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An Obstetrician and Gynaecologist at Lagos University Teaching
Hospital (LUTH), Kehinde Okunada, told Daily Sun that one out of every
two black women is living with fibroid in her uterus. According to him,
although all uterine fibroids are the same, they are categorised based
on their location in the body.
He explained that fibroids most commonly occur among women between
the ages of 30 and 40, and above, with black women at greatest risk.
A professor of obstetrics and gynaecology at NYU Medical Center,
United States of America, Steve Goldstein, describes fibroid tumours to
be composed of renegade muscle cells that come together to form a
fibrous mass within the uterus.
He corroborates Okunade’s view that there is virtually no immediate
threat of fibroid, and revealed that there were a number of excellent
treatment options, ranging from drugs to surgery. He recommended early
diagnosis and doctor’s advice on the type of treatment to take as key to
overcoming the tumour.
Sadly enough, in this part of the world, women usually embark on
marathon spiritual exercise to overcome the medical challenge rather
than depending on medication. Investigation reveals that many women who
are down with the health challenge have subjected themselves to
psychological torturing, in a bid to avoid what the doctors describe as
simple operation if necessary.
An obstetrician and gynaecologist at a private hospital in Lagos,
Ekene Jude, said women, usually out of ignorance, have been struggling
emotionally and physically with these tumours simply to avoid the knife.
However, the good news is that, according to him, patients, after most surgeries, generally recover in 10 days to two weeks.
For effective treatment, he said it is a combination of patients’
symptoms, the location of the fibroid, and the numbers and size, as well
as age and childbearing potential, that help determine the course of
treatment.
Risk factors
Okunada said most fat or obese women are predisposed to developing
fibroids. He clarifies that not all fat people have fibroids and not all
slim women are free from the condition.
Other experts have said that, at least one genetic link has been identified, indicating that fibroids may also run in families.
Symptoms and diagnosis
Okunada said for some women, fibroids cause none or major symptoms,
but when they do, problems often involve heavy menstrual periods and
prolonged bleeding, as well as pelvic or abdominal pain or swelling and
increased urination.
“A menstrual period could increase from five to 10 or more
days. There is also what we call pressure symptom, which has to do with
frequent urination because other parts of the system have been affected
by the growth of the tumour. And when the fibroids get bigger, it could
lead to vomiting and other reactions,” he said.
On diagnosis, he said physical examination is the first approach,
saying that a grown fibroid is easily noticed as the woman’s stomach
protrudes.
However, he warned that not all swollen stomachs are symptom of
fibroids, while explaining that after physical examination, cervical
ultra-sound scan is done to reveal the presence or otherwise of fibroids
in the uterus.
The doctor recommended surgeries as the best remedy to tackling
fibroid tumours. He, however, said there were drugs used in fighting the
disease, which have been helpful, but quickly warned that the drugs
would only suppress the symptoms while fibroids keep resurfacing.
Alternative to surgery
Managing Director of Cedarcrest Hospital, Ikeja, Lagos State, Dr.
Felix Ogedegbe, has said women may no longer necessarily have to undergo
fibroid removal surgery following new method of treatment
Ogedegbe, while speaking about uterine fibroid embolisation (UFE),
said women who have fibroid could have a catheter passed through their
blood vessel to get to the fibroid, adding: “Certain things are put
on the fibroid to make it burn away in few weeks. Women do not need to
have open operation to have fibroid removed anymore.”
“Blood transfusion is often not needed, risk of infection, long
stay in the hospital and all things that traditional fibroid operation
comes with. It is proved to be beneficial to a lot of women because it
is common among black women.’
Treatment options: What you should know
Not too long ago, doctors routinely performed a hysterectomy for
fibroid tumours. And while newer, less-invasive treatments are
available, studies show this dramatic operation is still being performed
today – far more frequently than necessary.
A panel recently convened by the governing body of the American
College of Obstetricians and Gynaecologists found that 76 per cent of
all hysterectomies performed today do not meet the criteria for this
surgery.
“They are being done unnecessarily,” says Ernst Bartsich,
associate professor of obstetrics and gynaecology at Cornell Medical
Center in New York. He said many women were conceding to a hysterectomy
for fibroid tumours because they are led to believe it’s the only
solution, which he said was wrong.
At the same time, Goldstein said it was also important to recognise
that not all hysterectomies are alike. In particular, he said the
newest form of this operation, called a supra cervical hysterectomy,
could still hold the answer for some women.
He explained: “In a supra cervical hysterectomy, you remove
only the uterine cavity holding the fibroids and you do not touch the
tubes, ovaries, cervix, or vagina, or any of the support muscles in the
bladder or pelvis.”
This, he says, means you don’t suffer any of the consequences
linked to a traditional hysterectomy, including bladder and sexual
dysfunction, or instant menopause. Recovery is also fast, stressing that
most women are out of the hospital in two days and back to normal
living within two weeks.
Said Goldstein: “It’s also a permanent treatment for fibroids
that can bring much-needed relief. My personal choice is to always do as
little treatment as possible; but at the same time, women should not
routinely close their ears when the doctor mentions hysterectomy,
because this one particular type can be extremely helpful and cause no
more problems than some of the newer alternatives.”
Myomectomy fibroid surgery
Okunade said myometomy is to remove only the fibroid tumours,
leaving the uterus and all other organs completely intact. This is
performed through three major approaches, which include: traditional
surgery with a large incision on the abdomen; minimally invasive
laparoscopic surgery done through pin hole-sized incisions, and,
depending on the location of the fibroid, and hysteroscopy – a surgery
done through the vagina.
The surgery will succeed in removing the fibroid tumour and offers
relief for up to several years, after which the fibroid can sometimes
grow back, though the percentage is low.
Hysteroscopy is said to be the most effective when the patient has
bleeding or fertility-related problems or recurrent pregnancy loss due
to fibroid tumours.
Okunade cautions that myomectomy can cause adhesions or scar tissue to develop, which often takes time to heal.
Other experts say the operation may interfere with fertility, which
may prompt a woman to need IVF in order to conceive. But the uterus,
however, remains strong enough to support a healthy pregnancy, as
revealed.
MRI-guided ultrasound
Another option is Managnetic Resonance Imaging (MRI)-guided
ultrasound, where doctors use high focused ultrasound waves converted to
heat to destroy the tumour. The MRI is used to guide the radio waves to
the tumour position.
To achieve this, patients are sedated and placed inside an MRI
machine that is specially equipped with the ultrasound. The procedure
can take up to three hours.
The heat destroys the fibroids, though frequently two or more
sessions may be needed. In the past, similar methods have used lasers or
some form of electric current to accomplish the same thing. It is best
suited for women who have completed childbearing.
Fibroids and fertility
Millions of people across the globe experience the heartache of
infertility or miscarriage. This is often due to a less than optimal
environment in the uterus. Yet, six in 10 women dispute (or are unaware)
that fibroids affect fertility.
Okunade told Daily Sun that fibroids could block fallopian tubes,
making it difficult for a fertilised egg to make it into the uterus.
This, as gathered, can potentially cause an ectopic pregnancy within the
tube, resulting in a life threatening condition for the mother.
Fibroids can make it difficult for an embryo to attach to the
uterine wall, or if they are very large, can impede the growth of a
foetus. In addition, many women with fibroids end up delivering
prematurely, putting the infant at risk.
Recovering from fibroids surgery
Many fibroids are deep within the muscle, and can be difficult to
access. Depending on how many fibroids, or how large they are, there can
be painful internal incisions that need to heal.
The likelihood of recurrence after childbearing is often high for
women who have fibroids, so after a point, many women decide that
removing the uterus is the appropriate step.
Okunada agrees that removing the womb, especially those through
with child bearing is a permanent solution to the illness. However, for
many women, retaining their uterus, either to become pregnant or other
personal reasons, is important.
A myomectomy is usually performed for fertility, and it is
essential that the uterus be reconstructed so that after healing it will
be strong enough to sustain a growing baby. The benefit of an open
myomectomy is that it can be thorough, and the uterus can be
reconstructed.
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