All you wanted to know about fibroids but were too scared to ask

After Grace Wambui gave birth to her first child at the age of 38 she started getting heavy periods.

“At first, I thought that it was normal after child-birth but this went on for a year and I had to consult my doctor. When I found out that I had fibroids I was worried because I thought that I would not be able to have more children,” she says.

Fibroids cause heavy bleeding by interfering with the muscular contractions of the uterus that help it control bleeding during a woman’s period. Fibroids also dilate and engorge the veins in the uterine walls making the bleeding heavier with clots and severe cramping.

“Four out of every ten patients that walk into my clinic today have fibroids,” says Dr. Obwaka a Nairobi gynaecologist and obstetrician with 35 years experience.

While the female hormone oestrogen is associated with the growth of fibroids, it has not been found to be their initial cause and for that reason the cause of fibroids is said to be something of a mystery.

Fibroids are small, non-cancerous growths on the uterus. According to research, uterine fibroids occur in about 66 percent of women by the time they reach the age of 50.

The collagen content of the growth gives it a hard, fibrous texture, thus the name fibroid. These tumors are also called myomas, leiomyomas or fibromyomas.

Fibroids are reported to be most common in women who are in their 40’s and early 50’s. However, most women know so little about them or have such misconceptions that they are devastated when they are diagnosed with fibroids.

All women are at risk of developing fibroids but they occur three to nine times more frequently in black than in white women. The actual cause for this is not known.

Fibroids start to grow once menstruation begins. Their growth depends on the female sex hormone oestrogen because they increase in size during the reproductive years when oestrogen levels are high and then stop growing and shrink after menopause when oestrogen levels dip.

They are also more common in women who have fewer children or none at all because the uterus remains exposed to high oestrogen levels without the interruption of pregnancy for long periods. Most fibroids do not grow during pregnancy.

According to Dr Job Obwaka, one factor linked to the rise of fibroids is obesity and more than 40 per cent of Kenyan women are now classed as clinically obese. “The culprit is urbanization,” believes Dr Obwaka. “It may have made life easier, but with it brings junk food and increasingly inactive lifestyles.”

Fibroids can cause a wide range of symptoms, from a general feeling of ‘fullness’ in the lower belly, to painful and heavy periods that can lead to anaemia. In some women fibroids do not cause symptoms and do not require any treatment, however for others treatment means drastic surgery to get them out.

Depending on the severity of the fibroids many doctors can remove only the fibroids and keep the uterus intact. This does not always solve the problem. About half of the women who keep their uterus find that their fibroids grow back. According to research, fibroids are responsible for about one-third of all hysterectomies.

Large fibroids cause heaviness, bloating, and discomfort in the pelvis and may compress nerves, causing pain in the legs and back. Fibroids can also block the outflow of urine from the bladder, forcing the woman to empty her bladder frequently, especially at night. If this obstruction is not relieved, it can eventually cause kidney damage.

They can also cause pain when passing stool, constipation, and even intestinal obstruction if they are large enough. Some women also experience painful intercourse.

When should fibroids become a concern? “It’s all about their size, the quantity and their positions,” says Dr Obwaka. “The bigger they are, the greater the risk. However, even a pimple-sized fibroid could cause issues if it is located within the uterine cavity, while a large fibroid on the outside of the uterus may never cause any problems.

It is only when fibroids cause severe bleeding; interfere with fertility, cause severe pain and pressure symptoms or when they start growing rapidly that something has to be done,” he asserts.

According to medical research, the only absolute cure for fibroids is their surgical removal. In Kenya, surgical treatment for fibroids include abdominal hysterectomy which is the surgical removal of the whole uterus with the fibroids; an operation suitable for patients who have completed child-bearing and open myomectomy which is the surgical removal of only the fibroids from the uterus; and is suitable for patients who want to give birth again.

According to Dr Obwaka, another popular procedure recommended is known as Uterine Fibroid Embolization (UFE) and it enables women to cure the disease without undergoing surgery. UFE was introduced in Kenya back in 2010.

It is a new approach in the treatment of fibroids in Kenya, and other African countries, though it is established internationally as a proven remedy to the disease.

Prof. William Stones, Chair Department of Obstetrics and Gynecology at The Aga Khan Hospital where the operation is being done was quoted saying that UFE is best suited for patients who want to avoid open surgery. Prof Stones further said that the method is best suited for women who may wish to become pregnant again.

Women who are approaching menopause are at the greatest risk for fibroids because of their long exposure to high levels of oestrogen but this can happen as early as a woman’s 20s. Not all women with fibroids will have symptoms.

In fact most women only discover that they have fibroids when they start causing trouble or when they have gone in to see the doctor for something completely different.

Fibroids are most often found during a routine pelvic examination. The sooner one finds out, the sooner it can be treated. Thanks to today’s medical advances and new technology, it is possible to regain a healthy uterus.

By Judy Chebii