Knowledge, perception and attitude towards fibroids

Approximately five years ago, Maria* started to have very painful periods. “Sometimes, they would last up to eight days,” Maria says. The painful, long-lasting periods would come and go, but every once in a while, it was bad. Due to the prolonged menstruation, Maria lost a lot of blood, too.

Finally, she decided to go to a doctor and talk about her symptoms. The physician advised to do an ultrasound. The machine quickly gave the reason for Maria’s pain. It turned out she had a fibroid in her womb of about four centimetres length.

“In layman’s terms, fibroids are swellings that occur in a woman’s womb of reproductive age”, Dr Cletus Kiwale explains. As a gynecologist working in a private practice, Dr Kiwale is familiar with the affliction. “There are a lot of wrong conceptions about fibroids,” he says adding; “many patients are misinformed.” A typical misconception according to the gynecologist is the notion that fibroids are the same as having a cancer. This is not the case, they are benign tumors that very rarely develop into cancer. Additionally, having urgency of urination, constipation or other abdominal symptoms often lead women to think they might have fibroids. “Not every chest pain is due to a heart attack”, Dr Kiwale compares. Having these problems does not prevent other quite different conditions to occur to a woman.

Fibroids are quite common in women aged 15 to 45 years, Dr Kiwale says, but most prevalent between 30 and 45 years of age. Women who were found with fibroids in an older age mostly developed them earlier, but weren’t diagnosed before. The symptoms of the swellings largely depend on where they are in the womb. The biggest problem is typically that by the time the fibroids are discovered, they have already reached a size where they have to be removed surgically. “The majority of the cases are asymptomatic hence resulting in delayed diagnosed”, Dr Kiwale says.

Early diaagnosis is better

In Maria’s case, the fibroids were diagnosed quite late as her swelling was already that big. It was clear that she would have to have it removed surgically. However, her doctor gave her medication first, that was supposed to make the fibroid smaller so the operation would be easier. However, for Maria that did not work. After one month of taking the medicaments and three months of observation through her doctor, her fibroid had not reduced its size.

“The majority of fibroid cases are managed by non-surgical intervention,” Dr Kiwale explains. Usually, a means called gonadotropin is used that releases hormone agonists. Additionally, according to the gynecologist, simple non-steroidal anti-inflammatory drugs such as acetaminophen and ibuprofen will provide adequate reliefs. Because women with fibroids often suffer from heavy periods, signs and symptoms of anemia tend to appear. This is treated at best by iron supplementation as well as drugs that minimize the excessive menstrual. For Maria, the non-surgical intervention did not work out, and she had to have an operation in order to remove her fibroid. Her lower body was numbed during the surgery, but Maria herself was awake. She had to stay in the hospital for three days before she was discharged.

“Afterwards, I felt fine,” Maria says, her periods went back to normal. “However, because of the operation I could not go to work for four full months.”

“When surgical intervention is considered necessary, two options are available”, Dr Kiwale explains. A doctor has to consider a number of factors: The necessity for the woman to conceive, her age, the size and number of the fibroids as well their location in the uterus. As in Maria’s case, the fibroids can be removed leaving the uterus behind, a procedure called myomectomy.

Cause unknown

The other definitive surgical option is to remove the whole of the uterus, a procedure called hysterectomy. “This is not done often”, Dr Cletus Kiwale says, “considering the risks involved.” Before opting for a hysterectomy, it is advisable to seek for a second opinion, as removing the uterus is definitive and will leave the woman unable to conceive. With age, or better, as soon as a woman goes into menopause, fibroids often shrink, due to diminishing levels of oestrogen. High oestrogen levels were probably the cause of Maria’s fibroid, too. Her doctor told her it was probably due to hormonal imbalance. According to Womenshealth.gov, the causes for fibroids are not known, but researchers think that more than one factor could play a role. Besides high hormone levels, genetics might be another cause, too: If one woman suffers from fibroids it is likely that other females in the family will, too. Fibroids grow rapidly during pregnancy, when hormone levels are high. They shrink when anti-hormone medication is used. They also stop growing or shrink once a woman reaches menopause.

“Fibroids are mostly associated with high levels of the hormone oestrogen which affects the smooth muscles that are inside a woman’s womb”, Dr Kiwale confirms, too. However, being pregnant or having had a conception earlier definitely has an influence. “Fibroids are most prevalent between 30 to 45 years of age. Women who have no history of conception before the age of 30 years and above are more likely to get this disease.” Even though there is no confirmed data how many women in Tanzania suffer from this condition, there is evidence that supports the fact that conception plays a role: The occurrence of fibroids is distinctly higher among nuns, most of them suffer from the swellings in the womb.

Conception plays a role

After her operation, Maria, too, was told that the best way to avoid another outbreak of fibroids was to get pregnant within six months. However, the young woman is single and there was no prospective partner in sight, so she remained childless – which had those exact consequences. “Five years later, the fibroids came back”, Maria says sadly. She had the same symptoms as before: A high blood flow with long and painful periods. Maria went to the hospital – this time to another doctor – just to hear a joke she did not want to hear: A good thing she wasn’t pregnant! The not-so funny joke is based on the fact that fibroids can complicate a pregnancy. A removal of fibroids might lead to an accidental removal of the embryo, too.

Fibroids cannot cause infertility as such, Dr Kiwale says. “But they may contribute to it depending on the size and position in the uterus.” Many women conceive without problems despite having fibroids. Maria had to go through the same ordeal again. First, having the fibroid removed surgically followed by a four-month recovery period where she was unable to work. Again, Maria was told that the best way to avoid future fibroids was to get pregnant as a return might finally risk her uterus to become affected. Maria still hopes she might get pregnant soon. “I am very grateful for my friends and family”, she says, “they have been very supportive during this difficult time.” She wants to advise other women to do regular checkups. “When found early, you might get rid of the fibroid without having to go through surgery.”

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