#HEALTHTALK 04: What you need to know about Fibroids

Did you know that according to the College of Medicine at the University of Ibadan, there are over 100,000 cases of fibroid in Nigeria every year? Many women (aged 30-50 years) are suspected to have fibroids at some time during their lives. But some are often completely unaware or refuse to take early action, especially younger women aged 28-31 years.

What are Fibroids? 

They are non-cancerous growths in the uterus that can develop during a woman's childbearing years. Fibroids are also called leiomyoma.

What causes Fibroids? 

The cause still isn't well understood in medicine. But women are at risk of developing fibroids if: there's a family history of fibroids, they are obese, or they had early onset of puberty. Hormonal imbalance due to things like stress are also suspect.

According to the US Department of Health and Human Services, if a woman's mother had fibroids, her risk of having them is about three times higher than average. For obesity, the risk is two to three times greater than average.

See also: #HEALTHTALK 03: ON BREAKFAST AND WHY IT'S REALLY IMPORTANT

Fibroids contain estrogen and progesterone receptors than normal uterine muscle cells do. Excess estrogen and progesterone which stimulate the development of the uterine lining during each menstrual cycle in preparation for pregnancy promote the growth of fibroids.

In other words, they develop from stem cells and therefore undergo abnormal continuous cell division which may be slow or rapid.

Fibroid Quick Facts

1. They are treatable by a medical professional. However, you should go to one who is well-experienced in handling fibroid cases. An experienced gynecologist is most preferred. 
2. It requires a proper medical diagnosis. Don't just assume that you have it. You need to be sure so you can get the correct treatment. There are other similar conditions like adenomyosis, endometriosis, pelvic inflammatory disease, ovarian cyst, polycystic ovary syndrome, etc. Go for a proper medical diagnosis first. 
3. Fibroids can grow either inside or outside the uterus (womb). But the most common one is the one that grows inside the uterus. 
4. Treatment type depends on its severity.
5. It is often seen in women aged 30-50 years, but many younger women aged 28-31 years often have fibroids already, but neglect getting it properly treated early. 
6. Fibroid development is mostly biological, but can also be hereditary too. 
7. Fibroids can be detected by ultrasound imaging and MRI, or an experienced doctor can do a pelvic-finger test. 
8. Fibroids can be chronic. They can last for many years, or in fact be lifelong. 
9. Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids. 
10. Women who have had children have a lower risk of developing fibroids, and the risk decreases further the more children you have.

Fibroid Symptoms

In very few cases, fibroids can be asymptomatic. But in most cases, symptoms include:

1. Heavy menstrual bleeding
2. Prolonged periods
3. Pelvic pain
4. Pains during sexual intercourse
5. Frequent painful urination 
6. Abdominal swelling
7. Pressure in the lower abdomen (cramps) 
8. Constipation
9. Frequent urination

Fibroid Treatment Options

Small fibroids can be taken care of by avoiding processed food. Persons who have it are advised to eat unprocessed food (fruits, vegetables and more fish than meat). However, large fibroids may need surgery to be removed, or drugs can be taken to shrink them.

See also: #HEALTHTALK 02: THE FOOD NUTRIENTS

Treatment options vary from the use of medications to surgical removal of the fibroid, depending on severity. Options include:
1. Palliative care: This involves watchful waiting—Monitoring the medical condition instead of taking action right away. But this should be done through the watchful eyes and care of a gynecologist. Fibroids may likely shrink at menopause but as one waits it out, it is advisable to go for regular medical checks. If the symptoms are severe, it is better to opt for medications or surgery, depending on your doctor's advice. However, please note that no medication can guarantee that the fibroid will not return.
2. Device Therapy: A small plastic device called a progestin-releasing intrauterine system (Progestin-IUS) can be placed inside the womb (uterus) to relieve heavy bleeding caused by fibroids. However, this dies not shrink the fibroid; it is only a palliative measure in the event of excess bleeding due to the fibroids.
3. Medications: This includes gonadotropin-releasing hormone (GnRH) agonists. GnRH agonists treat fibroids by blocking the production of estrogen and progesterone, putting you into a temporary menopause-like state. As a result, menstruation stops, fibroids shrink, and anemia often improves. This treatment is not for younger patients who are still sexually active or still want to conceive.
4. Surgery: The fibroid can be removed through a surgical procedure. Different types are:

a) Hysterectomy: Surgical removal of the uterus (womb). 

b) Uterine myomectomy: Surgical removal of non-cancerous fibroids.

c) Laparoscopic surgery: Surgery that uses a video camera and thin tubes inserted into small cuts on the body to remove the fibroids. Please see the video above for a demonstration of this type of surgery.

See also: ON 5G AND COVID-19: WHAT ARE THE FACTS? [PART 2]

5. Medical Procedures: Some medical procedures may also be used in fibroid treatment:

a) Ablation: Removal of fibroids using lasers, radio-frequency waves or focused ultrasound.

b) Uterine Artery Embolization: Procedure to seal off arteries which supply blood to the fibroids, thereby causing them to shrink. Usually, inert embolizing substances are injected during this procedure to achieve this. Please see the short video above for a demonstration of this procedure.
c) Endometrial Ablation: Surgical removal of the lining of the womb to reduce heavy menstrual flow.

To see a graphic picture of what fibroids look like, please click here. Warning: Viewer discretion is advised.

Becoming Pregnant while having Fibroids

Women who become pregnant while having fibroids become prone to having pregnancy complications. The complications include:

1. Bleeding 
2. Pain
3. Abortion (miscarriage) 
4. Preterm delivery
5. Labor difficulties (depending on size and position of the fibroid) 

The woman is advised to see her Obstetrician early enough for advice and action. Often times, the presence of the fibroids prevent contraction of the uterus, thereby preventing cervical dilatation for normal delivery from happening; so caeserian section is often opted for in these cases. 

Do Fibroids Lead to Death? 

Fibroids do not normally lead to death. But if they are allowed to grow so big, and result in extreme conditions for the patient, leading to excess loss of blood and anemia, they can indeed lead to death.

See also: WILL MAN'S SEXUAL APPETITE LEAD HIM TO A TIPPING POINT?

Common Misconceptions/Myths about Fibroids

1. Use of traditional herbs are an effective treatment for fibroids: While some people have been known to get positive results from this, many others have not been lucky. The truth is that it is an unscientifically proven method of treatment which can further endanger the health and life of the patient.
2. Prevalent assumption that promiscuity causes fibroids: Because the use of birth-control pills have a known link to the development of fibroids, most people tend to assume that anyone who develops fibroids lived a promiscuous life earlier. The truth is that many other people who have no history of using birth-control pills have also developed fibroids too.
3. That one is likely to die if they go for a fibroid sugery: This is simply not true, and mostly founded on fear and personal sentiments.

Chisom Deborah Ogbonna, a biologist writes from Lagos, Nigeria. Uboho Udom and Nkeiruka Ogbonna, Nurses in Lagos, contributed to this article. 


FURTHER READING:
1.   A US Population-Based Study of Uterine Fibroid Diagnosis Incidence, Trends, and Prevalence: 2005 Through 2014, a publication of the U.S. National Library of Medicine.
2.   Uterine Leiomyomata in South Western Nigeria: a clinical study of presentations and management outcome, a publication of the U.S. National Library of Medicine