By Job Osazuwa
There is hardly a woman who doesn’t feel a wave of terror when she is told there is fibroid in her womb. Indeed, the world, tumour, of any type, sends a strange sensation to the patient’s spine, even if there is little to really worry about.
An Obstetrician and Gynaecologist at Lagos University Teaching Hospital (LUTH), Kehinde Okunada, told Daily Sun that one out of every two black women is living with fibroid in her uterus. According to him, although all uterine fibroids are the same, they are categorised based on their location in the body.
He explained that fibroids most commonly occur among women between the ages of 30 and 40, and above, with black women at greatest risk.
A professor of obstetrics and gynaecology at NYU Medical Center, United States of America, Steve Goldstein, describes fibroid tumours to be composed of renegade muscle cells that come together to form a fibrous mass within the uterus.
He corroborates Okunade’s view that there is virtually no immediate threat of fibroid, and revealed that there were a number of excellent treatment options, ranging from drugs to surgery. He recommended early diagnosis and doctor’s advice on the type of treatment to take as key to overcoming the tumour.
Sadly enough, in this part of the world, women usually embark on marathon spiritual exercise to overcome the medical challenge rather than depending on medication. Investigation reveals that many women who are down with the health challenge have subjected themselves to psychological torturing, in a bid to avoid what the doctors describe as simple operation – if necessary.
An obstetrician and gynaecologist at a private hospital in Lagos, Ekene Jude, said women, usually out of ignorance, have been struggling emotionally and physically with these tumours simply to avoid the knife.
However, the good news is that, according to him, patients, after most surgeries, generally recover in 10 days to two weeks.
For effective treatment, he said it is a combination of patients’ symptoms, the location of the fibroid, and the numbers and size, as well as age and childbearing potential, that help determine the course of treatment.
Okunada said most fat or obese women are predisposed to developing fibroids. He clarifies that not all fat people have fibroids and not all slim women are free from the condition.
Other experts have said that, at least one genetic link has been identified, indicating that fibroids may also run in families.
Symptoms and diagnosis
Okunada said for some women, fibroids cause none or major symptoms, but when they do, problems often involve heavy menstrual periods and prolonged bleeding, as well as pelvic or abdominal pain or swelling and increased urination.
“A menstrual period could increase from five to 10 or more days. There is also what we call pressure symptom, which has to do with frequent urination because other parts of the system have been affected by the growth of the tumour. And when the fibroids get bigger, it could lead to vomiting and other reactions,” he said.
On diagnosis, he said physical examination is the first approach, saying that a grown fibroid is easily noticed as the woman’s stomach protrudes.
However, he warned that not all swollen stomachs are symptom of fibroids, while explaining that after physical examination, cervical ultra-sound scan is done to reveal the presence or otherwise of fibroids in the uterus.
The doctor recommended surgeries as the best remedy to tackling fibroid tumours. He, however, said there were drugs used in fighting the disease, which have been helpful, but quickly warned that the drugs would only suppress the symptoms while fibroids keep resurfacing.
Alternative to surgery
Managing Director of Cedarcrest Hospital, Ikeja, Lagos State, Dr. Felix Ogedegbe, has said women may no longer necessarily have to undergo fibroid removal surgery following new method of treatment
Ogedegbe, while speaking about uterine fibroid embolisation (UFE), said women who have fibroid could have a catheter passed through their blood vessel to get to the fibroid, adding: “Certain things are put on the fibroid to make it burn away in few weeks. Women do not need to have open operation to have fibroid removed anymore.”
“Blood transfusion is often not needed, risk of infection, long stay in the hospital and all things that traditional fibroid operation comes with. It is proved to be beneficial to a lot of women because it is common among black women.’
Treatment options: What you should know
Not too long ago, doctors routinely performed a hysterectomy for fibroid tumours. And while newer, less-invasive treatments are available, studies show this dramatic operation is still being performed today – far more frequently than necessary.
A panel recently convened by the governing body of the American College of Obstetricians and Gynaecologists found that 76 per cent of all hysterectomies performed today do not meet the criteria for this surgery.
“They are being done unnecessarily,” says Ernst Bartsich, associate professor of obstetrics and gynaecology at Cornell Medical Center in New York. He said many women were conceding to a hysterectomy for fibroid tumours because they are led to believe it’s the only solution, which he said was wrong.
At the same time, Goldstein said it was also important to recognise that not all hysterectomies are alike. In particular, he said the newest form of this operation, called a supra cervical hysterectomy, could still hold the answer for some women.
He explained: “In a supra cervical hysterectomy, you remove only the uterine cavity holding the fibroids and you do not touch the tubes, ovaries, cervix, or vagina, or any of the support muscles in the bladder or pelvis.”
This, he says, means you don’t suffer any of the consequences linked to a traditional hysterectomy, including bladder and sexual dysfunction, or instant menopause. Recovery is also fast, stressing that most women are out of the hospital in two days and back to normal living within two weeks.
Said Goldstein: “It’s also a permanent treatment for fibroids that can bring much-needed relief. My personal choice is to always do as little treatment as possible; but at the same time, women should not routinely close their ears when the doctor mentions hysterectomy, because this one particular type can be extremely helpful and cause no more problems than some of the newer alternatives.”
Myomectomy fibroid surgery
Okunade said myometomy is to remove only the fibroid tumours, leaving the uterus and all other organs completely intact. This is performed through three major approaches, which include: traditional surgery with a large incision on the abdomen; minimally invasive laparoscopic surgery done through pin hole-sized incisions, and, depending on the location of the fibroid, and hysteroscopy – a surgery done through the vagina.
The surgery will succeed in removing the fibroid tumour and offers relief for up to several years, after which the fibroid can sometimes grow back, though the percentage is low.
Hysteroscopy is said to be the most effective when the patient has bleeding or fertility-related problems or recurrent pregnancy loss due to fibroid tumours.
Okunade cautions that myomectomy can cause adhesions or scar tissue to develop, which often takes time to heal.
Other experts say the operation may interfere with fertility, which may prompt a woman to need IVF in order to conceive. But the uterus, however, remains strong enough to support a healthy pregnancy, as revealed.
Uterine artery embolisation
This is a radiological procedure that blocks blood flow to the fibroid, causing it to shrink and eventually die. It is done with a minimally invasive procedure, which involves placing a catheter into the uterine arteries through which tiny particles are injected that seal off the blood supply to the tumour.
The target is that without a blood supply, the fibroid withers and dies, but it is best suited for women who have completed childbearing.
While doctors agree this is a safe and smart treatment, that opinion changes dramatically if a woman has not completed her childbearing. Studies show that obstetric complications are higher following this treatment, including a higher rate of preterm labour.
Another option is Managnetic Resonance Imaging (MRI)-guided ultrasound, where doctors use high focused ultrasound waves converted to heat to destroy the tumour. The MRI is used to guide the radio waves to the tumour position.
To achieve this, patients are sedated and placed inside an MRI machine that is specially equipped with the ultrasound. The procedure can take up to three hours.
The heat destroys the fibroids, though frequently two or more sessions may be needed. In the past, similar methods have used lasers or some form of electric current to accomplish the same thing. It is best suited for women who have completed childbearing.
Fibroids and fertility
Millions of people across the globe experience the heartache of infertility or miscarriage. This is often due to a less than optimal environment in the uterus. Yet, six in 10 women dispute (or are unaware) that fibroids affect fertility.
Okunade told Daily Sun that fibroids could block fallopian tubes, making it difficult for a fertilised egg to make it into the uterus. This, as gathered, can potentially cause an ectopic pregnancy within the tube, resulting in a life threatening condition for the mother.
Fibroids can make it difficult for an embryo to attach to the uterine wall, or if they are very large, can impede the growth of a foetus. In addition, many women with fibroids end up delivering prematurely, putting the infant at risk.
Recovering from fibroids surgery
Many fibroids are deep within the muscle, and can be difficult to access. Depending on how many fibroids, or how large they are, there can be painful internal incisions that need to heal.
The likelihood of recurrence after childbearing is often high for women who have fibroids, so after a point, many women decide that removing the uterus is the appropriate step.
Okunada agrees that removing the womb, especially those through with child bearing is a permanent solution to the illness. However, for many women, retaining their uterus, either to become pregnant or other personal reasons, is important.
A myomectomy is usually performed for fertility, and it is essential that the uterus be reconstructed so that after healing it will be strong enough to sustain a growing baby. The benefit of an open myomectomy is that it can be thorough, and the uterus can be reconstructed.