Making an Informed Choice of Fibroid Treatment

Experts say that the choice of fibroid treatment method to be adopted by a patient should be informed by doctor’s advice, fertility plans, size of fibroid, severity and diligent research. Yinka Olatunbosun reports

Arguably, fibroid constitutes one of the most under-estimated health conditions that many women of childbearing age and beyond often undergo. Many who live with fibroids are usually capable of performing daily tasks efficiently which makes it very easy for some to dismiss it as a condition that can be managed without serious health complications.

Fibroids are non-cancerous growths that develop in and around the uterus (womb). Made up of muscles, they usually vary in sizes and they grow bigger over time.

Fibroids in women do not always have similar symptoms. While most patients have complained of symptoms such as heavy bleeding during menstrual period, bloating, sharp needle-like pelvic pains, miscarriages, infertility and in rare cases, no symptoms.

For those with heavy bleeding, anemia had been largely reported as a complication. When fibroids are allowed to grow too large, they can impact on the quality of life in both physical and mental well-being. For some, it may become difficult to eat large portions of food; lead to urine incontinence, constipation, fatigue, and other symptoms.

Enlarged uterus due to fibroids can make a woman appear to be pregnant. Gynecologists say that the hormones released during pregnancy allows the stomach region to be elastic as the foetus grows. But in fibroid cases, the enlarged uterus makes the abdomen area very hard.

Most doctors cannot really ascertain the actual cause of fibroids in women. Some had linked it to heredity, early onset of puberty and excess level of estrogen. Nutritionists have also advised fibroid patients to embrace a vegetarian diet in order to minimise the growth of myomas.

Women who follow some of this dietary approach may experience some relief of symptoms but many still had to undergo surgery after depriving themselves of eating balanced diet. Fibroids exist as parasites in the host, feeding off nutrients with no benefits in return.

A Lagos-based gynecologist, Dr. Paul Nwango explained that fertility consideration is one of the reasons for the choice of fibroid treatment.

“Some women plan to have a family. In this case, myomectomy is recommended. But for someone who has finished having children and does not have any intention of having more, we can advise the removal of the uterus. With myomectomy, the fibroids may still grow back. But with hysterectomy, fibroids will not grow anymore,’’ he said.

Myomectomy, which seems to be the most popular procedure in Nigeria, is an open surgery that requires a large incision to remove the fibroids. The incision can be a ‘bikini cut’ that is a small cut below the abdomen or a vertical incision, depending on the size of the fibroids. Complications associated with this procedure include bleeding, adhesion, infection, damage to other organs and more. With the aid of technology and advancement in medical practice, there are many other options today for the treatment of fibroids.

Dr. Nwango revealed that there are some medications that people believe to help in shrinking fibroids but many had not been proven to work for all cases of fibroids. Other treatments he highlighted include Uterine Artery Embolization (UAE), Hysteroscopy, Magnetic resonance imaging-guided ultrasound surgery and others depending on the size of the fibroids.

Dr. Nwango maintained that it is important for women who have been diagnosed with the condition to stay in touch with their doctor and report any symptom as soon as possible. Other minimally invasive methods of fibroids treatment include laparoscopy with involves the use of small incisions and camera to remove fibroid tumours. With this, recovery time is shorter and many patients are able to return home on the same day of surgery because there is less pain and reduced hemorrhaging with little or no chance of needing a blood transfusion.

Other patients who delayed their decision to undergo surgery say that is delicate for patients to rely on layman’s advice. Many women had been scammed by drug peddlers who claim to have herbal remedies for the fibroids. Sometimes, their marketers use catchy phrases like “Fibroid Finisher,’’ or “Fibroid Destroyer,’’ to woo their desperate customers.

For instance, a patient who preferred to remain anonymous revealed that she paid a sum of N200,000 for herbal preparations to treat her fibroids. Some of these contained alcoholic content which she had to take during office hours. The process which did not yield positive results was a very depressing episode for her. She eventually had a surgery at a facility based in Ikorodu with subsidised payment plan by a faith-based organisation.

In a May 2021 report published in a newsletter by Society for the Advancement of Patient Blood Management, a 36-year old patient presented an eight-year history of progressive abdominal swelling and weight loss. She had been diagnosed with uterine fibroids some six years earlier but for the fear of surgery, relied on herbal remedies which only worsened her situation.

Eventually, she was referred to a bloodless surgery specialist in Lagos and the 26kg fibroid was removed safely. Patient blood management protocols help doctors to minimise blood loss during surgery, avoid complications of blood transfusion and improve patient outcomes. This explains the growing popularity for bloodless surgeries.

While some of the publicised and over-hyped herbal remedies may help to shrink the fibroids, they may not eliminate them which means the fibroids will grow back. When fibroids grow larger, they may impact on nearby organs such as the spleen, stomach, lungs and kidneys or even become calcified, that is, having large deposit of calcium on fibroids that make them as hard as bones.

Before taking the decision to undergo surgery, one must ensure that due diligence is done. It may require looking beyond one’s proximity. Sometimes, the experts with the requisite skills are invited from outside Nigeria. Despite the complications, safe fibroid surgeries are still possible in Nigeria.