned, women who have endometriosis will often experience very painful menstrual cramps, increasing in pain until they become almost unbearable and require painkillers and/or until their work schedule or daily life and activities are impeded. Some women experience pain in other parts of the body as well, for example, pain in the lower back and pelvic area.

Sometimes it can cause flatulence, bloating or diarrhoea. Some women also experience deep pain in the uterus or lower abdomen during sexual intercourse.

Simply stated, this is a condition that has the potential to greatly affect the daily life and activities of women, and if left untreated for too long, it can progress to the point of unbearable pain, at which point surgical removal of the uterus may be required. And of course, allowing this to happen would mean an inability to have children in the future,

It is, therefore, wise to seek treatment early.

If the symptoms are mild, the doctor may choose to follow up with periodic examinations, and in cases that are further developed, prescribe medication. If, however, the medication prescribed appears to be ineffective, surgery might be necessary. The current surgical method for this type of procedure is laparoscopic surgery, a standard modern surgical procedure that requires only a small incision, resulting in minimal pain and a much faster recovery time. With this technique, surgery need not worrisome or alarming.

This type of surgery therefore is the perfect solution to a wide variety of other gynaecological conditions as well. As it is a method that is both fast and convenient, it meets the needs and lifestyle of today’s modern women with greater responsibilities both in the workplace and in society at large. For women today, long recovery periods are often impossible, making this type of surgery a perfect choice.

Endometriosis, while often not considered a serious disease, should not be left untreated, as it certainly causes pain and discomfort and disturbs one’s daily life and activities. Now, there is no reason to endure that kind of physical suffering.

Early detection and treatment is always the best solution before the condition becomes more dangerous or debilitating.

DR SANTI PONGPHANTARAK is an obstetrician and gynaecologist and a specialist in gynaecologic endoscopic surgery at Samitivej Sukhumvit Hospital.

Stiffness and pain in the shoulder joint are early symptoms of frozen shoulder.

While the exact causes of frozen shoulder are not known, it has been theorised that an autoimmune reaction may be responsible. Normally, the body’s defensive system protects it from bacteria, viruses, foreign objects and abnormalities such as cancer cells and affected tissues. In the case of a frozen shoulder, the defensive system mistakenly begins to attack the tissues of the body and this causes an inflammatory reaction in the tissue that is under attack. When the resulting inflammation in the shoulder joint becomes so severe that it causes the joint capsule to contract and become “frozen”, the shoulder joint will no longer move normally.

No one knows why frozen shoulder occurs so suddenly. It may begin after a shoulder injury or surgery. It can also start if the shoulder has not being used for a while, such as after a wrist fracture when the arm is kept in a sling, or even while recovering from cardiovascular disease.

Frozen shoulder might be an antecedent symptom for other shoulder problems like tendonitis, rotator cuff tear, or shoulder impingement syndrome. These problems may cause chronic inflammation that leads to the patient using the shoulder less than normal, leading to a situation that can cause frozen shoulder. The frozen shoulder should be treated first before the underlying problems are addressed.

More common in women than men, frozen shoulder mostly affects people ages 40 to 65 years old and is found in 10 to 20 per cent of patients with diabetes. It is also associated with other health conditions such as thyroid, ischemic heart disease, depression, Parkinson’s disease and upper limb injuries

The symptoms of frozen shoulder typically begin with shoulder pain and a reduced range of motion in the joint. The range of motion is the same whether you are trying to move the shoulder yourself or someone else is trying to move it for you. There comes a point in each direction of movement where the motion stops, as if something is blocking it and the shoulder usually hurts at that point. The shoulder can be painful at night. The tightness in the shoulder can make it difficult to do daily activities like combing hair, getting dressed, putting on a belt, or reaching for things, such as a bra hook or zip.

The diagnosis of frozen shoulder is usually made on the basis of the patient’s medical history and a physical examination. With the above symptoms, simple x-rays are not usually helpful. As the ability to move the shoulder increases, doctors may perform tests to rule out underlying conditions, such as impingement or a rotator cuff tear. The tests include:

l X-rays to find any bone abnormalities

l Ultrasound or magnetic resonance imaging (MRI) to view the tissues around the shoulder joint

Treatment mainly involves range-of-motion exercises though corticosteroids and numbing medications injected into the joint may sometimes be given. In a small percentage of cases, arthroscopic surgery may be indicated to loosen the joint capsule so that it can move more freely.

DR CHATHCHAI POOKARNJANAMORAKOT is an orthopaedic surgeon attached to the Sports and Orthopaedic Centre of Samitivej Sukhumvit Hospital Call (02) 711 8494-6.

Menopause has a variety of symptoms, the occurrence and severity of which can vary greatly. In more severe cases, these symptoms can have such an impact on the ability to carry on with normal routines that they adversely affect the quality of life.

In most cases, women will typically experience hot flashes, night sweats and insomnia, which leads to increased fatigue and irritability. Other possible symptoms include palpitations, headaches, an aching body, anxiety, decreased self-confidence, depression, and loss of libido. The urinary tract and vagina may also develop problems, such as vaginal dryness, vaginal inflammation, frequent urination and urinary incontinence. Not surprisingly, menopause can place a strain on a woman’s relationship with her spouse.

The loss of oestrogen is a major cause of problems faced during menopause. As the oestrogen levels fall, the hair becomes dry and some women experience hair loss. The skin becomes thin and dry, causing wrinkles, while the fingernails also become brittle.

In addition to the symptoms mentioned above, menopausal women are at increased risk of the following conditions:

l Osteoporosis

Because oestrogen helps to maintain appropriate levels of calcium in the bones, the shortage of oestrogen caused by menopause leads to the bones thinning and becoming more brittle over time. This heightens the risk of hip fractures, broken arms, and broken legs. As there are no obvious symptoms, menopausal women are advised to undergo a bone density test every two years.

l Cardiovascular diseases

Because oestrogen also protects a woman from the time she begins menstruation until menopause by reducing her cholesterol levels, the risk of heart disease and strokes increases during menopause. Even women with previously strong and healthy hearts are exposed to a greater risk of cardiovascular disease during menopause. Some of the early warning signs to watch out for include fatigue, insomnia, difficulty breathing, pain in the neck and shoulder area, stomach indigestion, and nausea. However, it should also be noted that women with heart disease often do not experience any chest pain during atherosclerosis (blocked arteries).

l Stroke

Low oestrogen levels also adversely affect the LDL level, and this is another risk factor for menopausal women as it can lead to a stroke. One of the main early warning signs to watch out for is a numbness or weakness in one part of the body, which then disappears in 30 minutes. Other indicators of an imminent stroke include feeling disoriented and having difficulty seeing, speaking or walking. When any of these symptoms occur, medical advice should be sought immediately to minimise the risk of a stroke and subsequent paralysis.

Because of the potential dangers, all women are recommended to visit their doctor for a full health examination as they enter menopause. While screening for cervical cancer, ovarian cancer and breast cancer are the most common tests performed on menopausal women, it is also advised that they undergo a more thorough examination.

Hormone Replacement Therapy (HRT) can be administered to replace the lost oestrogen with substances that have a similar molecular structure. While this can significantly improve the quality of life for menopausal women experiencing extreme symptoms, it is not necessary in all cases. Whether HRT is prescribed should be decided by the doctor after taking into consideration each woman’s particular situations and condition. For example, HRT should not be prescribed if a woman has breast cancer, endometrial cancer, deep vein thrombosis, or liver disease. Also, HRT should be used with caution if the patient has gallbladder stones, diabetes, high blood pressure, tumour in the uterus, asthma, SLE or migraine. In addition to deciding whether a woman is suitable for HRT, the doctor will also determine which type of HRT to recommend in order to improve the woman’s quality of life.

In addition to HRT, there are some steps that all women can take to maintain good health during menopause. A nutritious diet, regular exercise, sufficient rest, and a stress-free lifestyle can all play an important role in minimising the negative impacts of menopause. Menopausal women should try to eat a varied diet from all five major food groups. Foods which are high in calcium and naturally occurring oestrogen, such as soybeans, are strongly recommended, while fatty foods, alcohol, caffeine and smoking should all be avoided. Women should also aim to exercise least three times a week.

Understanding menopause and managing its risks can go a long way to helping women carry on as normal a life as possible during their “golden years”. While eating nutritious food, exercising regularly, and getting plenty of rest can minimise the risks and effects of menopause, even more important is an annual health check-up that includes a mammogram, a Pap smear test, a bone density test, and a blood test so that any potential complications can be identified and treated before they develop.

DR YAOWALUK RAPEEPATTANA is a specialist in obstetrics and gynaecology with the Women’s Health Centre at Samitivej Sukhumvit Hospital. Call (02) 711 8555-6.

A large cyst can be felt in the breast and usually feels like a soft grape or a water-filled balloon. The cysts usually disappear after menopause, except in cases where the women are taking hormone therapy.

Symptoms of breast cysts include:

A smooth, easily movable round breast lump with distinct edges

• Breast pain in the area of the breast lump
• Increase in breast lump size and tenderness just before the period, and decrease in breast lump size after the period

One important thing to know is that a simple cyst does not increase the risk of developing breast cancer. If you detect the presence of any new breast lumps or if an already identified breast lump seems to have grown, please seek medical attention in order to get it checked out.

Each of the breasts contains 15-20 lobes of glandular tissue. The lobes are further divided into smaller lobules that produce milk. Ducts then carry the produced milk. Breast cysts develop when an overgrowth of glands and connective tissue blocks the milk ducts, causing them to widen and fill with fluid.

Microcysts are too small to feel, but will be seen during such imaging tests as mammography or ultrasound.

Macrocysts are large enough to be felt. Most of them can be clearly felt at 2.5 centimetres. Large cysts can put pressure on nearby breast tissue, causing breast pain.

The cause of breast cysts remains unknown but it is believed they may be the result of excess oestrogen in the body. Screening and diagnosis of a breast cyst usually begins after a breast lump is identified by you or a doctor: The process will incorporate the following steps.

• The doctor will physically examine the breast. However, this breast examination cannot identify whether a breast lump is fluid-filled or solid and other tests will be needed.
• A breast ultrasound can help the doctor determine whether a breast lump is fluid-filled or solid.
• Fine-needle aspiration is performed. The doctor inserts a needle into the breast lump and withdraws fluid. If the fluid is not bloody, no further testing is needed. If the fluid appears bloody, the doctor will send a sample of the fluid for lab testing. If no fluid is withdrawn or the breast lump does not disappear, it suggests that the breast lump or a portion of it is solid and a sample of cells will be sent for analysis to check for cancer.

No treatment is necessary for simple breast cysts. The doctor may recommend closely monitoring a breast cyst to see if its size changes.

There are three treatment options

• The fine-needle aspiration procedure, which is used to diagnose a breast cyst also serves as treatment when the doctor removes all the fluid from the cyst resulting in the breast lump disappearing and the symptoms clearing up. The doctor will locate the position of the breast cyst and insert a needle to withdraw fluid. For more accuracy, ultrasound will be used to guide the accurate placement of the needle. After the fluid has been withdrawn from a breast cyst, a recurrence or new cysts are very common.
• Hormone use: Using birth control pills to regulate the menstrual cycles may help reduce the recurrence of breast cysts. Discontinuing hormone replacement therapy during the postmenopausal years may reduce the formation of cysts as well.
• Surgery: In some cases, the surgical removal of cyst is necessary. Surgery may be considered for an uncomfortable breast cyst or if a breast cyst contains blood-tinged fluid or shows other worrisome signs of cancer.

For prevention of breast cysts, you should wear a well-fitted and supportive bra to help relieve some discomfort. Avoid coffee. While there is no scientific proof that coffee consumption is linked to breast cysts, some women find relief from their symptoms after stopping coffee consumption. Reducing salt in the diet is also recommended because sodium increases the congestion of excess fluid retained by the body.

A breast self-examination should be done at least once each month. In case of finding any abnormality, seek immediate medical attention.

DR DUANGMANI THANAPPRAPASR is an Obstetrics-Gynaecologist attached to the Women’s Health Centre at Samitivej Sukhumvit Hospital. Call (02) 711 8555-6.