I walked towards the consulting room on that morning and spotted a plump dark woman whom I decided to interact with. Apparently, she had come to see a gynaecologist to schedule a surgery for her.Upon interacting with her, I realized she has been diagnosed with uterine fibroids.The question I asked myself was,"Do all fibroids require surgery?"Well, you would find the answer in some few paragraphs below.I think the story and awareness on fibroids have been championed enough in our societies especially in Ghana.Uterine fibroids are pretty much common among Ghanaian women and even in my own circle, I can count about 3 or 4 of my mother's friends who had that condition.Most people especially women have different misconceptions about fibroids. To some, it is some sort of cancer. Yet to another group,they believe it can be melted.I personally call it the white whorls because it looks like multiple round white masses in the uterus.
WHAT ARE FIBROIDS,RISK FACTORS AND WHAT CAUSES THEM
Fibroids are benign growths of the muscle layer(myometrium) of the uterus.The word benign basically means they are not cancerous.Being a black woman alone is a risk factor for getting fibroids.Again,women who due to one or two reasons may not have given birth has a high risk of getting fibroids. Lastly and most importantly,if any member of your family has fibroids(especially first degree relatives like mother,sister etc),you are likely to get fibroids.Regardless, there are women who may not have a positive family history of fibroids yet they do get fibroids later in life.Other sources argue that your diet may predispose you to get fibroids.I stand to say that there are no established evidence to that.
Females have hormones called oestrogens and progesterone which are responsible for development of secondary features like breast.They are also responsible for ovulation, menstruation, pregnancy and delivery.The main causes of fibroids are these hormonal imbalances and hence in its treatment,we use drugs that target these hormones.The ovaries in a female have ovum or eggs which make the oestrogens.A single egg is released per month to either undergo menstruation which you may see as blood or in the presence of the male sperm, it undergoes fertilization and subsequently pregnancy results.The oestrogens made by the eggs tend to have an effect on the muscle layer of the uterus causing it to grow which we see as fibroids.In case of pregnancy,progesterone level rises to maintain and support the pregnancy.So a woman who may have never given birth before is exposed to high levels of oestrogens than progesterone. This is the basic cause of fibroids-overexposure to oestrogens.
CLASSIFICATIONS OF FIBROIDS.
FIBROIDS are classified based on their location in the uterus.The uterus has 3 layers. From the inside to the outside,we have endometrium which is the innermost layer,followed by the the myometrium which is the middle and also the muscle layer and the outermost layer is called serosa. So fibroids can be on any of these 3 layers and sometimes even outside the confines of the uterus.
Based on location, we have:
1.Submucosal fibroids:These are within the endometrium
2.Intramural fibroids:These are within the myometrium or muscle layer.
3.Subserosal fibroids:These are within the outermost layer of the uterus.
4.Pedunculated fibroids:These types have a stalk that connects the mass or fibroid to the uterus.
5.Intraligamentary fibroids:The uterus is basically supported by tough ligaments such as the broad ligament. Intraligamentary fibroids are located deep within these ligaments.
6.Parasitic fibroids:These are fibroids which have sort of disconnected themselves from the uterus and have attached themselves to the bowel or intestines and tend to gain their blood supply from the bowel or intestines.
SIGNS AND SYMPTOMS OF FIBROIDS.
1.Heavy and prolonged menstrual bleeding.
This is the commonest symptom.Each fibroids is supplied by one major blood vessel.As the lining of the uterus(endometrium) sheds during every menstrual cycle, these fibroids tend to bleed too causing heavy or prolonged bleeding,usually more than 7 days.If bleeding goes on for a long period without any interventions, the woman may become anemic which means she will start experiencing headaches,dizziness,awareness of heart beating faster,and even fainting in extreme cases. This is because she has lost so much blood than what is in the body.
2.Pain
This mostly comes about when the fibroid outgrows its blood supply causing ischemia and necrosis.Depending on the location of the fibroid,some may experience pain during sexual intercourse.
3.Abdominal distension.
This is when the fibroids gradually enlarges or becomes bigger causing your abdomen to also become big.Most people say they feel their stomach is bloated. At this point, the mass may be felt when you touch your abdomen.In extreme cases, it may lead to fluid accumulation in your abdomen called ascites.
4.Pressure symptoms
These include urgency and frequency in urination,urinary retention with hydroureters and hydronephrosis,constipation etc. This is basically due to the enlarging fibroid blocking the urethra and the rectum.
5.Pedal oedema and varicose veins.
This occurs when the fibroids enlarge and subsequently block a blood vessel,likely a vein draining the leg areas.Veins function to return blood to the heart when this occurs,the blood from the legs cannot go back to the heart and such accumulates in the legs and feet.The accumulation causes swellings in your feet and legs which is known as pedal oedema.The varicose veins come bout when your veins become dilated due to blood and fluid accumulation.
They are mostly seen as tortuous green veins on the things,legs and feet.
6.Long standing or untreated fibroids associated with bleeding may cause a woman to loose weight and become malnourished.
7.Yet to another group of women, they have fibroids but have no symptoms.They are said to have asymptomatic fibroids.
CHANGES FIBROIDS UNDERGO
Like every chronic disease,if left untreated tend to worsen with time.Fibroids on the other and also undergo degenerative changes with time.Some of these changes are:
1.Necrobiosis/Red degeneration:It mostly occurs when the fibroid outgrows its blood supply causing ischemia, pain and necrosis.
2.Cystic degeneration:This is the build up of fluid in the fibroid tissue.
3.Fatty degeneration:Build up of fat in the fibroid tissue.
4.Hyaline degeneration
5.Infection
6.Calcific degeneration
7.Torsion of a pedunculated fibroid
8.Sacromatous change:This is when the fibroid undergoes changes to become cancerous. This is rare though.
TREATMENT OF FIBROIDS
This is where there are so many speculations about the treatment of fibroids. Some believe there are drugs which could cause the fibroid to melt.This is totally false.Treatment depends on the size of your fibroid which is determined by ultrasound scan. It also depends on whether you have symptoms or not and also based on your fertility wishes,that is,if you may wish to give birth to child or not.Whatever your situation may be,your doctor would likely focus on;
1.Stopping the bleeding if there is.
This could be stopped with antifibrinolytics like tranexamic acid,oral contraceptives and gonadotropin releasing hormone analogues like buserelin and goserelin.
2.Building your haemoglobin level
This is likely to be achieved with hematinics(commonly called blood tonics in Ghana),diet,parenteral iron,erythropoietin and in extreme cases, blood may be given.
3.Definitive treatment
This is mostly surgery which could either be surgical removal of the fibroid(myomectomy) or surgical removal of the uterus(hysterectomy).
Myomectomy may be doe if the woman wishes to give birth or has not completed her family.Note that with myomectomy,there is a high possibility of recurrence.Hysterectomy may be done if the woman has completed her family or may not wish to give birth again.In some cases, if the woman is approaching menopause and the fibroid is asymptomatic, no surgery is done. She may be given some oral contraceptives till she reaches menopause where the fibroids tend to shrink naturally. This is because fibroids depend on the hormones estrogen and progesterone for their growth. At and after menopause,there is a decline in these hormones which means the fibroids would not be able to grow.Since fibroids are associated with the uterus,it may be a suspected cause of infetility in a woman.But in cases where the fibroid is not a suspected cause of infertility and it is also asymptomatic, surgery may not be done.
In conclusion, fibroids are not cancerous and they are treatable. Do not entertain herbal medications in the name to melt your fibroids. Fibroids do not melt,it would only complicate the process or the condition.
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Women