Ways to treat uterine fibroid

Sarah Josiah, 38, felt serious discomfort whenever she had her monthly for some time and was later diagnosed with uterine fibroid. However, she was reluctant to go for surgery when she was advised to do so, having heard stories of women who could not conceive after fibroid surgery.  Fibroids are non-cancerous tumours that grow in, […]

Sarah Josiah, 38, felt serious discomfort whenever she had her monthly for some time and was later diagnosed with uterine fibroid. However, she was reluctant to go for surgery when she was advised to do so, having heard stories of women who could not conceive after fibroid surgery. 

Fibroids are non-cancerous tumours that grow in, on, or within the walls of the womb.

After much counseling Josiah went for the surgery and was married a year later. Three years down the line, she is yet to conceive and often wonders if it was as a result of the surgery.

Mrs Dauda was diagnosed with fibroid two years after marriage and conception was not coming forth. “I used to bleed heavily during my menstrual period with serious pain but after the surgery, the pain and heavy bleeding stopped.”

However, the fibroid re-occurred after three years. “I have done fibroid surgery two times now and I don’t wish to go for another one again” she said.

 Mrs Nsur David on the other hand was lucky to have conceived barely a year and a half after having fibroid surgery in 2015. She said, “To me, it is God and I can say medical technology has advanced and we must all take advantage of it.”

Medical experts say in Nigeria, women who are in their child-bearing age stand higher risk of developing fibroids. 

Fibroid is three times more common among black than white women, said a consultant obstetrician and gynaecologist, Dr Kayode Obende. He said the incidence of fibroids in black women in reproductive age may be as high as 75%.

Dr Obende, who is also the head, In-Vitro Fertilization (IVF) Unit at Garki Hospital, Abuja, said the vast majority remain without symptoms, having as many babies as they want, and that the fibroid could be discovered during surgery to remove the uterus for other reasons. “For example, excessive bleeding or during caesarean section,” he said.

The gynecologist said the current trend in Nigeria is that with the advent of ultrasound scan, woman are told they have fibroid when small fibroid seedlings are discovered, with a view to making extra money through an unnecessary operation. 

Generally speaking, fibroids should be left well alone except when they start causing symptoms, he said. “Fibroids are hormone dependent and may grow bigger during pregnancy due to increase in oestrogen production. On the other hand, fibroids may become smaller or regress in size during menopause due to deficient oestrogen in the circulation.”

He added that uterine fibroids, also known as leiomyoma, are benign (non-cancerous) growths of the uterus (womb) that occur mainly in women of reproductive age.

“The cause is not known, but there are theories that link fibroids with genetic and hormonal origin. What we know for sure is that fibroid is more common in blacks, and certain families have more cases than others. So, it may also have a hereditary angle,” he said.

He said women of younger age are coming up with fibroid these days. “There is a tendency for women to commence menstruation at an earlier age presently and also delay childbirth. This may be contributing to the apparent increase in fibroid,” said Dr Obende.

The major symptoms include heavy menstrual bleeding that can cause anaemia (low level of blood), pelvic mass (swelling), pelvic pressure and pain, urinary frequency, constipation, difficulty in emptying the urinary bladder, sometimes obstruction to the flow of urine, miscarriage, and rarely infertility.

According to him, the options in the management of fibroid are; expectant management where you just monitor the patient, this is done for small and asymptomatic fibroids. 

 The second option is medical management where drugs are used to reduce bleeding and even shrink the fibroid, and the third is surgical management, using surgery to treat fibroids.

The gynecologist said fibroid is generally benign swelling and does not cause cancer but, very rarely, transformation to malignancy can occur in less than 1 percent of cases.

He said if treatment is properly done, the disease should not affect the chances of getting pregnant. “We have seen cases where fertility is compromised after surgery. Therefore, we encourage patients to seek the services of specialist (gynaecologist) who are trained to manage these conditions,” he said.

Dr Obende added that the chances of a recurrence after surgery is present in women who are still within the reproductive age group. He advised women to pursue their reproductive career early enough to avoid fibroid.