Fibroid: What Every African Woman Should Know

 

 

By: Dr. Gbemisola Daramola, Principal Medical Officer, University Health Service, University of Ibadan, Ibadan, Nigeria and DHLA Volunteer Writer, with contribution from the DHLA Team.

 

 

 

What is fibroid?

 

Fibroid is the most common non-cancerous growths of the uterus (womb) that occur during childbearing years. It is also called uterine fibroid, leiomyoma or myoma. It does not increase the risk of developing a cancer.

Fibroid have been found to be commoner in blacks; Africans and African Americans more than other racial groups.

Experts say that by age 35, about half of black women have had fibroid and by age 50, 80% of them compared to 70% of white women. ⁽¹⁾

 

 

Types of fibroid

The type that you may have depends on the position in relation to the uterus.

 

The different types are discussed below and illustrated in figure 1:

1. Submucosal Fibroid: The growth bulges into the uterine wall. Grows in the middle layer of the muscle of the uterus. It is the least common fibroid.

 

2. Intramural Fibroid: The growth is within the muscular wall of the uterus. They are the most common type of fibroid. They can grow large stretching the uterus due to the location.

 

3. Subserosal Fibroid: the growth projects to the outside of the uterus in the serous membrane.  This is the outer lining of all organs and body cavities. They can grow very big and make the abdomen look bigger on one side.

 

4. Pedunculated Fibroid: It forms when a serosal fibroid develops a stem.

 

 

Risk factors for fibroid

 

Certain risk factors have been found to predispose to fibroid.  These factors (see figure 2) range from genetic predispositions to lifestyle behaviors and include:

1. A positive family history: If you have close family members that have a medical history of fibroid through genetic factors you risk developing fibroid is high.⁽¹⁾

 

2. Age: Fibroids do not occur before puberty and are less common after menopause. The earlier the age you start menstruation (menarche) or the later the onset of menopause the greater the risk of you developing fibroid.⁽¹⁾

 

3. Race: Fibroid are commoner in the black race than in any other race

 

4. Lifestyle factors such as diet vitamin A and D deficiency, high intake red meat, low intake of green vegetables, fruits and fish, increased caffeine and alcohol consumption, smoking, reduced physical activity, and stress in you have a potential effect to increase the format^(2,3)

 

5. Obesity: weight gain increases risk of fibroid only in women who had one or more children.⁽¹⁾   

 

6. Hypertension and Diabetes: Increase in blood pressure has been found to increase the risk of developing fibroid.

 

7. Contraceptives and Hormone Replacement Therapy:  Estrogen is a hormone that takes care of the womb particularly the replacement of its lining shed every month during menstruation. Progesterone another female hormone prepares the body for pregnancy every month by sustaining the womb to aid the implantation of a fertilized egg. High levels of oestrogen in birth control pills may cause fibroids to develop and grow bigger. Hormone therapy can reduce fibroid symptoms and shrink the fibroids.^(1,9)

 

 

How do you know you have fibroid?

 

You may not know you have fibroid. It may be discovered by a doctor incidentally when doing a pelvic examination (the physical examination of the external and internal female pelvic/ reproductive organs). This is because fibroid often cause no symptoms.

The size of the fibroid can determine if it causes symptoms or not.

Fibroid range in size from seedlings not detectable by the human eye to large masses which can be single or multiple, distorting and enlarging the uterus. This enlargement of the uterus can be so much the woman looks as if heavily pregnant with weight gain.

 

 

What are the common symptoms of fibroid?

 

When symptoms occur, they may include some and not necessarily all of the following:

• Excessive or painful menstrual bleeding.

• Menstruation that lasts longer than usual.

• Bleeding between periods.

• Pelvic pressure or pain.

• Pain during sex.

• Feeling of fullness in the lower abdomen.

• Increased menstrual cramps.

• Abdominal enlargement.

• Backache or leg pains.

• Low back pain.

• Frequent urination.

• Inability to urinate or completely empty your bladder.

• Chronic vaginal discharge.

• Constipation.

• Acute abdominal pain when it begins to die due to lack of blood supply

• Unexplained low red blood cell count (anaemia) which can cause dizziness, weakness and fainting.

 

 

When should you see a Doctor?

 

• When the pelvic pain is persistent or unbearable.

• Excessive, prolonged and painful periods.

• Bleeding/ spotting between periods.

• Difficulty emptying your bladder.

• If you look pale, feel weak and fatigued most of the time.

 

 

Can fibroid develop during pregnancy?

 

Preexisting fibroid may grow rapidly during pregnancy due to the increased production of some hormones during pregnancy.

However, pregnant women are less likely to develop fibroid.

A study in 2020 showed 20%-40% of all women could develop fibroid but only 0.1%-3.9% of pregnant women do. ⁽⁴⁾

Another study in 2010 also showed that 10%-30% of pregnant women with fibroid can develop complications especially if the fibroid is large and in the last two trimesters. ⁵⁾ Fibroid usually shrinks after pregnancy in most cases.

Fibroid usually require no treatment during pregnancy. If you experience pain or bleeding or threatened preterm labour, bed rest will be prescribed

 

 

Can fibroid affect pregnancy?

 

• Large fibroid reduce the room available for the baby to grow in the womb thus restricting the fetus growth.

• Fibroid can cause bleeding and pain during pregnancy.

• The placenta can break away from the wall of the womb if blocked by a fibroid.

• Pain from fibroid can cause premature contractions and lead to premature delivery.

• Pregnant women with fibroid are more likely to have delivery by cesarean section.

• The space occupied by the fibroid may cause baby not to align properly  and thus in breech position.

• Pregnant women with fibroid have an increased risk of a miscarriage

 

 

Can fibroid cause infertility?

 

If you have fibroid, you can still get pregnant naturally. Sometimes the size and type of fibroid particularly the sub-mucosal type that grows into the womb can increase the risk of infertility and miscarriage. Fibroid has been found in 5-10% of infertile patients and the only cause of infertility in 1-2.4 %.⁽⁶⁾

 

Fibroid can reduce fertility in the following ways:

• Changes in the shape of the uterus due to the fibroid can affect the movement of the sperm or embryo.

• The fallopian tubes can be blocked by fibroid.

• The fibroid can affect the wall of the womb.

• The shape of the cervix can be changed affecting the number of sperms that enter the uterus.

• The flow of blood to the womb can be affected which will reduce the ability of the embryo to implant in the wall of the womb and develop

 

If you are unable to get pregnant or keep a pregnancy, please see a doctor before concluding that it is caused by fibroid.

 

 

How is fibroid diagnosed?

 

If you suspect you have fibroid then you should get a medical examination. Take the following steps:

• See a doctor who may be a primary care doctor or general practitioner or family doctor who will ask about your symptoms and do a pelvic examination, If abnormal changes in the shape or size of the womb is observed, the doctor will send you for further tests.

 

• Ultrasound scan: This is usually the first kind of imaging your doctor will ask you to do. Ultrasound scan uses sound waves to take a picture of your womb. This will show if you have fibroid, the location and the size(s). This is achieved by the doctor or technician (sonographer) moving a probe over your abdomen (abdominal scan) (see figure 3) or inserting the probe into the vagina (transvaginal scan).

 

• If it is confirmed you have fibroid you may be referred to a gynaecologist (a doctor specialising in women’s reproductive health matters) for further assessment.

 

 

How is fibroid treated?

 

The treatment of fibroid is on individual basis; your symptoms, the size and location of the fibroid, your age, your desire to have a child or not are all put in consideration.

 

• If your fibroid is not causing symptoms then there is no need for treatment.

 

• Studies have shown that 3-7% of untreated fibroid shrink over time at menopause and the symptoms stop. ⁽⁷⁾ So if you are near menopause you may do nothing while you watch to see if symptoms improve. While waiting, undertake regular clinic visits to ensure the fibroid is not progressively increasing in size and prevent anaemia.

 

• If a fibroid is small sized, the recommendation is to treat the symptoms and stop estrogen containing medications.

 

• Surgery is recommended when the size of the fibroid is large, its location is causing infertility or adversely affecting a coexisting pregnancy or symptoms experienced are life threatening like heavy bleeding, leading to fainting and requiring regular blood transfusion.

 

There are 3 main surgical options.

 

1. Hysteroscopic Surgery: For small sized fibroid protruding into the womb, it can be removed by inserting a tube through the vagina into the womb. The fibroid is seen using a camera. It is broken down and removed, No incision is made on the abdomen so in most cases you can go home the same day.

 

2. Hysterectomy:  For women who do not desire to become pregnant, and their fibroid is large in size and causing severe symptoms, hysterectomy is recommended. It is the removal of the womb and it is a permanent treatment for fibroid. It can be done using laparoscopy, through the vagina or making an abdominal incision.

 

3. Myomectomy: This is an alternative surgery for women who still desire to get pregnant but are having heavy bleeding. It is associated with a risk of recurrence which depends on your age, number of fibroid before the surgery, size of the womb, other coexisting disease and childbirth.

 

About 15-33% of fibroids recur after a myomectomy and about 10-21% of women who previously had myomectomy have to undergo a hysterectomy within five to ten years later. ⁽⁸⁾

 

The risk of recurrence is higher in women with a family history of fibroid, those with many symptoms and with multiple fibroids. A repeat myomectomy can be done but with each surgery is the increased risk of pelvic adhesion (binding of adjacent organs in the pelvis together) which can lead to more complaints.

 

 

Can fibroid be prevented?

 

Fibroids cannot be prevented. However, research shows lifestyle changes such as reducing high sugar diet, eating fresh fruits and vegetables rich in vitamins C, E and K and regular exercise can reduce the risk. Also reduction of alcohol and caffeine intake and no smoking.

 

 

References:

1. Morhason-Bello IO, Adebamowo CA. Epidemiology of uterine fibroid in black African women: a systematic scoping review. BMJ Open. 2022 Aug 3;12(8):e052053. doi: 10.1136/bmjopen-2021-052053.

2. Ciebiera M, W?odarczyk M, S?abuszewska-Jó?wiak A, Nowicka G, Jakiel G. Influence of vitamin D and transforming growth factor β3 serum concentrations, obesity, and family history on the risk for uterine fibroid. Fertil Steril. 2016;106(07):1787–1792. 

3. Paffoni A, Somigliana E, Vigano' P et al. Vitamin D status in women with uterine leiomyomas. J Clin Endocrinol Metab. 2013;98(08):E1374–E1378. 

4. Eyong E, Okon OA. Large uterine fibroids in pregnancy with successful caesarean myomectomy. Case Rep Obstet Gynecol. 2020 Nov 10;2020:8880296. doi: 10.1155/2020/8880296.

  5.   Lee HJ, Norwitz ER, Shaw J. Contemporary management of fibroid in pregnancy. Rev Obstet Gynecol. 2010 Winter;3(1):20-7.

6. Guo XC, Segars JH. The impact and management of fibroids for fertility: an evidence-based approach. Obstet Gynecol Clin North Am. 2012 Dec;39(4):521-33. doi: 10.1016/j.ogc.2012.09.005.

7. The Society of Obstetricians and Gyneacologists of Canada. Uterine Fibroid, How are fibroids treated? Accessed April 19, 2023.

8. Kramer KJ, Ottum S, Gonullu D, Bell C, Ozbeki H, Berman JM, Recanati MA. Reoperation rates for recurrence of fibroids after abdominal myomectomy in women with large uterus. PLoS One. 2021 Dec 9;16(12):e0261085. doi: 10.1371/journal.pone.0261085.

9. Kwas K, Nowakowska A, Fornalczyk A, Krzycka M, Nowak A, Wilczy?ski J, Szubert M. Impact of Contraception on Uterine Fibroids. Medicina (Kaunas). 2021 Jul 16;57(7):717. doi: 10.3390/medicina57070717.

 

 

 

Published: May 8, 2023

Last reviewed: May 15, 2024

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