Africa-Press – Uganda. Fibroids are swellings or noncancerous gynecological tumors in premenopausal people, which according to the Office on Women’s Health, may affect between 20 and 80 per cent of people before the age of 50.
The uterus has the muscle and the fibrous tissue. This is the reason they are also called fibromyomas, leiomyomas or myomas. It is estimated that at least 20 per cent of women by the age of 30 have fibroids in Uganda. Although there is no tangible cause, there are predisposing factors. Dr Stephen Kyakonye Kaddu, a gynaecologist at UMC Victoria Hospital, said chromosomal abnormalities are related to genetics. When one of the family members has them, the fibroids are automatically passed on to an offspring.
“They are also common in women who delay to have children. The earlier one has children, the lower the risks of developing fibroids. When you are pregnant, there are many hormones which are reduced, taking an example of estrogens which are suppressed by progestin, the hormones that are more active during pregnancy,’’ Dr Kaddu said. GrowthDr Kaddu says he once removed 61 fibroids from a 21-year-old. Results show that the girl had them for a long time because by the time she went to the hospital, she was anaemic. Dr Kaddu also said the fibroids can grow as heavy as four kilogrammes if one takes long to get surgery.
He added that the fibroids grow by two centimetres every year.“As they grow bigger, they get into the uterine cavity. Once that happens, one starts getting issues with their menstrual periods,” he said. Pregnancy and menopauseMuch as pregnancy reduces the risk of developing fibroids, getting pregnant when one already has the fibroids is termed as unhealthy.
Because there is a lot of blood going to the uterus when one is pregnant, it ends up feeding the fibroid too. This increases its chances to enlarge.
That is one of the reasons why one could have pain during pregnancy.
When one goes into menopause, the estrogens keep reducing and the fibroids cease to grow and start shrinking by themselves because the estrogen hormones are cut off. Fibroid ignoranceThere is no clear prevalence rates of the exact number of women in Uganda with fibroids, and this is attributed to lack of enough scanning. By the time someone figures out they have fibroids, it is when they already cannot take the effects or discomfort anymore.
Treatment is also another challenge. “You get someone who has already got fibroids. When you advise them that the stage they are in needs operation, they will tell you they want to first do the herbal medicine, which puts them in more danger,” Dr Kaddu said. Knowing you have fibroidsNormally, the symptoms depend on the type of the fibroids one has. If it is subserosal and intramural, a woman may not have any issues with their periods so she can only know when she gets uncomfortable or appears ‘pregnant’.
Some affect the menstrual cycle. “One may start from their normal three days of menses to five or more days with clots and an increased number of pads too. Eventually, because you lose too much blood, you may become anaemic. You may also get a headache and the rapid beating of the heart plus, of course, dizziness,” Dr Kaddu said.
At the age of 20, it is advised to do a scan to make sure you are okay.
If you start feeling like your tummy is swelling or your periods are getting heavier, you could go for a scan to find out why. Otherwise, doing a scan annually is the right thing to do. InfertilityInfertility rates depend on where the fibroids are located. If the fibroid is around the area where the Fallopian tubes attach to the uterus, it may block the movement of spermatozoa. That is one way they cause infertility.
When there are very many, the uterine cavity becomes long, and you find that the spermatozoa have a long distance to find the other end of the tube so they die before they reach the eggs. That means there is no conceiving taking place which may lead to infertility.
Even when you have conceived and you have mucus fibroids, the embryo may fail to attach. This normally ends in a miscarriage.
When the baby has stayed in the womb until the birth date, normal delivery is difficult. This too depends on the location of the fibroids. When the fibroids are on the lower side of the uterus (towards the cervix), the cesarean section there is paramount.Because of the uterine contractility, one may have postpartum haemorrhage. TreatmentNot every fibroid must be operated. Treating intramural fibroids often involves “watchful waiting.” Your doctor will monitor your symptoms for changes and examine you to see if the fibroids have grown in size.
If you begin to experience significant symptoms, your doctor may recommend other treatment options, including: Myomectomy, the surgical procedure removes the fibroid while leaving the uterus intact.
Hysterectomy, with this surgical procedure, your doctor will remove the entire uterus to prevent further complications from fibroids.
Uterine artery embolisation (UAE). This technique cuts off the blood supply to the fibroid. The goal of a UAE is to reduce the size of the fibroid or completely eliminate it.
Gonadotropin-releasing hormone (GnRH) agonists. This treatment lowers estrogen levels and triggers medical menopause. The goal is to shrink or eliminate the fibroid.
“There is a woman I operated on recently and after three months, she conceived. Some people kept telling her that she will not be able to carry the pregnancy. She kept coming in for consultation and I affirmed to her that she will be able to bear the child. In early March, although it was through the cesarean section, she delivered her child,” Dr Kaddu said.
There is an injection called Zoradex which shrinks the fibroids. This is however, not a permanent solution. Once you stop the injections, the fibroids tend to grow back to their original size.
It is also limited to a maximum of six months and not a cheap venture.
The limitation happens because the injection has side effects once it is taken more than six times.
“It has a way of affecting the bones by making them weaker. Because it is a hormone too, it disrupts one’s menstrual flow. One may miss certain months and at times conceiving may become difficult. This injection goes for an average of Shs400, 000.
“This option is considered when the doctors are planning for an operation but they are too big or too many. The medicine helps to shrink the fibroids and reduce the blood flow to the fibroids so that operation becomes easier,” Dr Kaddu said. Laparoscopic surgeryLaparoscopic surgery is also performed on women whose fibroids are not so big.
According to Medlife, laparoscopic surgery is a surgical technique in which short, narrow tubes (trochars) are inserted into the abdomen through small (less than one centimetre) incisions. Through these trochars, long, narrow instruments are inserted. The surgeon uses these instruments to manipulate, cut, and sew tissue.
The other option is about embolisation. It is still rare in Uganda but can be found in a few hospitals. It is a non-surgical way of treating fibroids by blocking off the uterine arteries that feed the fibroids and making the fibroids shrink. It is performed by an interventional radiologist, rather than a surgeon, and is an alternative to an operation.
The radiologist uses a slender, flexible tube (catheter) to inject small particles (embolic agents) into the uterine arteries, which supply blood to your fibroids and uterus, without surgery.
Because there is radiation, this may lead to infertility, which is why it is not recommended for women who still want to give birth.
After one’s fibroids have been removed, they are advised to try and conceive after a maximum of six months. When one waits for more than three to five years the fibroids tend to grow back.
Types of fibroids- Intra mural fibroids An intramural fibroid is a noncancerous tumor that grows between the muscles of the uterus. As it grows, the uterus appears larger.As these fibroids grow, they can cause excessive menstrual bleeding, which can cause prolonged menstrual cycles, clot passing and pelvic pain. This happens from the additional pressure placed on surrounding organs, which consequently cause frequent urination and pressure.- SubmucosalThese grow on the walls of the innermost layer of the uterus where the menstrual flow passes. No matter how much small it may be, it may still cause one to lose a lot of blood during menses that may need transfusion in the later days, unlike the rest of the types.- Subserosal fibroidsThis happens on the outer membrane of the uterus. It may not cause serious pain but the bigger it gets, the more uncomfortable it makes you feel in addition to putting pressure on the surrounding organs. This is when a woman appears to be pregnant as the fibroid enlarges. -Pedunculated fibroids. These fibroids grow on a stalk, just like a baby grows from the umbilical cord. They may cause pain and pressure because they tend to twist on their stalk.
