How to manage uterine fibroids

How to manage uterine fibroids

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Fibroids, also known as leiomyomas and myomas, are solid benign (noncancerous) smooth-muscle tumors that appear, often in groups, on the outside, inside, or within the wall of the uterus, possibly changing the size and shape of it.
About 30 per cent of all women get fibroids by age 35 and almost 80 per cent of women will have fibroids by age 50. Black women are more likely to have fibroids, and to get them at younger age.
A research conducted in 2011 by African Health Sciences, in the southern part of Nigeria titled: “Uterine Leiomyomata in South Western Nigeria: A Clinical Study of Presentations and Management Outcome,” revealed that the common presenting complaints were menstrual irregularities, which constitute 47.7 per cent, abdominal swelling, 39.1 per cent and infertility, 1.9 per cent. The average uterine size at presentation was 15±9.7 weeks.
Majority of the women have multiple leiomyomata at 79.9 per cent. The commonest anatomical position of the nodules, (a small rounded lump of matter distinct from its surroundings), were multiple positions and intramural in 707 (60.9 per cent) and 172 (14.8 per cent), respectively.
It was also discovered that myomectomy, (a type of open surgery to remove fibroid), was performed in 54.7 per cent of the cases. Post-operative complications occurred in 20.9 per cent of cases with post-operative pyrexia (13.5 per cent); blood loss warranting transfusion (12.8 per cent) and post-operative anaemia (10.4 per cent), being the most common complications.
A general practitioner at Salus Health Consultants, Dr. Kazeem Kadiri, said uterine fibroids or leiomyomata are benign growths that develop in the walls of the uterus. They range in sizes from small nodules or pellets to large masses that might mimic advanced pregnancy.
A gynecologist at DE-ELLZ Women & Children Clinic, Dr. Ekujumi Lanre, described uterine fibroid as a non-cancerous growth of the uterine smooth muscle, which is quite common worldwide, adding that about one out of every two black women has it.
Dr. Kadiri said there are different types of uterine fibroids and each type is named based on its location within the uterus: the first is called subserosal, which develops under the outer covering of the uterus; the second type is intra-mural, which develops within the muscle layer of the uterus; the third one is submucosal, it develop under the inner lining of the uterus; while the fourth type, according to him, is pedunculated, which develop as an appendage from the outer covering of the uterus.
untitledDr. Lanre said uterine fibroids cannot be prevented, because the primary cause is unknown and the major predisposing factors are not within our control. “Though maintaining optimal weight and not delaying conception may reduce the rate of growth. Not all fibroid needs treatment. Any fibroid that is not disturbing a woman (asymptomatic) should not be touched,” he stated. The doctor, however, advised that when fibroid cause symptoms, then there is the need to see a good gynecologist so that appropriate treatment can be instituted. Dr. Kadiri, on the other hand, said there are no specific preventive measures or causes of uterine fibroids, but rather, there are risk factors that can be attributed to increased risk of fibroids, which includes; familial predisposition (hereditary), race (it is most common among blacks), and the environmental factors like early age at menarche (first menstrual period), use of birth control, obesity and the consumption of red meat. “Uterine fibroids can prevent a woman from getting pregnant, depending on its location, as it can prevent the sperm from reaching the egg or prevent implantation of a fertilised ovum. It can also cause miscarriages, as it can prevent the foetus from developing from its mass effect,” he said.
Dr Lanre indicated “some of the symptoms of uterine fibroids as: severe lower abdominal pain; heavy menses, which can sometimes be prolonged; abdominal swelling; leg swelling; frequent urination; pressure on the kidneys; recurrent miscarriage; premature labour, among others.”
Stressing that for fibroids that are symptomatic in women of reproductive age, the main modality for management is surgery, Dr Lanre added, “However for older women who are close to menopause, drugs can be used for a short while till menopause sets in when the fibroid begins to shrink on its own.” Dr. Kadiri said, “Medications for fibroid treatment include: gonadotropin releasing hormone agonists, tranexamic acid, progestin intrauterine devices and non-invasive procedures like focused ultrasound surgery.
“There are minimal invasive procedures like uterine artery embolisation, myolysis, laparoscopic myomectomy, hysteroscopic myomectomy. Open surgery, which is the most commonly done here in Nigeria, is myomectomy and hysterectomy.”
He concluded by advising women that has delayed conception that the first step is to visit a gynecologist.
He added: “So, a woman with fibroid, who has been trying to conceive, needs to see a gynecologist, who will investigate her and the husband first to determine the reason for delayed conception.
“It is only when all the results are normal and the only abnormality found is a large fibroid, that we can opt for surgery after proper counseling, informing the couple that the surgery is being done to better their chances of conception and not a license to pregnancy.
“A patient that undergoes fibroid removal (myomectomy) should be able to go home within a week.”
The African Health Sciences researchers, after conducting the research in south western part of Nigeria concluded that, “Uterine fibroid is common in our environment and its removal is commonly associated with post-operative pyrexia, blood loss, and anaemia and wound infection. Midline incision, closure of rectus sheet with chromic catgut and myomectomy were associated with postoperative complications in this review.”

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