Just waiting in front of the doctor’s office can increase nervousness.
The thoughts are multiplying, and the review hasn’t even started yet.
The discomfort is almost inevitable – the cold instruments, the silence in the darkened room and those few minutes that seem like an eternity.
It is difficult to find a girl or a woman who is happy to go for a gynecological examination.
The fear that the doctor will notice a change grows even more as he carefully observes the images on the screen.
When you hear complex medical terms, various scenarios and countless questions come to mind.
“You immediately think the worst,” says Diana Stamenković, who was diagnosed with a polyp, a benign change on her uterus.
Similar is the experience of Tamara Gvozdenić, who has been living with fibroids for years, another benign change.
Polyps and fibroids occur inside or on the surface of the uterus or its cervix, which are observed during an ultrasound or vaginal examination, indicates Sara Pempelfort, a gynecologist from Belgrade.
“The cause of their occurrence is not yet known, they have similar symptoms, but they are also quite different,” he explains to the BBC in Serbian.
The first symptoms that indicate these gynecological changes are heavy and painful menstruation.
Polyps appear between the ages of 40 and 50, when women enter in menopausebut lately that limit has moved and more and more girls are noticing these changes, Dr. Pempelfort shares her practical experience.
About 30 percent of women in the world have polyps, according to the data available.
Fibroids are also common, but they occur at any age, he adds.
It is estimated that every third woman there are fibroids in Serbia, but some appear with mild symptoms, so women only find out about it during the examination.
A fifth of women in the world, these changes occur in the reproductive age (the period when she can get pregnant).
‘I already thought I had cancer’
Heavy bleeding was the alarm for Nišlijka Dajana Stamenković to finally consult a gynecologist.
She postponed the examination, fearing the diagnosis, and was comforted that everything had been fine so far.
Whenever she was too physically active, her period would be early or too painful.
However, when she got her period twice within ten days, she knew she couldn’t wait any longer.
During the ultrasound examination, she was told that a polyp was suspected, but that she would have to come back in a month to find out for sure.
At the time, she was 40 years old and wanted to get pregnant with her partner.
“My legs started shaking, I was already projecting in my head that I had cancer,” this 54-year-old woman recalled for the BBC in Serbian.
Although it is still not known what causes them, it is assumed that one of the most common causes is hormone imbalance, more precisely, elevated female hormone estrogen, explains the gynecologist.
“That’s why they most often occur in the reproductive and period of perimenopause when hormonal changes occur.
“They arise from the lining of the uterus and appear inside it or in the cervical canal (the passage that connects the cervix with the vagina),” he adds.
They can grow up to several centimeters.
Therefore, during the inspection, it is important to inspect the canal in detail in addition to the internal part, he notes.
Watch a video about menopause, a change in every woman’s life
A month later, Diana went for a gynecological examination again, when it was confirmed that she had to undergo an operation.
In premenopausal women, you can try progesterone therapy and wait a few months before removing them, but they are always removed in the end, explains gynecologist Pempelfort.
“It is important not to remove the entire endometrium (the inner lining of the uterus) for further pregnancy planning,” he points out.
The polyp is always removed surgically, using a simple method, hysteroscopy, he adds.
It’s about procedure which examines the inside of the uterus by passing a thin telescope-like device through the cervix and diagnoses gynecological conditions (changes) including cancer.
It is used to examine problems such as heavy periods and postmenopausal bleeding, and doctors can use this method to perform biopsies and remove polyps or fibroids.
A histopathological report is then sent to determine whether there are any benign or malignant changes.
“The risk of malignancy and atypical cells is higher in polyps that appeared during menopause.
“Those that occur during premenopause contain only a percentage of cancer risk,” adds the gynecologist.
Diana’s polyp was successfully removed and the first test showed that there were no malignant cells.
However, she found herself on the operating table again – the polyp returned.
“The very thought of having to undergo surgery again, even though it was a harmless procedure, scared me.
“I spent my days questioning and analyzing my behavior and whether I could have prevented the polyps in any way,” she recalls.
More than anything, she was afraid of the results of the new findings and that she might actually have cancer.
“When the doctor told me everything was fine, I think I cried for hours – non-stop,” she adds.
During one of her regular gynecological examinations, Tamara was told she had a fibroid.
“As soon as you hear that something has been spotted, the first reaction is fear.”
“I knew something about it, but at that moment while you are on the bed, the only thing that goes through your head is that something is wrong,” she recalled for the BBC in Serbian.
The doctor explained to her that it is not an alarming condition and that it does not need to be surgically removed, but that six-month follow-ups are mandatory.
At one of them, Tamara finally asked the question that had been bothering her since they discovered this change – could she get pregnant.
“I barely spoke,” she recalls.
She received an affirmative answer and became pregnant within a few months, but the knowledge that she had a fibroid weighed on her.
She was afraid that she might grow up and still go under the knife.
“I did not enjoy pregnancy at all, I was constantly thinking that it would affect the fetus.
“I gave in and researched the experiences of other women on the Internet, which had a negative impact on my mental health,” she recounts ten years later.
Watch the video: Five things you need to know about cervical cancer
Fibroids arise from the tissue of the uterus and can appear in seven different places in relation to the muscle of the uterus, explains the gynecologist.
The cause is unknown, but a genetic connection has been observed.
If two generations of women in a family have this change, there is a high probability that the third generation will also have it.
Fibroids, which are often irregular in shape, are followed up with regular check-ups every six months, and if they do not exceed a certain size, they do not need to be removed.
“If they are in such a place that they block the passage to the fallopian tubes, they must be removed like polyps, otherwise they are not touched,” he adds.
There is still no oral therapy that can make them disappear, the only thing that has been observed is that their volume decreases in menopause.
Hormonal treatment is not recommended because it can encourage the growth of fibroids.
Like polyps, fibroids can come back, which is why check-ups are important, as their growth is monitored, says Dr Sarah Pempelfort.
Diana and Tamara became mothers in the meantime, and they do not skip gynecological examinations.
“Those few minutes while I lie there waiting for what he will tell me still seem like an eternity,” says Diana.
Her polyp did not return.
Tamara’s fibroid does not grow and she often jokes about it.
“After the examination, when I come home, I say – ‘everything is the same, we haven’t grown’, we are good,” he says jokingly.
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