GY is a 38-year-old interior designer. Her menstrual flow was of normal volume which lasted four days in a regular cycle until six years ago. She now bleeds heavily, painfully, and irregularly. She sometimes bleeds for more than ten days. An ultrasound scan revealed multiple fibroid masses in her womb.
Fibroid is an abnormal but non-cancerous growth in the womb of some female individuals. Before the invention of ultrasound scan machine, affected ladies lived their lives without having the knowledge that they had the mass in their wombs. Among the poorly informed persons, interpretations given to bleeding caused by fibroid include, ‘flushing out of dirt from the womb,’ or ‘spiritual attack.’ There is no doubt that the health of affected women is impacted in several predictable ways.
A few persons have been misinformed about the use of herbal or natural products for treatment. As a result of inconsistent reassuring outcomes from such practice, many women have been disappointed. Some women have lost their lives from massive blood loss. Fibroid is a condition that is manageable. The affected woman can have good quality of life if managed appropriately.
Risk factors: There are no direct causes. However, the presence of the following may increase the risk of a woman having fibroid in her womb.
• Family history of fibroid
• Black race women
• Delay in child bearing
• Intake of red meat
• Consumption of alcohol
• Use of estrogen containing contraceptive pills.
Types of fibroid: The growth can be found in different areas of the womb. It could be located
• Underneath the inner lining of the womb (submucous type)
• Within the muscle of the womb (intramural type)
• Underneath the outer lining of the womb (subserous type)
It can occasionally be within the cervix-neck of the womb
Impact on health: Not every woman who has fibroid is disturbed by it. Among those who have complaints, the size, the number, and type, all determine the severity of the complaints. Common symptoms and signs include
• Painful menstruation
• Heavy menstruation (with possible blood clots)
• Prolonged duration of menses (usually lasting more than one week)
• Pressure effect of the mass on the bladder thereby increasing the frequency of urination. On the intestine, it may cause constipation.
• Cosmetic effect: Some women have huge fibroid that makes them appear pregnant.
• Infertility: Though not a very common effect of fibroid, the mass may obstruct the ease of transfer of sperm into the tube to fertilize the egg. In other cases, the fertilized egg may not find a healthy part of the womb to develop due to the presence of fibroid at the site of its implantation, hence, the fertilized egg aborts at a very early stage.
• Loss of pregnancy: As the pregnancy advances, a huge fibroid may disturb adequate supply of nutrients to the growing baby. This may result in the loss of the pregnancy before the unborn baby matures.
• Anemia: Due to excessive menstrual flow, some women have their blood volume remarkably reduced. Some would require blood transfusion to prevent death.
Management: This involves the use of orthodox medications or surgical treatment, or a combination of the two. The choice depends upon several factors which include the age at which it was detected, the severity of the woman’s complaints, effect on fertility or pregnancy, et cetera. Surgical removal of the fibroid is however highly recommended in the following scenarios.
• Pressure effects from the fibroid (abdominal discomfort, increased urination, etc.)
• Heavy menstrual flow which does not reduce with use of orthodox medications.
• Painful menstrual flow which does not reduce with use of orthodox medications.
• Infertility or loss of pregnancy which has not been attributed to any other cause.
The common options of surgery in the management include either removal of the fibroid masses only or removal of the womb with the fibroid within it. Among older women who have completed their family size, removal of the womb is beneficial. If the tubes and ovaries are also removed along with the womb, there is no future risk of cancer in the removed organs.
Prevention: There is no scientifically confirmed approach to prevent the growth of fibroid in women. However, women who did not have fibroid before the onset of menopause are least likely to have it due to the absence of hormonal supply to the womb to support its growth.
Dr Ademola Orolu is a Consultant Family Physician. He holds the Fellowship of The West African College of Physicians. He is also an Associate Fellow of The National Postgraduate Medical College of Nigeria. He is in active clinical practice. He is a writer, a patient advocate, and has a passion for health education. He is the chief editor of The Family Doctors. He can be contacted via firstname.lastname@example.org