Untreated uterine fibroids can cause heavy blood loss, miscarriage – Gynaecologist

16th April 2023

OLAMIJULO

By Fatteh Hamid

Dr Ayo Olamijulo, an associate professor of obstetrics and gynaecology at the College of Medicine, University of Lagos, and consultant gynaecologist at Magodo Specialist Hospital, Lagos, speaks to FATTEH HAMID about uterine fibroids and the complications

What are uterine fibroids?

Uterine fibroids are a benign or non-cancerous group of the uterus. They are a fairly common occurrence of a clinical or medical condition. They are fairly common in our female population and the growth can vary in size; they can be very small, so small that the patient or even the doctor may not notice but sometimes, they can be quite big that they make the woman look pregnant. The important thing is that they are benign and not cancerous.

What causes uterine fibroids?

The simple answer is we really don’t know exactly what causes uterine fibroids but we can guess based on certain circumstantial evidence. They seem to have something to do with individual genetic makeup and the fact that it is common in black people. Also, there are some families where the mother, sister, and family members have uterine fibroids, making you see that it might be some genetic or familiar tendencies. They manifest usually in the reproductive age group of women, women in their 20s, 30s, and 40s. You tend not to find them before the age of puberty and you tend not to find them newly in women who have gone through menopause. So, what I will suggest is that they have something to do with the reproductive hormones, particularly estrogen, and progesterone. Also, research has suggested that there may be some growth factors that are involved as well. There has been some evidence also that may link them with the type of diet that is consumed. It’s been suggested that diets like vegetables and fruits may be protective against fibroids whereas diets heavy on red meat and the like may predispose to uterine fibroids. There have also been some suggestions that micronutrients might play a role. For instance, they have been linked to a relative lack of Vitamin D. These are some of the things that researchers are still working on as possible causes but we cannot specifically point out that this is exactly the reason why women have fibroids.

What are the early signs of uterine fibroids?

The early signs actually are that there may be no signs because the majority of women that has fibroids do not know that they have fibroids. They only become aware either when they are being examined by the doctor or they go for routine medical check-ups, routine ultrasound scans which may be for something entirely different, or some other form of scan and then they find out that the uterus has some fibroids. Commonly, now that we do an ultrasound scan for women who are pregnant, sometimes, that is when a woman is told that apart from the pregnancy, they have one or two fibroids as well in their uterus. Oftentimes, that is the first thing that makes a woman know that she has fibroids and some other symptoms and signs will come up where the woman is experiencing certain clinical symptoms. When fibroids become symptomatic, they tend to relate to the periods, so the periods may become heavier and they may become prolonged. Instead of bleeding for four to five days, for example, they bleed for longer than that, maybe over seven days. Then the patient may notice that the number of sanitary pads she’s using increases or she’s having to sometimes wear towels to prevent accidents during her periods.

How do they affect pregnancy?

Also, sometimes when there are delays in getting pregnant, that can be a result of uterine fibroids. Usually, by the time the patient notices pressure, heaviness, or abdominal swelling, usually, that tends to be associated with big-sized fibroids. Of course, there could be other related signs and symptoms like pressure symptoms of the bladder because the uterus and the bladder are neighbours, so, if you have a swelling unit in the uterus pressing on the bladder, that may reduce the capacity of the bladder and the woman needs to go pass urine frequently. Occasionally, it might also be difficult to pass urine. Similarly, rarely you may find constipation because of the pressure on the rectum because it is a neighbour to the uterus. Occasionally you may have leg swelling and things like that. So, these are not what you’ll regard as early signs because they tend to come when the fibroids are well established. Very rarely, fibroids may present with pain but generally speaking, they don’t come with pain. This is particularly in some women who get pregnant with fibroids, so they may have pain as a result of regeneration because of blood supply to the fibroids. There can also be consequential symptoms. For example, I mentioned that having a heavy and prolonged period can be a symptom of fibroids. So, for some women, this may then make them become anaemic. That is, they experience a shortage of blood because they are losing more than they are making. So, they may have symptoms like feeling tired, sometimes palpitations (breathing fast) which can be a symptom of anaemia, and sometimes again, leg swelling, and fainting. These are things that may draw your attention to the fact that a patient has fibroids.

What are the risk factors?

Age is a risk factor, especially for women in their reproductive age group, particularly in their 20s, 30s, and 40s. The older the woman is within the reproductive age, the more likely they are to have fibroids. This is a risk factor in blacks than whites. Even in other countries where you have negroids, that is blacks and whites, you find out that the black population tends to have more fibroids. Also, if a woman’s mother or sister has had fibroids before, then the risk that the woman will have it is also there. Also, women with infertility are likely to have uterine fibroids especially when fertility has been delayed. Now, the relationship between fibroids and infertility is somehow complex. Yes, there is an association, but the fact that you find fibroid doesn’t mean that is the reason for infertility. The woman needs to be thoroughly investigated because it is possible, if you remember, I mentioned that some women get to know that they have fibroid for the first time when they are doing a pregnancy scan, which means that their type of fibroids hasn’t prevented them from getting pregnant. But it is also true that there are some women that you can ascribe their infertility to the fibroids and the moment you remove the fibroids, their fertility is restored. The size and location of the fibroid are also important. In this regard, fibroids that are located closer to the lining of the womb are what we call submucosal fibroids, and those with this are likely to present with issues of infertility. What I’m trying to clarify is that a woman having fibroids doesn’t necessarily mean that she’s going to be infertile. Even in infertile women, the finding of fibroids doesn’t mean they are the cause of their infertility. You still need to investigate them properly to make sure that there are no other reasons for infertility.

How common are uterine fibroids in Nigerian women?

Fibroids are quite common, especially in the black women I mentioned. A lot of women do not know that they have fibroids, but it depends on how thorough your search is and we find out that up to 80 per cent of women have one fibroid or the other during their lifetime. It depends on what work or paper you are reading. For instance, if you have routinely scanned people, you are likely to pick up more fibroids but if you are looking at women in infertility clinics, you’re likely to find more fibroids rather than use the patient’s historical facts.

How will you describe the level of awareness about uterine fibroids in Nigeria?

Fibroids are quite common, especially in the black women I mentioned. A lot of women do not know that they have fibroids, but it depends on how thorough your search is and we find out that up to 80 per cent of women have one fibroid or the other during their lifetime. It depends on what work or paper you are reading. For instance, if you have routinely scanned people, you are likely to pick up more fibroids but if you are looking at women in infertility clinics, you’re likely to find more fibroids rather than use the patient’s historical facts.

What I will say is that the level of awareness among Nigerian women is fairly reasonable. A lot of people know one person or the other who has uterine fibroids. However, how people perceive fibroids is another issue and that is why the emphasis is that they are fairly common, benign, and not cancerous. Particularly as it leads to infertility, sometimes, some people have unnecessary surgery because they’ve had delays and somebody mentioned to them that they have fibroids and then the next thing is fibroids surgery. Not every fibroid needs to be treated, you have to put things into the proper perspective. On the other hand, correct treatment can be quite rewarding. Awareness, I think it’s reasonable in relation to other things. As far as fibroid is concerned, particularly when it comes to how it affects fertility, the awareness is fairly there. Now, when it comes to period problems, less so and of course when it comes to other issues that might affect us, again, the awareness can be poor.

Are women with fibroids prone to infections?

Fibroid is not an infection or an infectious problem and infection is a very rare complication with fibroids, it’s a benign issue and usually, it is not exposed but within the uterus and very rarely it can become infected. An infection has very little role, except if it’s as a complication of such, then a woman can have an infection. But it doesn’t increase her risk of contracting other infections like a sexually transmitted infection and all that.

What are the complications that can result from fibroids?

As I said, the majority of fibroids are harmless and therefore a woman doesn’t need to panic. It can be an incidental finding and it won’t have a complication whatsoever. Well, the complication that can occur is that there can be regeneration. This usually happens when pregnant women with fibroids have what we call red regeneration which has to do with a compromise in the blood supply which causes a lot of pain. Fibroids can also be the reason for miscarriages, especially submucous fibroids. Fibroids can also cause pain, some fibroids are not within the wall but outside the wall, which can cause the loss of blood supply. It is very rare for fibroids to become cancerous, but they have other complications like anaemia which I mentioned earlier. If a woman is having excessive blood loss month in, and month out, she’s bleeding heavily, then the amount of blood loss is lower than the rate at which she is recovering her blood, then it can become anaemia and anaemia can lead to heart failure sometimes. But I think the vast majority of complications from fibroids are rising from the treatment of fibroids itself. That is why people must be selective, as I said, not all fibroids need treatment and when you are informed that your fibroid needs treatment, make sure it is done in a good centre so that the complications from the treatment, which includes excessive bleeding, can be curbed and that is like the most serious complication that we can think about and some patients have died as a result of that and that is also one reason why a lot of people are afraid of fibroids surgery.

How safe is fibroids surgery?

Bleeding, inadvertent damage to other organs, and infections can occur as a result of complications from surgery. Generally speaking, people are afraid of surgery and they want to do everything so they don’t have surgery. Also, there are some alternative practitioners, who are not doctors but quacks. They offer women the insertion of certain caustic materials into their vaginas, and they tell them that they don’t need surgery and that they have materials that can be put in the vagina and over the weeks, the fibroids would melt. To the gullible, that might sound like a good proposition to avoid surgery but what tends to happen is that the caustic material causes a dunce within the vagina and as a result of that, the vagina starts discharging itself, what then happens is that the vagina wall breaks down and then such women are in agony. They discharge for one to two weeks and then the discharge would stop. Unfortunately, the fibroid would not have gone anywhere, it remains where it is. But when healing is occurring in the vagina, the vagina then closes up, a woman who has a normal vagina before no longer has a vagina, she’s no longer able to have periods, she’s no longer able to meet with her husband and now needs much more complicated surgery to open the vagina. I think this may be an opportunity to create awareness about this evil in our society. Unfortunately, these people get away with their evil practice which has ruined many lives. We see a lot of these women come in nursing their injuries by themselves, and they don’t tell others what they have gone through because it’s such a shameful thing. The level of education doesn’t matter. We’ve seen professionals being victims of this sort of practice.

What are the dos and don’ts in the management of uterine fibroids?

First is to recognise that not every fibroid needs to be treated, if the fibroids are benign and they are not causing any issues. Most of them do not cause any problems for the woman, so leave them alone. If you have any concerns, you should see a gynaecologist. When I say gynaecologist, a lot of people pronounce themselves as one and are not. Make sure that your gynaecologist is truly one and again, experience matters as well. Also, the fear of surgery as I narrated to you can be an issue and provided you have your surgery done in a good place, you have nothing to fear. However, people go into the wrong hands when they are looking for where to avoid surgery and low cost, and then they fall into the hands of these quacks. If money is an issue, it is better to go to a government hospital like a teaching hospital or a good general hospital. Things are relatively cheap there but if you must go to a private medical facility, go to one with quality but if you are looking for cheap services, that might be a problem. I want to believe that no doctor, not a quack, will want to put the lives of their patients at risk. Don’t panic, don’t fear, go to the right place, get properly evaluated, and if you need surgery, get it done.

PUNCH

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