Fibroids are a woman's worst nightmare

Photo credit: Day 183/365 Doing nothing, by Daniel Oines

Many women live through painful periods and discomfort, totally oblivious of the possibility of enlarged fibroids until their reproductive system is affected. Ms. Ann Kyobe discovered she had fibroids at 30 after two pregnancy losses and she had a premature birth by caesarean section after that.

Before this, she had lived through painful and heavy menstrual periods that lasted two weeks each time. Occasionally, Ms. Kyobe felt pain in her lower back. According to Dr. Rhona Mijumbi of International Air Ambulance, Ms. Kyobe exhibited typical signs that one could be having enlarged fibroids.

Ms. Kyobe says that she had scanty knowledge of fibroids so there was no way she could suspect anything was wrong just because her periods were painful and heavy. There are many women who have heavy or painful periods so I thought it was normal, she says. Dr. Mijumbi describes fibroids as non-cancerous swellings that grow in, on or around the walls of the uterus.

They could grow to as many as 20 or just one in varying sizes: they can be as small as a pea or as large as a basketball. The size, number, and location determine the severity and what effects they will have on their victims.

The most severe of effects are reproductive-related. They include birth by cesarean section, pregnancy loss, or failure to conceive in the first place. Frequent urination, a feeling of fullness in the lower abdomen, bleeding between periods and painful sexual intercourse could also indicate their presence. If they are growing on the outer lining of the uterine walls, the fibroids could cause the stomach to bulge.

In school, we were taught that fibroids affected women above the age of 35 but the reality in the field is that although it is prevalent (in that group), even women as young as 20 are diagnosed with them, says Dr. Mijumbi.

According to Dr. Charles Kiggundu, a gynecologist at Mulago Hospital, the prevalence rate for fibroids among Ugandan women is 30 percent. This accounts for three out of every 10 women in their 30s and four out of every 10 women in their 40s.

These are however based on the women that have been diagnosed, excluding those that have not gone for a medical check-up, he says.

Dr. Mijumbi says although over time, black women have been found to be more prone to developing fibroids than their white counterparts and 20 percent of sufferers worldwide are above 40 years of age. Kiggundu further explains that women who give birth late or have few children are more prone to fibroids.

This highlights the fact that the more affluent woman who takes a longer part of her life studying, making money and thus gives birth later in life to fewer children is at a higher risk of suffering from fibroids.

A hormone, estrogen favors the growth of fibroids while another called progesterone, which is produced in large amounts during pregnancy helps counter the possibility of developing fibroids. The earlier one bears children, therefore, the more progesterone they produce in their bodies which helps reduce their chances of developing fibroids, explains Dr. Kiggundu.

Having this in mind, many women have been driven to seek male companions in a rush to stop the hand of nature. Ms. Julia Nabunya says that when her 42-year-old aunt found out she had fibroids, she advised her to get a baby as soon as possible to avoid developing them as well.

Thus, at 22, Ms. Nabunya got pregnant, not caring much about who she picked for her child's father. Although early birth may reduce the risk of getting fibroids, there is no definite way to prevent them.

At best, the doctors advise medical examinations if any of the symptoms are experienced so that if fibroids are found early, one can plan on how to manage pregnancy, for example.

There are cases where we advise women to give birth early, but not to prevent them as some women think, Dr. Mijumbi says. It is instead to ensure that one gives birth before the fibroids are too big to interfere with pregnancy.

In other cases, the fibroids are cut out if found severe and causing a lot of complications. At worst, the entire uterus is removed. According to doctors, fibroids are not known to have any direct effect on fertility but rather interfere with conception and pregnancy depending on their size and location.

If a fibroid is located at the entrance of the uterus or is blocking the fallopian tube(s) and is big enough to cause blockage, the sperm and ova might not get to meet and thus there is no fertilization, Dr. Paul Ssemugoma of International Medical Centre says.

Dr Mijumbi adds that in cases where a fibroid grows at the entrance to the womb, sex could be painful and delivery complicated resulting into birth by cesarean.

This is an example where we would need to operate and remove the fibroids but we can't operate when one is pregnant so we wait and see whether the foetus survives long enough to be delivered by caesarean then operate later before their next pregnancy, she explains.

The other instance where they are removed is when a swelling twists on its stalk. Fibroids have a stalk attached to the uterine wall. When one of the fibroid swellings begins to twist on its stalk, it causes unbearable pain. In that case, surgery to remove the fibroid has to be carried out.

Fibroid swellings thrive on estrogen - a female hormone produced by the ovaries which increases in the body during ovulation, menstruation, and pregnancy. They enlarge during heavy surges of the hormone in the body causing heavy and painful periods as they expand and contract.

Some patients are in fact injected with estrogen free hormones to hinder the development of the fibroids but this hormone impacts negatively on their fertility rates, says Dr. Mijumbi.

During pregnancy, they enlarge and if they are growing on the inner walls into the uterus, they compete for space with the fetus and usually win thus causing pregnancy losses or premature births. In most cases though, even when the doctors diagnose fibroids, the patients are left to live with them.

They are usually small and harmless save for the painful and heavy periods that most women can live with taking painkillers, says Dr Ssemugoma. Otherwise, the fibroids die out with menopause because the ovaries stop producing the estrogen they thrive on.

REAL LIFE EXPERIENCE:
It happened to me: Grace Areymo a 49-year-old mother of five shared her experiences with Winifred Agudo. When I was growing up, this complication was attributed to women who decided not to give birth. This was to change drastically in 1998 when my menstrual cycle became constantly heavier, more painful and would last two weeks.

I immediately sought medical help and fortunately, a female doctor attended to me. She recommended antibiotics for one week, thinking it was an infection. A week later, with no improvement, I was forced to see the doctor again, this time around however, it was a male doctor.

He prescribed pills for my pain for 30 days, thinking it was a hormonal imbalance. I was fooled into thinking the problem was gone when the bleeding stopped, but my next period was very painful so I was advised to see a gynecologist.

After several tests and sound scan in 2000, I was diagnosed with fibroids. My first reaction was shocked because society always had it that fibroids exist among Nuns and women who deliberately refuse to give birth, besides I am a mother. Since then my abdomen has gradually expanded so much, that it is uncomfortable.

People who knew me before keep wondering what happened and this has put pressure on me to look like did before. Thinking back now, remember this complication could have started when was in my 30s, though I ignored it then.

I have tried some preventive methods like herbal medicine, which has slightly reduced the size of my tummy. I am still hesitant to have an operation because of the side effects.

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Category: estrogen, fibroids, Hormones, progesterone