January 17, 2017

How misconceptions, late presentation delay treatment of fibroids in Nigeria



By Sola Ogundipe

Every woman shivers in fear when she is diagnosed with  fibroid tumour. But experts say there is little to fear. Research shows that in more than 99 percent of fibroid cases, the tumours are benign (non-cancerous).

“These tumours are not associated with cancer and do not increase a woman’s risk for uterine cancer. They may range in size, from the size of a pea to the size of a softball or small grapefruit, but there is no association with cancer,” an expert confirmed to Good Health Weekly.

Excellent treatment

Also debunking the cancer myth, a Professor of Obstetrics and Gynaecology at New York University Medical Centre, Dr. Steve Goldstein observed that: “There is virtually no threat of malignancy – and there are a number of excellent treatment options, as well as the option to do nothing at all – so there  is no reason to worry.”

FIBROID SURGERY: Research shows that an estimated 7 in 10 black women are affected.

In 2005 when Beatrice, an Immigration Officer was diagnosed with uterine fibroids, it was a difficult  decision for her to accept to undergo surgery to have the fibroids removed. “I got married at 30 became pregnant afterwards and had my baby at 31,” she told Good Health Weekly in a chat.

Beatrice  tried to get pregnant again, but without success. “Two years after I had my child, I noticed that I was bleeding heavily. I went to Dubai, had series of checkups and tests before i got to know that I had fibroid.”

Beatrice opted to return to Nigeria but kept postponing the surgery. “The bleeding continued and I was constantly anaemic and dizzy, until I knew I had to go for the surgery in 2007.”

She had a successful fibroid removal surgery called Myomectomy that allows the uterus to be left in place without losing function, and, for some women, makes pregnancy more likely than before.

Beatrice thought her problems were over, but she was wrong. Five years after the myomectomy, the fibroid returned and she began to bleed again. “After the surgery, the doctor had warned that if  I did not get pregnant  soon after, the fibroid would recur. But I had been trying to get pregnant without success.

Regrowth offibroids

“Five years later I started experiencing the same bleeding again,  I went back to the hospital in Dubai and was really devastated when  I got to know that the fibroids had regenerated. So i had a second myomectomy. Deborah was also diagnosed years ago. When she began experiencing heavy bleeding, her stomach protruded because the fibroids were large, and the only surgery she was offered was a hysterectomy.

She decided to do nothing, but as the symptoms worsened over the next four years, she was forced to change her mind.

“I looked pregnant, people used to ask when the baby was due, and I sometimes struggled for breath while exercising.”

Today, Deborah is free from the misery of fibroids and without losing her uterus.

Many women with fibroids are like Beatrice and Deborah. They delay treatment.  Many turn down fibroid surgery because of myths and misconceptions. A common myth is  that  the  womb would be removed through hysterectomy (surgical removal of uterus). However, medical experts say there are several options that help preserve the uterus. Myomectomy is often the preferred fibroid treatment for women who want to become pregnant.  While it is not clearly known what causes fibroids, it is believed that each tumour develops from an aberrant muscle cell in the uterus which multiplies rapidly because of the influence of estrogen.

Fibroids are widely misunderstood and a number of misconceptions that create confusion for women with fibroids have been cleared up over time, yet they persist.

Common misconceptions: Perhaps one of the commonest misconceptions is that every woman with fibroids will experience heavy menstrual bleeding and pain.

However, researchers estimate that between 50-80 per cent of women with fibroids will experience no fibroid symptoms at all. Many women never even know that they have the condition and because fibroid tumours are almost always benign (non cancerous), those who aren’t experiencing symptoms may not seek treatment.

Laparoscopic ultrasound

It is also incorrect to expect that a routine ultrasound scan will detect any uterine fibroid. Doctors say the size and location of uterine fibroids varies greatly, and extremely small fibroids are not always detectable through a routine pelvic ultrasound, so a  laparoscopic ultrasound, which requires inserting a scope through the vagina and into the abdominal cavity, is usually preferred as it can detect up to twice as many fibroids as transvaginal ultrasound.

Fibroid tumours are almost always benign, so simply having fibroids does not increase a woman’s chances of developing cancer in her reproductive organs.

If left untreated, fibroids will not continue to grow throughout a woman’s lifetime. Fibroid growth is fueled by estrogen. Fibroids will grow and shrink in response to the body’s hormone fluctuations and although fibroids do tend to disappear naturally after menopause, pre-menopausal women who are suffering with symptoms of uterine fibroids may not want to wait.

It is also not true that undergoing fibroid removal surgery will render a woman infertile, as several women that have undergone surgery have concieved and given birth successfully.

When fibroids are interfering with the quality of life, doctors say it’s advisable to discuss treatment options with a gynecologist.

In a hospital based study to assess the level of knowledge, perception, and attitude towards uterine fibroids among women diagnosed with the condition, Dr. M. A. Adegbesan-Omilabu and K. S. Okunade, both of the Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, LUTH, and Dr A. Gbadegesin, of the Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, LASUTH, discovered that there is generally poor knowledge about uterine fibroids among women in Lagos.

Fibroids and infertility

In the study entitled “Knowledge of, Perception of, and Attitude towards Uterine Fibroids among Women with Fibroids in Lagos, Nigeria”, published in Scientifica – a peer-reviewed, Open Access journal, it was observed that several  women were taking over-the-counter drugs that are likely to enhance the growth of fibroids. From the study review, it was  observed that the majority of the women studied had various misconceptions about fibroids and infertility.

The study showed high level of awareness of fibroid among the respondents (98.6 per cent per cent), although found a high level of misconception about the disease that was attributed to a reflection of numerous advertisements and publicity generated by the traditional medical practitioners on both electronic and print media.

According to the study: “Most of the respondents (33.3 per cent) were aware that fibroids are commonly seen in nulliparous, obese, and black women.  About one-fourth (26 per cent) of these women were also aware that fibroids run in the family perhaps because these women have relatives that also have uterine fibroids.

“Most of the women (67.0 per cent) perceived fibroid as a spiritual problem and hence sought treatment from the spiritual homes and invariably presented late to the hospital.” The fear of complication of surgery for fibroids made many seek alternative means of treatment, the researchers noted, saying it is not unlikely that this fear of surgery was borne out of misinformation that they might have obtained from the mass media, although surgery for uterine fibroid is not without complications.

Intensive enlightenment

The researchers said many of the respondents have used most of these herbal products either singly or in combination with some orthodox drugs such as bromocriptine, cod liver oil, or clomiphene citrate at one point or the other in the past.

In their recommendation, the researchers stressed the need for intensive enlightenment about the aetiology and modality of treatment of fibroids through the print and electronic media. Further they called for the involvement of qualified health care professionals in the public enlightenment and campaign, saying such measure would go a long way in quelling the various misconceptions about the condition among the populace and also encourage early presentation and hence prevent complications that accompany surgical operation of huge fibroids.

Common symptoms: A protruding abdomen, bleeding between menses, continuous bleeding or heavy flow, menorrhagia, severe abdominal pain even when they don’t menstruate, a hard mass in the abdomen, some will tell you they cannot pass urine, pains during sex, etc. Fibroids can make a woman urinate more frequently,  depending on how heavy and location it can degenerate  and protrude and come out on its own, dragging the uterus, such that the woman cannot walk. In short, fibroids are  really troublesome for women.

The manifestations are different, sometimes the pain is so much and there could be peritonitis. It does not allow the woman  eat and she may vomit torrentially. There is pressure on  the  kidneys, spleen,  liver or other organs in the abdomen.

In medical circles, if it is not problematic, leave it but once it begins to give symptoms it becomes and issue. For the woman, it is either she wants to live with the fibroid and continue with the problems, or take it out and end the problem.

Risk factors: Women approaching menopause are at the greatest risk for fibroids because of their long exposure to high levels of estrogen. Experts say fibroids become more common as women age, especially from the 30s and 40s through menopause. After menopause, fibroids usually shrink.

Symptomatic fibroids

“Having a family member with fibroids increases risk. Black women and women that are obese are more likely to develop fibroids. Black women also tend to have multiple and larger fibroids and more symptomatic fibroids at the time of diagnosis.”

According to a gynaecologist, when the womb is dormant, fibroids are found there, however, nowadays we see fibroids co-existing with  pregnancy.

Research has also shown that some factors may protect a woman from developing fibroids. Some studies, of small numbers of women, have indicated that women who have had two liveborn children have one-half the risk of developing uterine fibroids compared to women who have had no children. Scientists are not sure whether having children actually protected women from fibroids or whether fibroids were a factor in infertility in women who had no children.

A surgeon at the LUTH told Good Health Weekly that the diagnosis and treatment of fibroids is often straightforward, but often complicated by late presentation.

“But it is not every woman with fibroids that  needs surgery, it has to be that this fibroid is causing the woman some problems either bleeding or pressure symptoms or infertility or it is becoming so much of a weight and the woman is deformed by fibroid. When that happens, the woman must  be helped. There is hope and if you have fibroid it is not the end of the world.”

In the views of Adebola, 40, sometimes late marriage contributes to the development of fibroids. Adebola who has undergone fibroid surgery twice believes that the condition is not natural. “Our grandparents married early and had many children and the issue of fibroids was not as serious or prominent as it is now. Perhaps that is why there has not been much awareness till recently.

“I have tried the traditional  it was done for me, my whole body pained me for days and I decided not subject myself to that torture again, so I now preferred the medical way,” she opined

According to Dr. Moses Ani, an experienced family physician and surgeon,   fibroids affect at least 20 percent of all women sometime during their life, however, clinical evidence shows that women aged between 30 and 50 are most likely to develop fibroids.

Common factor

Ani, who created Irene Fibroid Foundation in Festac, Lagos,  as an outfit to help women tackle the menace of fibroids and its related effects on the family and lives of women especially the indigent, said the common factor among fibroid patients is that they are women, they have large size abdomen. Women who secrete hormones.

“Fibroids can determine if a woman will have normal delivery or undergo Cesarean Section because if the fibroids are in the lower segment of the uterus, there is no way the woman can put to bed naturally. The fibroids and the head of the baby will be in competition.

“Usually the woman with fibroid come in very sad. Most times what you have is the woman saying she has been married for years without a child. Some come and say they have been menstruating unending others say they have been losing so much blood, they are dejected.”

Ani observes that most of the women that have surgery  do get pregnant, but there is a percentage that come out with other secondary issues such as blockage of the Fallopian tube, etc. “When a woman goes into menopause, the tendency is that the ovaries atrophy (shrink). But even if you are postmenopausal, you can still have fibroid, large ones. Sometimes the best thing is removal of the fibroids.”