Uterine fibroids, an abnormal growths that appear on the uterus, has made the lives of women who are suffering from this condition, unbearable, due to its symptoms like heavy menstrual bleeding, pelvic pressure or pain, frequent urination, difficulty emptying the bladder, constipation and backache or leg pains, among others.
These symptoms have grossly affected the lives of women like Mrs Angela Okorie, 35, Miss Cathy Osagie, 29 years and Mrs Miracle Femi, 42.
For instance, Okorie, an entrepreneur in Lagos told LEADERSHIP Weekend that she was diagnosed with five fibroids in her uterus, adding that the condition has made her life unbearable.
“I am living with severe back pain and my periods are prolonged and extremely heavy. I currently suffer from anaemia and I experience pain during sex,” Okorie explained.
“With lengthy and heavy bleeding, i also experience clots during my menstrual period. I would bleed for days and because of the heavy bleeding, I would bleed through my outfit, Miss Osagie, a banker told LEADERSHIP Weekend.
Though, she is not married, Osagie said she looks pregnant because of the bump in her abdomen. “Sometimes, I get depressed because the condition has affected my relationship with men. I am 29 years, and I don’t have a stable relationship,” she added.
For Mrs Femi, a tailor, living with the symptoms was the least of her problem as the condition has made her unable to carry her bundle of joy. “My doctor diagnosed that I have up to seven (big) fibroids in my uterus, which has prevented me from getting pregnant. Because of the bump in my abdomen, you will think I am pregnant, but I am not.
I am 42 years and I have never been pregnant,” Mrs Femi lamented.
Prevalence Of Fibroids In Nigeria
As devastating as this condition on the health of women, its prevalence is increasing in Nigeria. Mrs Okorie, Osagie and Femi, are among the 80 per cent of Nigerian women who are living with fibroids, even as a five-year survey of uterine fibroids at a Nigerian tertiary hospital, revealed that the most common gynaecological problem among women of reproductive age in Nigeria is uterine fibroids.
The study which is a retrospective descriptive analysis of all the uterine fibroids carried out at the University of Abuja Teaching Hospital, Gwagwalada from 4th January 2013 to December 31, 2017, revealed that the condition accounted for 6.4 per cent of all gynaecological admissions and 21.3 per cent of all major gynaecological surgeries.
The condition was found to be common between the age range 30-39 years (47.5 per cent), followed by 20-29 years (26.3 per cent) and 40-49 years (15.7 per cent), the study showed.
The study also revealed that 76 of the respondents (38.4 per cent) presented with me-norrhagia; 71 (35.9 per cent), presented with abdominal mass; 68 (34.3 per cent) presented with infertility and 48 (24.2 per cent) presented with abdominal pain.
Risks Of Fibroids Surgery
No doubt, no woman would want to live with this condition, as she would do anything to get rid of it. Aside the fact that, it cost between N200,000 to N700,000 (depending on the clinic) to remove fibroids through surgery, it is sad to know that many women in Nigeria who could afford it, are reluctant to get rid of it, because of the risks associated with fibroids surgery, which have claimed the lives of many.
Several studies have showed that fibroids surgery may present a range of issues, starting with a longer recovery time and including an increased risk for heart disease, uterine cancer, infertility, and regrowth of fibroids.
For instance, few years ago, the United States Food and Drug Administration (FDA), warned women that a device-assisted procedure for treating fibroids could inadvertently spread cancer from the uterus to other parts of the body.
The agency discouraged doctors from performing the procedure, known as laparoscopic power morcellation which uses an electronically powered device to grind and shred uterine tissue so it can be removed through a small incision in the abdomen. The technique is widely used to treat painful fibroids, either by removing the noncancerous growths themselves or the entire uterus.
The procedure was developed as a less invasive alternative to traditional surgery, in which the uterus or fibroids are removed through the vagina or a large incision in the abdomen. Studies suggested that the device-assisted approach results in faster recovery and smaller scars.
But FDA warned that the procedure could actually be spreading uterine cancer to other parts of the body, while estimating that one in 350 U.S. women who undergo fibroid procedures may have an undetected cancer known as uterine sarcoma.
“There is a risk that the procedure will spread the cancerous tissue within the abdomen and pelvis, significantly reducing the patient’s likelihood of long-term survival,” said the chief medical officer and director, office of product evaluation and quality, FDA, Dr. William Maisel.
Surgery comes with a lot of complications, the managing director, Fibroid Care Centre, Lagos state, Dr. Abayomi Ajayi tells LEADERSHIP Weekend, adding that, “People have heard so many stories about fibroids treatments, hence the reason why they are afraid to remove it.”
Ajayi disclosed that a lot of women are not only afraid of the surgery but the anaesthesia. “While some of the deaths can come from the surgery itself, majority come from anaesthetic, especially, in an environment like Nigeria, where we have shortage of anaesthetists,” Ajayi added.
However, there has been seem to be respite in the treatment of fibroid, as global experts who spoke with LEADERSHIP Weekend, at a media webinar, organised by Fibroid Care Centre, Nigeria, revealed that new technology like the High-Intensity Focused Ultrasound (HIFU), which is non-invasive, has made fibroids treatment safer.
The HIFU treatment option is for patients who want to preserve their uterus, do not want to go for surgery, and do not want blood products, says the director, HIFU Centre, Bara Hospital, South Africa, Dr. Raymond Setzen.
Setzen said the HIFU machine is a machine that generates a lot of energy (heat) into the fibroid. “The heat does not cause any damage to other cells in the body, the only damage that is done is inside the fibroids. Increasing the temperature to over 50 to 60 degrees, will cause the cells that is making the fibroids to grow, to die, and with time, the fibroids will shrink on its own.”
During the procedure, the director said the patients usually are awake to tell the doctor how they are feeling. “In that way, it is a very safe procedure compared to surgery that comes with complications like internal bleeding, loss of blood, slip of tissue leading to death and recurrence of fibroid tissue.”
Speaking on the side effects of HIFU, Setzen said, “The only side effect is that the patient can get burning on the skin, and to avoid that, we ensure that the patient is awake to tell when the temperature is too hot on their skin, to enable us adjust the machine.”
After the procedure, the director said, the only thing that can happen is first degree burning of the skin, which can heal on its own without serious treatment, adding that the procedure is done within two hours, after which, the patient is free to go home, that same day.
“Because of the precise ablation to the target area, it allows for normal vaginal delivery in future pregnancies. There is no general anaesthetic, patients recover faster, return to work within days, there is no ionising radiation, which makes the procedure to be repeated, especially if the patient has multiple fibroids, and no damage to ovaries. It is cost-effective in that it decreases hospital stay and no blood transfusion required. HIFU provides a safe and effective alternative in the management of patients with symptomatic fibroids.”
Speaking further on the benefits of HIFU, Ajayi said, “Complications are less; anaesthetic risks are completely knocked out; the need for an anaesthetist and surgeon completely knocked out; the turn-around time is shorter; no scar and no blood transfusion.”
The managing director said the machine is currently in Nigeria, at the Fibroid Care Centre, which is the first in West Africa and third in Africa, adding that, about 143 women have been treated with HIFU with no complication.
“The HIFU procedure is so easy to treat Fibroids and Adenomyosis. A patient can come in that day, do the procedure and go home that day and start living her normal life. One of my patients said, 72 hours after the surgery, she returned to the United States because there was no complication. Also, one of our patients is now pregnant after the HIFU procedure,” he added.
As good as that may sound, Ajayi however said it is not everybody who can benefit from HIFU. “We try not to use the HIFU for people who have done previous surgeries and have up and down incision, known as the midline incision, because, it is possible that the intestine has adhere to the scar and that will make it impossible for the rays to go where we want it to. So we want to avoid such people.
“We also want to avoid people who are grossly obese. For instance, anybody who weighs more than 130kg cannot benefit from HIFU because of the thickness of the skin. The way the HIFU works is that you must focus at a particular radius, so if the skin is too thick, it will make it difficult to get to where the Fibroid is. We also don’t want to use the HIFU for people with big Fibroid. If the diameter of the Fibroid is more than 10cm, then, that patient cannot benefit from the HIFU.
“The good thing about this procedure is that because it does not involve ionizing radiation, it is ultrasound, and as such, can be repeated and for patient who are pre-disposed to cancer, there is no risk of developing cancer, because it is ultrasound. HIFU can also be used to treat solid tumours and adenomyosis as well.”
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