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UTERINE FIBROID

WHAT ARE FIBROIDS?

ANS: Fibroids are benign tumours of the muscle of uterus (womb). They are one of the most common tumours found in women during their reproductive years. They are more common in women who have not had any child, women who are overweight and black women. Normally, fibroids grow slowly. However, they respond to increased level 'of oestrogen which allows them to expand rapidly during pregnancy or if a woman is taking oral contraceptive or oestrogen replacement therapy. After menopause, these tumours usually shrink and often disappear completely.

HOW DO YOU SUSPECT ONE HAS FIBROIDS?

ANS: Majority of women with fibroid will have no complaint; therefore will not know they have fibroids. Common symptoms include heavy and painful period, abdominal swelling, infertility, urinary/bowel symptoms caused by local pressure from the fibroids. In women who do conceive, the fibroid may cause complications in pregnancy, including miscarriage, premature labour and pain. Where in doubt, diagnosis is usually confirmed by ultrasound scan. Other ways include hysteroscopy or CT scan.

WHAT IS THE ASSOCIATION BETWEEN FIBROID AND CHILDBLESSNESS?

ANS: It is estimated that infertility is the major presenting factor in about 27 percent of women with fibroids. The percentage is higher in black women. Infertility in this part of the world is often of multiple origins. It is therefore not uncommon for a woman with uterine fibroids to have tubal blockage, chronic anovulation "or an associated male factor in terms of poor sperm quality. There is therefore a need for detailed investigations in all cases of infertility to identify all factors responsible, so that proper treatment can be given. Fibroids may cause cornual occlusion or distort the cavity thereby interfere with implantation; distort the normal relationship between ovary and tube thereby interfere with ovum pick-up. There is also an increase in the prevalence of spontaneous abortion, premature labour, abnormal lie and bleeding after delivery in women who get pregnant with fibroids.

WHEN SHOULD FIBROIDS BE TREATED?

ANS: Fibroids should be treated if they are causing symptoms as described above, or in certain cases if a woman is trying to conceive. The age is important since fibroids tend to continue to grow under the influence of oestrogen, and it is true to say that in younger women, they are easier to remove whilst they are small.

HOW SHOULD THEY BE TREATED?

ANS: Treatment depends on the size and site of the fibroid. The options include:

• Hormonal treatment
• Fibroid embolisation
• Myolysis/Cryomyolysis
• Hysteroscopy surgery
• Conventional surgery (Myomectomy)
• Hysterectomy

CAN DRUGS SHRINK?

ANS: Hormonal Therapy can be useful for women who are close to menopause and wish to avoid surgery, but hormonal treatment is unlikely to be of any benefit in women who wish to conceive and avoid unnecessary delays. Unfortunately, the shrinkage only occurs while the woman is on the drug and there is a rebound growth once the drug is stopped. These drugs can be used to shrink fibroids before surgery to reduce the complexity of the procedure.

MYOMECTOMY

Myomectomy is the removal of fibroids by a surgical operation. Myomectomy for infertile patients should be considered early after extensive investigations to rule out other causes of infertility. It is an operation that should not be taken lightly in view of possible complications like accidental damage to the fallopian tube and peritubal adhesion formation which would further compromise the chances of the wpman getting pregnant in future. Intra-operative bleeding which could be life threatening does occur in view cases. It is therefore an operation that should be carried out only by qualified gynaecologists in well-equipped centres.

The fact that there is possibility of recurrences should not discourage affected women from seeking help early, as delay will only complicate the problem.

WRONG TREATMENT METHODS

Sometimes, certain incorrect measures are embraced in the treatment of fibroids and these include:

•   Failure to seek treatment early, leading to further increase in size of fibroids.
•   Use of ineffective herbal medicines recommended by alternative practitioners.
•   Reliance on the efficacy of prayers without prompt, necessary action.

MYTHS/MISCONCEPTIONS CONCERNING FIBROIDS

•   That patients always die following operations and that myomectomy always leads to      infertility.
•   That insertion of herbal pessaries into the vagina can dissolve fibroids and that      ingesting local gin on an empty stomach can burn off fibroids.
•   That chronic staphylococcus infection causes the development of fibroids.
•   That inducing diarrhoea with certain herbs can result in the fibroids being passed out      as faecal matter.

CONCLUSION

Fibroids are common condition, causing symptoms in less than half of cases. A range of conservative treatments now exists for the management of these symptoms, some of which may improve the chances of conceiving, either following fertility treatment or natural conception. A fertility specialist will conduct thorough investigation and evaluation in its entirety to detect other contributing factors of infertility before recommending appropriate management plan, taking into account the woman's age, symptoms and her desire for further pregnancies.

NOTE: The material contained herein is by no means exhaustive. For details and further enquiries, please contact a consultant Gynaecologist.

DR. Y.O. SANUSI, MBBS, FWACS, MBA (IFE) Consultant Obstetrician & Gynaecologist. Isalu Hospitals Limited, 10 Wempco Road, Ogba-lkeja, Lagos, Nigeria.

Tel: 234-1-0803-308-9592, 234-1-792-8206, 234-1-818-3134.