Doctors say that uterine fibroids could be a cause of infertility in women, among other complications, like anaemia due to prolonged menstruation, constipation, to mention but a few. Dr Michel Baingi, a general practitioner in Kigali, says uterine fibroid is the most common benign tumour (not cancerous) of a woman’s uterus during procreation period (puberty). Fibroids are tumours of the smooth muscle found in the wall of the uterus. They can develop within the uterine wall itself or attach to it. They can grow into the uterine wall, into the thickness of the uterine wall, or on the surface of the uterus, into the abdominal cavity. They may grow as a single tumour or in clusters. Generally, fibroids tend to grow slowly and rarely turn to cancer. Dr Iba Mayele, an obstetrician gynaecologist at Clinic Galien, Kimironko, says uterine fibroids are non-cancerous growth of the uterus that often appears during childbearing years. He notes that they are also referred to as leiomyomas (lie-o-my-O-muhs) or myomas and that they aren’t associated with an increased risk of uterine cancer and almost never develop into cancer. CAUSES/RISK FACTORS Baingi notes that the main causes are unknown but fibroids grow in response to stimulation by the hormone oestrogen, produced naturally when the body starts the period of puberty until the beginning of menopause. He explains that the factors of risk are a family history of uterine fibroid, overweight or obesity (body weight tends to increase oestrogen production, thus aggravating fibroids growth), and precocious puberty (onset of the menstrual period under 10 years). SIGNS AND SYMPTOMS Baingi says excessive (menstrual bleeding soaking through more than three pads per hour) or long menstrual bleeding, blood clots, dizziness, severe or prolonged pelvic pain by pelvic pressure, frequent urination or urgency to urinate by the pressure on the bladder, constipation or haemorrhoids by pressure on the rectum, infertility, feeling of masses in lower abdomen or heaviness if it’s big myoma, increasing abdominal wideness, are all signs of uterine fibroids. Mayele says most women with fibroids will experience no symptoms at all, however, for many large or numerous fibroids can cause the following symptoms; bleeding between period, frequent urination, pain during intercourse, difficulty getting pregnant. He explains several factors may affect a woman risk for having uterine fibroids including; African race, high blood pressure, no history of pregnancy, vitamin D deficiency, among others. Baingi says, rarely can fibroids turn to the malignancy (cancer sarcolemma), the large tumours can lead to hysterectomy (a surgical operation to remove all or part of the uterus). PREVENTION “Avoid weight gain after the age of 18 and maintain a normal body weight compared to body mass index, exercise can help to control weight and to decrease hormone production, avoid tobacco use as quitting smoking will improve general health and reduce the occurrence of fibroids,” Baingi says. He urges routine health visits and medical consultation since it may allow early detection of fibroids. Mayele says eating fruits and vegetables may be able to decrease fibroid risk. TREATMENT Baingi also says the treatment of uterine fibroids depends on the severity of symptoms, the size and location of the fibroids, age, the patient’s desire to have children and general health. He adds that medical treatment in most cases is not necessary, particularly if the woman has no symptoms, has a small tumour or has gone through menopause. Baingi notes that if no malignancy is found, the vaginal bleeding often can be controlled by hormonal medication and a progesterone receptor modulator like EllaOne. He says, surgical (myomectomy) can also be done in cases of abnormal vaginal bleeding as fibroids require a surgical scraping of the uterine cavity or in cases of sarcoleiomyoma, or big fibroids. COMPLICATIONS Mayele says although uterine fibroids aren’t usually dangerous, they can cause discomfort and may lead to complications, such as a drop in red blood cells (anaemia), which causes fatigue, from heavy blood loss. Rarely, a transfusion is needed due to blood loss. He further says fibroids usually don’t interfere with getting pregnant. However, it’s possible that fibroids, especially submucosal fibroids, could cause infertility or pregnancy loss. Mayele adds fibroids may also raise the risk of certain pregnancy complications, such as; placental abruption, foetal growth restriction and preterm delivery. editorial@newtimesrwanda.com
