A consultant obstetrician and gynaecologist, Dr. Olanrewaju Ekujumi, discusses fibroids with DOLAPO AKITOYE
What are fibroids?
Fibroids are non-cancerous growths of the normal smooth muscle and stomach of the uterus.
What are the types of fibroids?
Fibroids are classified based on their locations in the uterus. Now, it can be outside the uterus, which is referred to as subsesoral fibroids. It can also be within the muscles of the uterus referred to as intramural fibroids. It can be inside the uterus itself, that is within the cavity, which is referred to as the submucosal fibroids. Then, it can also be based on location: You can have fibroids in the anterior part, the posterior part and it can be in the cervix and in other positions.
Are there any positions where fibroids can be found that has low risk?
Fibroids are mainly located in the womb but sometimes, it can be around the womb like the round ligament, but those ones are not very common. Sometimes, you can see it around the cervix.
What are the causes of fibroids?
The main cause of fibroids is unknown. Nobody has been able to attach a cause to it but there are factors that are predisposed to fibroids. The first thing is that it is only seen in women that have attained puberty because it is driven by oestrogen and that is the major factor. Then, studies have also shown that it has some measure of genetic relations because it is common with black women than white women. Then, it seems to have some familiar tendencies to run in the family, which is something chromosomal. So, nobody can pinpoint the cause of fibroids. Truly speaking, another factor is obesity but it is not a major factor because fibroids are seen in both slim and fat women. Basically, it is hormone-dependent, it has some racial predispositions and it has some familiar tendencies. So, it has nothing really to do with diet.
What are the symptoms of fibroids?
Fibroids can have symptoms and may also not have symptoms because fibroids are common, that out of every two women, one has fibroids. It’s just that the majority will have small fibroids. So, as long as a scan indicates that a woman is not disturbed by fibroids, one should just leave it alone. You do not need to do anything about it. So, the only fibroids that really demand attention are the symptomatic fibroids i.e. fibroids that have symptoms. Now, commonly for some women based on location, they can bleed heavily. It can make their menstruation take a longer number of days and the amount of blood lost will be very much. Basically, menorrhagia takes place, which is an increase in the duration and quantity of flow.
Then, some people might come down with a pelvic mass – it occupies the entire pelvis – which usually causes pelvic pains. Some may come down with pressure symptoms for example, their legs getting swollen when they sit because of the huge fibroids that they have. Then, besides that, the fibroids can get big to the point where people may begin to assume that the woman is pregnant because there are some women that carry big fibroids and might become embarrassing. Some can be so big they might not be eating well because any little thing they take, they get filled up and start losing weight.
Can a woman with fibroids get pregnant?
Truly speaking, fibroids do not stop a woman from getting pregnant. It is not a cause of infertility. The only time that removing fibroids is considered for a woman who is trying to have a baby, is if the fertility tests of the woman and her husband come back normal but the only thing there is the fibroids.
Then, fibroids could be removed because studies have shown that it improves the chances of conception but that does not still mean that the couple is going to conceive. Apart from that, for some people that have fibroids, when they conceive, they suffer from miscarriages. Fibroids can be a cause of a woman having repeated miscarriages. For some women, fibroids can make them go into pre-term labour. Sometimes, it can also cause severe pain during pregnancy and that might involve going to the hospital often. This is referred to as degenerative fibroids. Anybody that has fibroids, especially big people who are pregnant, should be managed by a gynaecologist.
How can fibroids be diagnosed?
If a woman is bleeding heavily and goes to the doctor and a scan is conducted, then, it will be seen that the woman has fibroids. Sometimes, they notice that their stomach is so big and the woman goes for a scan and it can be discovered that she has fibroids. The main means of diagnosis is scan. There is nothing more that is needed to diagnose fibroids other than that. Once the scan shows a woman has fibroids, there would be a need to determine if the fibroids disturb the woman or not. If the former is the case, the doctors will decide to intervene.
Can fibroids be mistaken for cancer?
Fibroids can be mistaken for cancer but it is extremely rare for fibroids to become a cancer. It is not impossible but it is extremely rare. It is rare that a doctor can work for the next 100 years and not see such a case like that.
Can some symptoms be mistaken for fibroids?
When you have a swelling around your navel and there is a mark, there are other things besides fibroids that can cause it for example, endometriosis and adenomyosis. These are reasons why a woman will bleed heavily because their uterus is big but not because of fibroids. It can be mistaken for fibroids. Besides that, some people might also have ovarian cysts, which is a form of cancer. However, a lot of times, when a woman goes for a scan, the doctor might tell the lady to take other scans such as an MRI that will pick up the issue. It is important that a woman sees a specialist when she notices the above.
How can it be treated?
Now, any fibroids that are not disturbing a woman should be left alone because they can’t stop the woman from getting pregnant. Many women get pregnant and even do family planning with their fibroids. Any big fibroids causing a woman to have symptoms, the best thing is for the woman to go to the hospital and see her gynaecologist. Depending on the goals of the woman, treatment can be determined. For example, for a woman around 45, who has fibroids and no cancer is discovered after several tests have been conducted, we might not offer her surgery. We might just give her drugs that will knock off her period, so that her bleeding can stop. However, for a young woman, with a large fibroid that is symptomatic, the only solution is removal of that fibroid via surgery.
The treatment is dependent on age, the reproductive goals of the woman and the symptoms the woman has. A woman, who is close to menopause will be managed until she enters menopause because once it comes, the bleeding stops and the fibroids will continue to shrink on its own. However, for a woman who is far from menopause and is displaying all these symptoms, the solution is surgery.
Can fibroids be prevented?
Basically, there are no means of preventing fibroids because they occur on their own. For all intents and purposes, there really isn’t anything one can do to prevent fibroids. The only preventive measure is that, if you have fibroids and you have seen your gynaecologist but still getting disturbed, you need to ensure that you do not wait until complications set in.
What ages are prone to fibroids?
Women prone to fibroids are those within reproductive age as soon as they reach puberty. This is because fibroids are oestrogen and hormone-driven and during reproductive age, women’s hormones are at their peak. For those that have the tendency, it will develop.
What is the mortality rate of those having symptomatic fibroids?
Fibroids do not kill ordinarily but they reduce the quality of life of the individual because they can be in pain many times that they might not be able to leave the house. They might have to keep on going to the hospital for blood transfusion because they have lost much blood. The woman will get nervous every time her period is approaching and she is basically in and out of the hospital and until they remove the fibroids, they keep managing themselves. It is extremely rare for fibroids to be the cause of death of an individual.
What are the common myths and misconceptions about fibroids?
There are lots of myths and misconceptions about fibroids. Our people used to think that there are some herbs that will make one pass fibroids out through stool or through the vagina. However, the truth is, for the large symptomatic fibroids, the only solution to them is surgery, especially for a young woman. There is nothing spiritual about fibroids.
Fibroids are natural growths and not treatable with herbs. It is also not all fibroids that need treatment. Any fibroids not disturbing a woman should not be treated. Some people think it is a bad thing to develop fibroids but one cannot help it. They will occur on their own and you need not bother so far they don’t disturb you.
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