Monday June 2 2014

Fibroids: A common problem few women talk about

Experts say fibroids are among the most common

Experts say fibroids are among the most common conditions among women. photo by Faiswal Kasirye  

By Christine W. Wanjala

Like most health conditions, there is no magic bullet for fibroids, and no “one size fits all” treatment. Fibroids (medically known as uterine leiomyomas) are benign growths in the muscular tissue of the uterus.
The actual trigger for the growth is not known yet. But what is known is that the female hormone oestrogen accelerates their growth.
They are named according to the location within the uterus.
Submuccosal fibroids are those that occur just under the inner lining of the uterus.

Subserosal occur under the outer walls of the uterus while intramural occur within the uterus lining.
Pendunculated fibroids grow on a stalk from the uterine walls and hang either in the uterine cavity or outside.

According to Mulago hospital gynaecologist, Dr Geoffrey Alia, fibroids are the commonest benign condition among women. And in his view, subserosal are the most commonly occurring fibroids.
Estimates put fibroids at affecting up to 60 per cent of women of African descent.

are you at risk?
According to Dr Julia Birungi, a gynaecologist at International Hospital Kampala and Mulago hospital, fibroids more commonly occur in women between the ages of 31 and 35. Although there have been cases of fibroids in girls as young as 14 years. “Women who start their menses earlier, below the age of 10 may get fibroids earlier in life,” she said. As oestrogen levels drop towards menopause the fibroids tend to shrink.

Being of African descent is also a risk factor. Studies have shown fibroids are three times more likely to occur in black women than in Caucasian women.

If there is a history of fibroids in your family, then chances are you may also become a victim. “People whose female relatives have had fibroids are more likely to have them,” says Dr Geofrey Alia.

If you delay pregnancy and child bearing or leave large gaps between pregnancies during one’s reproductive years, then you ought to look out. “The uterus’ exposure to oestrogen for extended periods may explain this,” said Alia.

That is not all, obesity also plays a role as more fat means higher oestrogen levels.

one woman’s experience
I had heard of several people being treated for fibroids, but most of them were women in their 40s. I know one who had gone to a herbalist in Jinja, but I did not really bother to follow up on what happened to her.

A few months after my wedding, I experienced the first of serious abdominal pains. I tried to ignore it but by the end of the week, I simply could not stand it anymore. I had to see a doctor. I thought I had an infection of some sort and the doctor would order some drugs and the pain would go.

He ordered for several tests, including an ultra-sound scan on my belly, which some months prior had progressively become distended.
The results, as he told me, was I had a urinary infection, but I was also one month pregnant and had fibroids, two of them about the size of a fist. I remember being numb from all this information and crying all night.
I only calmed down when I returned and asked my questions.

He told me the fibroids were within the walls of the uterus and that despite them being there, it was still possible that I could still carry the pregnancy to term. I stopped worrying much about the fibroids though my abdomen seemed to be growing by the day and I always felt bloated.

But at around nine weeks, I began experiencing cramp-like pain in my stomach. By then, my abdomen had grown so big that people thought I was in my sixth month of pregnancy yet I had barely made three months.

I was advised to take it easy and all would be well, but the pain persisted. One weekend, the pain which felt more like cramps was intense that I bled a little. I rushed to hospital where a doctor told me it was a false alarm and that all I needed was some bed rest. But that evening I was in pain again and we rushed back. But it was too late and I lost my baby.

The doctor advised me to focus on removing the fibroids before I try getting pregnant again. But they had to be shrunk first before the surgery, otherwise I would risk losing a lot of blood and possibly my uterus.

He knew of my desire to have children, so he wanted to save my uterus. I had the surgery three months ago and only have a slight scar to show now. I am still hoping to get pregnant again, soon. The doctor does not think there is a reason I should not.

Linda, 32

sizes and numbers

According to Dr Geofrey Alia, a gynaecologist, sometimes fibroids are so small they are barely noticeable but they can also grow so big, that they put pressure on other body organs causing complications like difficulty in breathing. They can also be several but the size and number will differ from individual to individual.

Worst case scenario
Pressure from the growing fibroids may affect other organs as earlier mentioned. It could also cause great discomfort.
Heavy bleeding, which if unchecked, could lead to anaemia. The bleeding is thought to be as a result of their increasing the surface area of the uterus. They are also thought to have an effect on the chemical balance which causes more bleeding.

In some instances, fibroids will interfere with fertility either by causing obstruction by compressing the fallopian tubes or preventing implantation of a fertilised embryo. “Fibroids may also cause abortions,” Dr Alia says.

According to Dr Alia, however, submuccosal and intramural are the ones that cause the most fertility problems.

should you be worried

“It all depends on an individual’s symptoms. It is not an easy question to answer en masse,” says Dr Birungi.
Thankfully, fibroids are benign, and Dr Alia says the chance of them becoming cancerous is minimal.

Most fibroids are also asymptomatic, meaning many women will have them and not even notice they do as they will not experience any symptoms at all.
Only a small percentage ends up causing any problems. They are also hard to predict whether they will cause problems later or not, so testing early may not be that helpful. Fibroids are discovered accidentally, or when a person complains of symptoms.

As far as pregnancy goes, doctors recommend having a full pre-pregnancy evaluation to identify anything that might affect your chances of conceiving and carrying a pregnancy.

fibroids and pregnancy

“Fibroids do not cause infertility per se. But depending on size and location, they may cause miscarriage or preterm delivery,” said Dr Birungi adding that those within the uterus lining may raise the risk of abortions. Subserosal, those on the outer wall and pendunculated pose a minimal risk to pregnancy.

As such, it is possible to have fibroids and carry pregnancy to term. However, fibroids are known to cause pain during pregnancy as they undergo a process called red regeneration. According to Dr Birungi, pregnancy may have one of several effects on fibroids. Some may shrink due to increased levels of the pregnancy hormone progesterone. Majority remain unchanged during pregnancy.

In some instances, existing fibroids may grow within the first trimester of pregnancy.
“All in all, pregnancy is a protective factor and the more pregnancies the less likely one will develop fibroids,” she said.

treatment options

How fibroids are approached depends on size, fertility desires, age, other effects they have on the body, symptoms, presence of other morbidity and one’s general health.

Most people think surgery, when they hear fibroids but Dr Alia says not all fibroids require surgery. “Surgery is for those causing problems,” he said, adding that for those that have no symptoms they are best intervention method will be conservative observation.

Medical advancement means there are several options now for the treatment of fibroids. Some interventions like MR-guided ultrasound which directs high intensity ultrasound to the fibroid causing it to disintegrate is still not readily available this side of the world. But there are other methods like uterine artery embolisation which involves blocking the blood supply to the fibroid and thus causing it to degenerate.

Surgery involves either the removal of fibroids or of the uterus as a whole. Even under this, there are less invasive procedures.
And there are medical methods to improve the symptoms before surgery. Dr Alia says if the fibroids are too big, the approach is to try and shrink the fibroids by introducing doses of progesterone. “However, this is usually done before the surgery as it only achieves short-term result,” he says.

Except for hysterectomy, which is the removal of the whole uterus, no treatment method will make you 100 per cent fibroid free. “There is always a risk of fibroids recurring as long as one is still of reproductive age and the treatment option left the uterus intact,” says Dr Birungi.

similar conditions

According to Dr Birungi, the following may have some symptoms similar to fibroids. To be certain, you need to see an obstetrician/gynaecologist who will examine and order the relevant investigations.
•Endometriosis-The tissue that lines the uterus grows outside the uterus. It is characterised by heavy bleeding and abdominal pain.
•Adenomyosis-Here the uterine lining also known as the endometrium grows into the uterine wall.
The symptoms are pressure in the abdomen, bloating, severe cramps and a prolonged heavy bleeding during ones menses.
Other pelvic tumours- They may also cause discomfort and pressure symptoms.

contraceptives and fibroids

According to Dr Julia Birungi, some hormonal contraceptives have an effect on fibroids. “Progesterone only can be given in low doses to manage some of the symptoms like bleeding. Basically to improve symptoms,” she said.
The experiences of women with fibroids vary greatly, and it is really up to each woman to reflect on which of her symptoms needs addressing, and how she wants to do so. It is important to keep in mind that not all fibroids require surgery.

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