With research reports showing that uterine fibroids are common in women aged 30 years and above amid growing cases of infertility, women who are desirous of reaching certain levels in their careers before having children are increasingly becoming apprehensive. Many gynaecologists, however, maintain that fibroids don’t cause infertility; nevertheless, they encourage healthy lifestyle and regular medical checkups that will not only help young career women to beat this ravaging medical issue in its game but also boost their reproductive cells, Maria Diamond wwrites:
“I got married four years ago and since then I have not been able to conceive.
“The doctor diagnosed that I have fibroids and based on some of the unpleasant stories I have heard about the surgery process, I felt I could manage the fibroids and still get pregnant, after all some people get pregnant with fibroids but eventually the doctor advised that I do the surgery to remove them some months back.
“During one of the sessions with my doctor before the surgery, it was very disheartening to hear the doctor tell me that if I had gotten married in my 20s and tried conceiving at that age, I probably wouldn’t be having conception issue and chances are that the fibroids probably wouldn’t have multiplied.
“That was hard to hear and stomach because in my 20s I wasn’t ready for marriage. I needed to build my career and my husband, who was my friend, wasn’t ready for marriage either.
“We both wanted to build our career before settling down. Unfortunately, that is like the biggest crime committed against myself. I really want to have children and I am hopeful that God will prevail over this situation.”
With these words of lamentation, a 40-year-old chartered accountant (names withheld), who recently had a fibroid surgery, narrated what she was passing through in her bid to conceive and have a child. Listening to her as she recounted her experiences in the last four years of her marriage was pathetic as pain and disappointment etched boldly all over her face.
“In fact, one could conclude that what keeps her going is her faith that God will prevail over her situation.
However, as agonising as her case seems, she is just one in millions of women across the world that doctors have told they have fibroids in their uterus and can only conceive if they are surgically removed.
“While many have succeeded in conceiving and cuddling their own children after going through the process, a lot of others are still expecting and this is raising concerns among young career women who feel like delaying child bearing until a certain age.
A 35-year-old career woman (names withheld), who would be getting married in three months time, said that she had wanted to get married earlier but developments beyond her control compelled her to focus on her career.
However, now that the right man has come, she has been diagnosed with fibroids and she is praying that it does not prevent her from conceiving.
“I will be getting married in three months’ time but I have fibroids and my fiancé, who is a medical doctor, is aware and he says there is no cause for concern. But deep down, I am worried both about my symptoms, especially the heavy bleeding and my chances of conception,” she said.
Ravaging women in their childbearing age like hurricane, Uterine Fibroids, non-cancerous growths made up of muscle and fibrous tissue of varying sizes that develop in or around the womb (uterus), has given rise to diverse challenges and concerns amongst women all over the globe, especially those whose fertility chances are minimised as a result of these unhealthy growths.
Also called uterine myomas or leiomyomas, these non-cancerous growths spring up inside the uterus, within its muscle wall or on its outer surface, changing the shape of this vital female reproductive organ as they grow.
Although experts are yet to affirm the actual causes of fibroids, as they are still not known, increasing evidence supports the hypothesis that they originate from stem cells in the myometrium; but the specific cell of origin has not yet been identified.
Research shows that many fibroids contain changes in genes different from those in typical uterine muscle cells.
Hormones – estrogen and progesterone, blood flow, inflammation and genetic mutations that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy appear to promote the growth of fibroids.
Research reports have shown that some fibroids begin as cancer, but are very rare as they are often almost benign, such that usually does not cause any serious problems in the long term.
Notwithstanding, only a medical professional can determine whether fibroids are a cause for concern or not.
However, while uterine fibroids are not originally supposed to be life threatening except for very serious surgery complications, they can change the structure of a woman’s uterus both in size, shape, location and symptoms, thereby affecting fertility.
It has been revealed that sometimes, the complications arising from fibroids are mostly dependent on the type and severity of symptoms. This is because not all fibroids cause symptoms for women but those with symptoms often find fibroids hard to live with due to the excruciating back pain, leg pain, frequent urination, pain during sex, bloated abdomen that makes the stomach to protrude and heavy menstrual bleeding.
Occasionally, some women suffer quite a long time with fibroids until they experience nearly continuous bleeding. If not treated early enough, fibroids can develop large enough to harm the ureter, the tube that joins the kidney with the bladder, in extremely rare cases.
If the flow of urine is obstructed due to a fibroid pushing on a ureter, the resulting back pain can cause the kidney to expand, a disease known as hydronephrosis.
According to Advanced Gynaecology Melbourne (AGM), there are four types of fibroids. These include Intramural fibroids, which grow within the muscular uterine wall; Submucosal fibroids, which bulge into the uterine cavity; Subserosal fibroids, which project to the outside of the uterus and Subserosal fibroids, located near the outer layer or serosa of the uterus and are less likely to cause significant symptoms.
While the majority of fibroids cause infertility in some women, many patients with fibroids can get pregnant.
According to gynaecologists, the risk of uterine fibroids increases as one ages, especially from the 30s and 40s through menopause.
A Consultant Gynaecologist in Lagos, Dr. Marcus M.C, revealed to The Guardian that as a gynaecologist, uterine fibroids are the commonest tumours of the female genital tract.
He said: “In essence, anyone with an uterus (a womb) is at risk of having fibroids. The cause of uterine fibroids is not known, however there are risk factors. These risk factors include genetics or what is known as familial tendencies. It may run in families.
“Nulliparity (not carrying a pregnancy till at least 28 weeks of gestation) is another risk factor for uterine fibroids. Getting pregnant is protective against developing uterine fibroids.
“Higher parity is associated with a reduced risk (80 per cent risk reduction in those with three or more deliveries compared with nulliparous women).
“Black race for reasons not completely clear is another risk factor for uterine fibroids. Obesity, weighing more than 90kg, a sedentary lifestyle, delayed child bearing, early menarche, are some other documented risk factors for uterine fibroids.”
Marcus stated that in this part of the world, working class young women who delay child bearing till they are ready are at risk of having uterine fibroids.
He, however, added: “Fibroids per say do not cause infertility. Majority of women can get pregnant even with fibroids in situ.
“Fibroids are only problematic when they present with symptoms that affect the quality of life of women.
“Heavy bleeding, chronic pain, pressure symptoms (constipation, urinary retention), from abdominal swelling caused by the fibroids are some pressing symptoms fibroids can cause.
“Fibroids in infertility should be treated after excluding other causes of infertility.”
Are there valid preventive measures against fibroids? Marcus responded that fibroids have no known causes.
“Their growth is because of the response of receptors on the fibroids to the female hormones oestrogen and progesterone. There are identified risk factors. Avoiding such risk factors may reduce the risk of developing uterine fibroids.
“This is not completely absolute and the non-modifiable risk factors cannot be avoided, for instance, genetics. Avoiding delayed childbearing, avoiding a sedentary lifestyle, exercising regularly to manage obesity and breastfeeding are some preventive measures that may help.
“Genetics of course cannot be altered and is among some other non-modifiable risk factors for uterine fibroids,” he explained.
Asked if removal of fibroids via surgery could guarantee conception for a woman who is still in her childbearing age, Marcus said:
“Fibroid removal surgery does not guarantee conception in a woman following a successful procedure. Fibroids do not cause infertility.
“It stands to reason that the location of a fibroid myoma could obstruct the movement of sperm cells from the cervix through the cervical canal to the tubes.
“The removal of these fibroids may improve the chances of conception. However, the surgery can cause adhesions, which may worsen the prognosis of conception.
“Fibroid removal, especially for small sized fibroids, should be the last resort in the management of infertility after excluding other causes of infertility.”
The gynaecologist also noted that there is no medical procedure yet to permanently remove fibroids in women.
“Removing the uterus (womb), a surgery known as hysterectomy is the definitive procedure for putting a permanent stop to the growth of fibroids.
“All other procedures including medical management options, myomectomy, Uterine Artery Embolisation (UAE), can lead to a recurrence or regrowth of uterine fibroids. Provided the womb is still in situ, and not removed, the fibroids can grow again,” he said.
He equally faulted the notion that if a woman does not do fertility treatment and gets sexually active after surgery, the growth of the fibroids would multiply.
“Getting pregnant is protective,” he noted. “There are microscopic seedlings that the surgeon during a myomectomy may not visualise and remove during a fibroid surgery. These seedlings may regrow into huge and large fibroids over time.
“Myomectomy is not the permanent solution of uterine fibroids. The average recurrence rate from different studies is placed at 15-30 per cent over a 10 to 20-year period after a myomectomy.
“It’s however reasonable to say the least that getting pregnant after surgery may be protective against recurrence. This should be guided by the respective managing physicians.”
On why fibroids are more prevalent in Blacks than Whites according to studies, Marcus said only the Lord could answer the question, adding:
“These studies are true as most of them are observational studies, reporting what was observed. The same reasons there are stated risk factors for different conditions. It is stated that
“Blacks are three times at risk of developing uterine fibroids than their White counterparts. Genetics (our genes) as blacks have a major role to play and the reason is not completely known or clear.
“The same reason some conditions are more common in Whites than blacks e.g. cystic fibrosis; fibroids are commoner in Blacks.
“Geographical location, diets and genetics are amongst different postulations to explain the reasons, which are still not conclusive till date.”
Marcus also spoke on the fibroids surgery complication and fatality, especially as it makes a number of women suffering from this health issue to avoid the surgery.
“Fibroid surgeries include the conventional myomectomies (removing the fibroids and leaving behind an uterus capable of reproduction), and hysterectomies could be extensive surgical procedures depending on the size of the myomas, the locations, number of fibroid nodules, previous surgeries, amongst others.
“A lot of factors come into play to make the procedure a successful one. Surgical safety is key not just for fibroid surgeries, but all surgical procedures as a whole.
“The cadre of the surgeon, the hospital where it is performed, the anaesthetist and the anaesthetic technique used, supporting staff like the perioperative nurses are all factors that contribute to a successful surgical procedure.
“I would advise patients not to abstain or avoid surgery when indicated, and surgeons to be particular about surgical safety, the majority of which is beyond the scope of this discussion.”
Also, Dr Nwachukwu Paul of White Clinics and Fertility Centre Ota, said: “The cause of these cellular dysfunctional growths resulting in fibroid are genetic implications, which relate to parental background inclinations.
“Hormonal implications from the surge of estrogens and progesterones, which help to develop the uterus but their extra activities, could aid and abate abnormal tissue growth.
“Not to also talk about extracellular tissue malfunction due to diseases like excessive growth hormones, hyperglycaemia, that is high sugar level in the body. The scourge of infertility or barrenness has been promoted by endometrial fibroids, cornual fibroids at different strategic findings.
“Impressively, when these fibroids are taken out via surgery and the preventive risk factors are adhered to, fertility gradient increases.
“Post-surgery, a female should get pregnant within two to three years to tame hormonal induced causes. There’s the use of invasive and non-invasive surgical therapy to combat fibroid.”
He, however, advised against seeking herbal remedies for fibroids.
Another gynecologist, who pleaded for anonymity, also said that there are no valid preventive measures or routine to fibroid; neither does the surgery guarantee conception for a woman in her child bearing age.
“Fibroid is not an exact or proven cause of inability to conceive. Perhaps there will be evidence tomorrow. The relationship between uterine fibroids and inability to conceive is casual.
“There have been women with fibroids that conceived spontaneously and also there have been those that could not conceive until they had the fibroid removed.
“However, following conception, it may be associated with increased abdominal pain, miscarriages, premature placenta separation, etc,” he said.
The gynaecologist also noted that the only permanent solution or perhaps cure for fibroid is to remove the womb (hysterectomy).
“Also, I may add that it is unlikely to continue growing after attaining menopause. Also, fibroid in blacks are more likely to be huge and multiple.
“However, I am not sure any study has been able to give the reason. On fatality, it is unfortunate to have fatality following fibroid surgery. It is not one size fits all. Each case has its peculiarities. Generally, it is a relatively safe surgery,” he said.
A retrospective descriptive analysis of all the uterine fibroids carried out by experts at the University of Abuja Teaching Hospital Abuja, from January 4, 2013 to December 31, 2017, published in an open Journal of Obstetrics and Gynaecology, showed that uterine fibroids accounted for 6.4 per cent of all gynaecological admissions and 21.3 per cent of all major gynaecological surgeries.
“Uterine fibroid was found to be common between the age range 30 – 39 (47.5 per cent) years, followed by 20 – 29 (26.3 per cent) and 40 – 49 (15.7 per cent) years.
“One hundred and twenty-two (61.7 per cent) were nulliparous while 48 (24.2 per cent) were primiparous. Majority of the women 88 (44.4 per cent) had tertiary education, 49 (24.7 per cent) secondary, 48 (24.3 per cent) primary and 13 (6.6 per cent) had no formal education.
“Seventy-six (38.4 per cent) presented with menorrhagia, abdominal mass 71 (35.9 per cent), infertility 68 (34.3 per cent) and abdominal pain 48 (24.2 per cent).
“Most of the patients had multiple fibroids; 81 (40.9 per cent) had intramural, 70 (35.4 per cent) submucous and 52 (26.3 per cent) subserous.
“Out of 198, 165 (83.3 per cent) had myomectomy, 23 (11.6 per cent) had total abdominal hysterectomy and 9 (4.6 per cent) myomectomy and tuboplasty.
“Anaemia 41 (20.7 per cent) was the commonest morbidity, followed by wound infection 12 (6.1 per cent) and wound dehiscence four (2.0 per cent).
“Uterine fibroid is common in our environment and usually presents with menorrhagia, abdominal mass, infertility, pelvic pain, and recurrent miscarriage.
“Thus healthy lifestyle should be encouraged and routine checkups conducted so as to detect and possibly treat such tumours early,” the report concluded.
The Guardian
