How exercises can reduce risk of uterine fibroids

Uterine fibroids, also known as leiomyomas, are noncancerous growths or tumors that develop in the muscular walls of the uterus.

They are the most common type of swellings or masses in women of reproductive age, and can vary in size from small and undetectable to large enough to cause significant discomfort and complications.

Fibroids can be classified according to their location in the uterus. They can grow on the outside of the uterus (subserosal), inside the uterine cavity (intracavitary), or within the uterine wall (intramural). However, some women may have multiple fibroids in different locations.

Causes

Dr Peter Kungu, a resident pathologist at the College of Health Sciences, Makerere University, said the exact cause of uterine fibroids is not fully understood, but several factors may contribute to their development, including estrogen and progesterone hormones that stimulate the growth of the uterine lining during the menstrual cycle. Excessive levels of these hormones may cause fibroids to grow and multiply.

The other cause, Dr Kungu said, is genetics whereby the fibroids may run in families, suggesting a genetic predisposition to their development.

In addition, he said age can also be a cause since the disease is prevalent in women between the ages of 30 and 50, and tend to shrink after menopause when hormone levels decline.

Race is also another cause of the disease whereby, Dr Kungu said, Black women are more likely to develop fibroids than women of other races because of their genes.

“Black women, according to studies, have higher estrogen and progesterone hormone levels and have poor access to healthcare services,” he told Saturday Monitor in an interview on Tuesday.

Dr Godfrey Esiru, a retired gynaecologist  in the Department of Reproductive Health at the Ministry of Health, also said uterine fibroids are prevalent but the exact cause is not well known .

“The exact cause is not known but we think it is related to hormones. Sometimes, we think the cells of the uterus overreact to the hormones and then cause the problem,” he said in a telephone interview yesterday.

Symptoms

Dr Kungu said many women with uterine fibroids do not experience any symptoms, and the tumors are discovered incidentally during routine pelvic exams or imaging studies.

However, for some women, fibroids can cause a variety of symptoms, including heavy or prolonged menstrual bleeding, painful periods, pelvic pain or pressure, frequent urination, difficulty in emptying the bladder, constipation, pain during intercourse, abdominal swelling or bloating, and anemia due to excessive bleeding.

The severity and frequency of the symptoms may vary depending on the size, number, and location of the fibroids.

There is limited data on the prevalence of uterine fibroids in Uganda. However, Dr Kungu said it is known that uterine fibroids are a common gynaecological problem in Africa, and studies have suggested that the prevalence of fibroids in African women is higher than in women of other races.

A study conducted in 2015 in Mbarara, Uganda, found that uterine fibroids were the most common benign gynaecological tumor among women attending a regional referral hospital, with a prevalence rate of 11.8 percent.

Another study conducted in 2017 in Kampala, Uganda found a prevalence rate of 15.5 percent among women attending a gynaecology clinic.

Prevention

Dr Kungu said there is no guaranteed way to prevent the development of uterine fibroids.

However, there are some steps that women can take to reduce their risk or lower the likelihood of fibroid growth and complications, including maintaining a healthy weight by balancing their diet and exercising regularly.

“There is no scientific evidence, however, regular exercise helps to maintain a healthy weight and reduce the risk of obesity-related health problems, including fibroids,” he said.

He also advised women to balance their diet by eating healthy foods such as fruits, vegetables, and whole grains that may reduce the risk of fibroids.

He adds: “A diet high in red meat and low in fruits and vegetables may increase the risk.”

He further advised them to manage stress since it plays a bigger role in the development of the condition. This can be done by practicing stress-reduction techniques such as meditation, yoga, or deep breathing.

He also said birth control pills can help reduce the risks of getting the disease whereby birth control pills may help to regulate the menstrual cycle and reduce the risk of fibroids.

If fibroids are detected, seeking prompt medical treatment may help to reduce the risk of complications and the need for more invasive treatments.

Who is at risk?

Dr Peter Kungu, a resident pathologist at the College of Health Sciences, Makerere University, said uterine fibroids are common in women of reproductive age, especially women between the ages of 30 and 50.

Other factors include women who have genetic fibroids history, Black women, women who are overweight or obese, women who have higher levels of estrogen and progesterone, which are hormones that stimulate the growth of the uterine lining, women who have never given birth or had a late first pregnancy, and women who consume a diet high in red meat and low in fruits and vegetables, and those who consume alcohol.

Background

According to a 2010 World Health Organisation report, fibroids affect between 20 percent and 25 percent of women, and close to 235 million women, representing 6.6 percent of the global women population.

A group of researchers from Mbarara University established in their 2022 research study on the prevalence, clinical  presentation and factors  associated  with  uterine fibroids among  women  attending  the  gynaecology  outpatient   department   of   a   large   referral   hospital   in southwestern Uganda, out of the 319 study participants who were enrolled into the study, 90 (28.2 percent) of these had uterine fibroids.

The study, however, indicates that there were significant differences in age groups, marital status, body mass index and age of menarche (the first occurrence of menstruation) between women with and those without uterine fibroids. That is to say, women with fibroids were older than those without and were mostly in the 31 to 50 age category.

 Of  the  90  cases  with  uterine  fibroids,  67 (74.4 percent)  were  symptomatic,  while  23  (25.6 percent)  were asymptomatic and the majority respondents with uterine fibroids  had  lower  abdominal  pain  (72.2 percent),  menorrhagia were 63.3 percent, irregular menses were 50 percent, pelvic mass were 22.2 percent, failure  to  conceive  (10 percent),  recurrent  miscarriage  (4.4 percent) and  urine  retention  (2.2 percent)  was  the  least  common  of  the clinical presenting features.