By Meluse Kapatamoyo
A visitor to my blog recently requested that I do some research on fibroids. Here is an interview I had with Dr Mulindi Mwanahamuntu, a gynaecology consultant at the University Teaching Hospital (UTH) in Zambia’s capital, Lusaka.
|Dr Mulindi Mwanahamuntu, a gynaecology consultant at the University Teaching Hospital (UTH)|
Fibroids, also called Leomyoma, are new overgrowths of the fibrous muscles of the uterus. Although they are essentially one and the same type of tumour, they are given different names according to the part of the uterus they occupy. Intramural fibroids are located in between the uterine muscle while the ones that push into the uterine cavity are called sub-mucous and those on the surface of the uterus are known as Sub-Serosa fibroids. The sub-serosa fibrods can even be in a suspended position from the uterus surface like fruits hanging from a branch, these are referred to as Pedunculated fibroids. All these are seen in equal measure at the University Teaching Hospital (UTH) but they present with different severity of problems (symptoms).
Fibroids occur in the years of child bearing age and most symptoms culminate when a woman is in her 30s. This is because fibroid growth is aided by prolonged presence of the hormone, oestrogen. Oestrogen is only opposed by the hormone progesterone when a woman is pregnant and this may explain why women that have never experienced a pregnancy-related-protection by progesterone are more prone to fibroids.
It is important to mention that of the diseases associated with the uterus, cancer of the cervix is the commonest cause of severe illness and responsible for 98.1 percent of all deaths related to new growths on the uterus. The preoccupation of women and care givers should be to discover cervical cancer cells early and not fibroids. That said, fibroids are responsible for much suffering and poor quality of life that include bareness, heavy menses leading to anaemia, life threatening infections, pain and occasional death to mention but a few.
What are the statistics of fibroid cases at UTH?
Fibroids are common among women such that slightly over 10 percent of women live with fibroids and only 2 to 3 percent of these actually have them large enough to cause symptoms of pain, menstrual disorders and sub fertility thus requiring treatment.
Treatment of fibroids ranges from simple implantation of anti oestrogens under the skin to surgical procedures such as uterine curettage, open surgical procedure referred to as myomectomy (operation conducted on the uterus to remove fibroids) and to hysterectomy - the total removal of the uterine.
What determines the treatment?
The location of the fibroid and accompanying symptoms all guide to the selection of the method of treatment. Location, size and symptoms are most crucial determinants of mode of treatment. However, age of the patient, general condition, fertility wishes and previous intra-abdominal procedures all contribute to the choice of treatment. Patients are part of the process of choosing the mode of treatment but basic medical principles mentioned should not be breached. Most importantly, the cost of treatment, thoroughness of treatment and safety of the patient should not be confused. In navigating between these principles, many patients at UTH rightly end up undergoing surgical procedures.
The treatment can even cause death. Poor evaluation of pelvic and back pains has led into fibroid “operations” and the pain continues or worsens alongside many other irreversible complications. Treatment of fibroids is a specialist undertaking which does not entertain shortcuts.
Can a woman who has undergone a fibroid operation before get pregnant?
Part of the evaluation and counselling process in treatment of fibroids include preserving or enhancing chances of fertility. Treatment of fibroids when fertility issues are pertinent, it is not an event but a process. Majority of women treated for fibroids even surgically fall pregnant but the doctor must continue to look after such a pregnancy until delivery. For example, a third of fibroids are treated because of demand to restore fertility and 70 percent of such treatments are successful.
Every single operation is different from the other and doctors will advice since they are aware of how mutilative the procedure is. For example, after curettage, a month is all the rest you need while after a myomectomy, anything up to one year’s rest from pregnancy may be required.
Fibroids and Pregnancy
Fibroids undergo a painful degenerative process because of hormone changes during pregnancy. Sometimes labour can be difficult or even impossible when fibroids impinge on the pathway of a baby. Further, this uterine anomaly can be responsible for increased post-delivery bleeding. All this constitutes interference with pregnancy.
A woman has a 70 percent chance of normal vaginal delivery. But an evaluation of this possibility needs to be made by specialists and not by trial and error.
This is not studied but fibroids will keep coming if the contributing condition continues to persist. Interestingly the majority of fibroids stop growing or even shrink after menopause. Doctors do not usually wait for this natural “self-treatment” of menopause since some fibroids are known to become cancerous and in any case, cancers in their own right increase at this age.
There is no known dietary connection to fibroids. However heavy menstrual bleeding related to fibroids requires replenishment of iron by foods rich in iron such as greens, fish and stake.(A huge thank you goes to Mrs Annoymous to whom this article is dedicated. I hope all your questions have been answered)