Many women go about with protruding stomach even when they are not pregnant. It is common to find women looking fat at the waist region. Findings show that many of these women have fibroids. About seven in every 10 black women are, according to a research, affected by fibroids. Today, fibroids are widespread. Statistics from hospitals also reveal that at least one in every four Nigerian women will develop one or more fibroids in her lifetime. Fibroids are no doubt part of the contributor to the increase in needless deaths among women. Quite a number of women who died, even celebrities, have been linked to complications arising from fibroids. Sunday Vanguard looks at the burden of the condition, why it is on the rise and treatment options.
Fibroid tumor
Patients stories
It has been difficult living with fibroids,” says Mrs. Bola Ayeni. Married at the age of 38, Bola has had this bulky stomach for years. She also struggled led with persistent bleeding, frequent urination, and cramping.
The bleeding sometimes comes so heavy that she would be confined within the walls of her bedroom for days. Even her finances are not spared as she uses between 11 and 15 pads a day anytime she is menstruating.
The pains and bleeding were so unbearable that she did whatever that comes her way including patronising native doctors.
“I have looked for solution from even places you cannot imagine but at the end of the day, there was no relief. Everybody thought it was, spiritual problem until it was finally confirmed that I have uterine fibroids, Bola told Sunday Vanguard.”
At this point, desperation set in. In a desperate move to end the pain and at the same time have a child, she said: “Many people have advertised all sorts of cure which I have tried, all of the herbs that you can imagine and they worked for a while, but it’s very expensive because you have to keep on going.”
Within a space of five years after marriage, Bola had several miscarriages. It became so bad that she resigned from her job. Although, medical diagnosis revealed she has about seven fibroids in the uterine cavity, where the foetus would have occupied if all was well, Bola never backed down on her determination to give her husband a child.
Just like every other Nigerian woman, she visited many prayer houses in search of solution. Unfortunately, the fibroids continued to increase in size, causing more harm and discomfort.
“Fibroids have compromised my career and life but knowing I may never be able to conceive is my worry. I’m not giving up on my desire to have children,”she said.
Months after months, her cycle started getting longer and longer. “It felt like I was bleeding all the time. My energy was low, and my relationships were strained. My bleeding was so severe that I felt very vulnerable and tied to my home. I did not want to be embarrassed. I was always having lower abdominal swelling and this has persisted for years.
“I was also having constipation even after eating a full plate of fruits. I have been afraid of doing surgery for some reasons. There have been stories about people who could not conceive after surgery. The worst part is that so many women have lost their lives after complicated fibroid surgery”.
Meanwhile, Bola is not alone. Felicia, an accountant, has similar story to tell. Married at age 40, after she obtained a master’s degree from the University of Lagos in 2003, Felicia never have any inclination what life held in store for her.
Unfortunately, after two years of blissful marriage and continuous sexual activity without any sign of pregnancy, she decided to consult a gynaecologist. She visited many hospitals until she was finally diagnosed of uterine fibroids; it was a trying time for Felicia and her family. According to experts, fibroids usually develop in women aged between 30 and 50 years and seem more regular in women who weigh over 70 kg. Fibroids are growths of the uterus or the womb. They are also called uterine leiomyomas or myomas. The uterus is made of muscle, and fibroids grow from the muscle. Fibroids can bulge from the inside or outside of the uterus.
“At 42, the thought of surgery was not an option for me. I got married at 40; since then I have been trying to get pregnant”, she said. All her efforts were without success.
Sadly, her bleeding during her cycle continued and she was constantly anaemic and dizzy, until her husband insisted she must go for surgery. A year after, she had a successful fibroid removal surgery called myomectomy, which allows the uterus to be left in place without losing function, and, for some women, it makes pregnancy more likely than before.
Felicia was relieved from the pains and bleeding, but little did she know that the problem was not yet over. Today, Felicia is battling another set of fibroids. The fibroids, according to experts, returned because she was unable to get pregnant immediately. Although doctors have advised Felicia to go for another surgery; she has decided to do nothing about it. “I look pregnant, people ask when the baby is due, and I sometimes struggle for breathe while exercising.”
Describing the ailment as her worst experience in life, she said: “I cannot wish it for my enemy. I don’t like talking about fibroids because of the psychological trauma it has caused me.”
Bola and Felicia, like many other Nigerian women, are overwhelmed by fibroids due to ignorance, misconceptions, late marriage and conception.
Today, there seems to be epidemic of fibroids among Nigerian women. More pathetic is the fact that myths and misconceptions about fibroids have tied so many women to the pains and frustrations of fibroids. Out of ignorance, they delay treatment and turn down surgery.
One of such myths is that the womb would be removed through hysterectomy (surgical removal of uterus).
However, medical experts have traced rising cases of fibroids to late marriage and conception. According to them, these factors are currently fuelling cases of fibroids.
They say many African women are postponing child birth which could cause the hormones (estrogens) in the uterus to malfunction.
In a report, Chief Consultant Radiotherapist and Oncologist, National Hospital, Abuja, Dr Abdurasaq Oyesegun, said fibroid was on the increase.
Oyesegun said the uterus was designed to carry baby and when such did not happen, the muscles in the uterus will increase to the point that it will become fibroid.
“The uterus is designed to carry babies and when it cannot carry babies, the growth increases and the muscles keep increasing. There is an increase in the incident of fibroids among women these days because women now get married late, and the only way to prevent it is for women to marry early.”
He advised women to marry in their early 20s to avoid the possibility of developing fibroid.
Debunking misconception on the link between fibroids and cancer, Oyesegun said fibroid was a non-cancerous growth in the womb that could sometimes cause heavy periods, abdominal swelling and urinary problems. He said although it was possible for young women to develop fibroid, it was not very common. According to him, early marriage would also enable women not to have difficulties in child-bearing. “Women with fibroid should patronise qualified gynaecologists because most deaths arising from fibroid operations were due to the activities of unqualified personnel,”he stated.
Supporting his views, an obstetric gynaecologist at the University College Health Sciences, Kampala, Uganda, Dr. Eve Nakabembe, explained that when conception is delayed, estrogens that is the hormones responsible for developing a baby in the womb tends to malfunction as a result of which the individual will start developing fibroid.
“We are seeing them more because African women are now postponing child-birth. And it is more in Catholic nuns because they don’t get pregnant and they have long duration of estrogens that are unchallenged. But when a woman is pregnant, she doesn’t ovulate. At that time the uterus is relaxed and then hormones are challenged.”
She explained that although the cause of fibroids is unknown there is no sure way to prevent them, adding that fibroids can be negatively influenced by female hormones.
“Depending on your nutrition you can surge your hormones more than necessary. Regular exercise and reducing BMI, reduces the amount of circulating estrogens.”
Myths
On the myth that the womb would be removed through hysterectomy to eliminate fibriods, she listed, options that help preserve the uterus.
According to her, fibroids are managed depending on how the patient wants it. “We base treatment on the fertility desires of the patient, that is, if the patient still wants to have children or has stopped a child bearing. Most times we perform hysterectomy or myomectomy depending on what is available. It can also be treated through uterine artery embolism.”
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.
According to 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 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. In the study, 67 percent of the women perceived fibroid as a spiritual problem and hence sought treatment from spiritual homes and invariably presented late to the hospital.
Furthermore, the fear of complication of surgery for fibroids has also made many women seek alternative means of treatment. The researchers further noted that the fear of surgery was borne out of misinformation that they might have obtained, although surgery for uterine fibroid is not without complications.
While calling for intensive enlightenment on the aetiology and treatment of fibroids, the researchers said many of the respondents have combined herbal products and some orthodox drugs at one point or the other in the past.
Throwing more light on the condition, Dr. Moses Ani, a family physician and surgeon, observed that most of the women that have surgery do get pregnant, but there is a percentage that comes out with other secondary issues such as blockage of the fallopian tube. “When a woman goes into menopause, the tendency is that the ovaries atrophy (shrink)”, he stated.
Consequently, as fibroids continue to threaten the lives of Nigerian women, critical health watchers are of the view that there is urgent need for government to design a programme to tackle fibroids as a public health issue.
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