Causes of fibroid, among other issues bordering the disease, remain a subject of debate. Lawrence Amaku and Rotimi Omisore write that recent findings and advancement in medical technology have dispelled the fears and myths surrounding the its nature.

Mrs. Okwe’s (not real names) hope of rocking her first baby was shattered by a miscarriage when the pregnancy was only 22 weeks old. To make matters worse, she was recently diagnosed with a fibroid. Expectedly, her first impulse was that the fibroid was responsible for the abortion. She, however, had her mind disabused by the doctors who told her that the sizes of the fibroids found in her womb were not big enough to put her chances of bearing children in harm’s way.

In a chat with Saturday Tribune, Mrs Okwe, who hails from Kogi State, said that she has got over her initial fears about fibroid which as a teenager she dreaded so much. 

Unfortunately, many women in her shoes still have the same old prejudice against fibroids.

According to Dr. Adebola Roberts, a consultant obstetrician and gynaecologist, University College Hospital (UCH), Ibadan  “really, nobody knows the cause; it is a benign tumour; it is a combination of genetic and environmental causes, it may include nutrition, genetic, such that you might see sisters, twins, having fibroid. Fibroid is a derivative of the fact that it is supposed to contain fibrous tissues interlacing walls of the uterine muscles.”

For ages, fibroid has been one of the greatest health problems that women, especially in Africa, have been afflicted with. Despite the serious health challenges the disease poses to African women, especially in the area of childbirth which the society places so much premium on, knowledge of the nature of fibroid and its causes remain a subject of debate. Moreover, opinions ebb and flow on its cure and implication on fertility and childbirth among women.

Fibroids are usually identified and named by the parts of the body they are located in. Growth and location are the main factors that determine if a fibroid leads to symptoms and problems. A small lesion can be symptomatic if located within the uterine cavity, while a large lesion on the outside of the uterus may go unnoticed. Different locations are classified as follows:

Intramural Fibroids
They are located within the wall of the uterus and are the most common type; unless large, they may be asymptomatic. Intramural fibroids begin as small nodules in the muscular wall of the uterus. With time, intramural fibroids may expand inwards, causing distortion and elongation of the uterine cavity.

Subserosal Fibroids
They are located underneath the mucosal (peritoneal) surface of the uterus and can become very large. They can also grow out in a papillary manner to become pedunculated fibroids. These pedunculated growths can actually detach from the uterus to become a parasitic leiomyoma.

Submucosal Fibroids
They are located in the muscle beneath the endometrium of the uterus and distort the uterine cavity; even small lesion in this location may lead to bleeding and infertility. A pedunculated lesion within the cavity is termed an intracavitary fibroid and can be passed through the cervix.

Cervical Fibroids
They are located in the wall of the cervix (neck of the uterus). Rarely, fibroids are found in the supporting structures (round ligament, broad ligament, or uterosacral ligament) of the uterus that also contain smooth muscle tissue.

While experts believe that advancement in medical technology have afforded mankind the ability to cope with the condition, usually through medical treatment or various surgical operations, as the case may be, others claim that cure for it can be sought through herbal drugs, making it needless to go under the operation knife.

One of such alternative healthcare professionals is Shola Oslo, who specialises in female alternative health, and the endocrine system. She proffered a kinesiological solution to the cure for fibroid in an Internet blog where she recommended seven-step action plan designed to help anyone with fibroids to relieve their symptoms fast.

She observed that there is a “huge lack of knowledge out there about shrinking fibroids without drugs, surgery or side effects.” She opined that the Fibroid Alternative Treatment will not only help patients “get rid of the fibroids but discover what the cause is and also how to prevent a recurrence.”

Saturday Tribune sought the views of a consultant obstetrician and gynaecologist at the University of Ibadan, Dr Adebola Roberts on a wide range of issues on the disease.

Prevalence
Starting with the prevalence of the disease in Africa, Dr. Roberts observed that using a hospital-based data may not provide a reliable data for all patients of the disease, as it does not take care of the rural community.

“It is definitely true that fibroid is prevalent here in Africa, but the problem with prevalence is that we don’t really have a population-based study. To find a prevalence of a particular condition, you have to go to the local population and enquire about the condition using ultrasound. But if you now use a hospital-based data, you know it is hospital, people who are already diagnosed with the disease are the ones who come here. So, there is going to be a high incidence within the hospital data, the word incident is a bit more technical, but prevalence is better. The hospital incident we may know, but the real incident I don’t think we know it. So, we don’t have any figure for the prevalence or the incidence. The problem, even we as practitioners have, is that that kind of figure is not even available to us. But what we know generally is that at least one-third of women by the age 50 would have been affected by fibroid.

Relation With Fertility
Fibroid is widely believed to be closely related to infertility— an assumption that thrives on superstitions surrounding it. Some people hold that it is like a monster that consumes the unborn child. But, in recent studies, experts have debunked such assumptions. A medical practitioner and Managing Director of Medmobile in Lagos, Dr. Elliots Aigbedo, said that the disease is only responsible for three per cent of infertility. He observed that the couple could be responsible for 30 per cent of the cases. 

Dr. Roberts, in corroborating the above view, said that it is only in a rare case when the fibroid is positioned in such a way that it prevents the male sperm from entering the womb to fertilise the egg that it affects fertility.

“Fibroid doesn’t cause infertility, but what we know is that it is related to infertility, the relation is not quite clear because some people only discover their fibroid after they’ve done the scan, what you call pregnancy scan, that is one way of detecting it.

“It is a wrong believe that fibroid causes infertility. But it has relationship with childbearing; what it causes most is repeated pregnancy losses. But severity varies from patient to patient, depending on the size and position. Supposing the fibroid is located at the entrance of the fallopian tube into the womb it may prevent the sperm from entering the womb to fertilise the egg. So, it is technically possible,” he stated.    

The consultant stated further that the problem sometimes arises from muddling fibroid with other fertility problems, like impotence on the part of the man.

Causes
Another myth held by people is that some food items, especially yam can cause fibroid. However medical experts who gave their views on this were quick to dismiss the claim that fibroid is caused or induced by the type of food eaten. Dr. Aigbedo, in his view, noted that the condition is hormonal, saying “people believe yam causes it because yam contains diethylestrogen and excesss estrogen causes fibroids.”

Cure
Advancement in medical technology has also pushed back the frontiers in the cure for fibroid. Several forms of treatment have been advanced for its treatment. Dr Roberts identified some of them: 
“We have the medical method which is taking tablets, that can suppress the growth, it doesn’t melt it, and the ones that are most efficient are called analogues of the brain hormones. They are different compounds. They are all available in the market, and are known to reduce the volume of the fibroid.

“Then when you go surgical you can do hysteroscopic removal; it is a terminology for the equipment which is inserted through the neck of the womb into the womb to literally remove the fibroid, it is usually used for the ones lining the fallopian tubes. But lacroscopic removal is done from above. It requires the use of the telescope; the telescope will tell you where they are and relay the image on the screen and you will do the surgery without cutting the womb.    

“Unfortunately, majority of the cases we have here are usually already late and have already gone out of hand before they are brought to us. So, by the time they come we cannot do the minor operations for them. The only option that they will now have is to be given macro-surgery, the one that requires opening the abdomen, removing the fibroid one by one.

Chances Of Survival
As dreadedful as the fibroid disease may be, the cheering news for sufferers is that it is not as deadly as , HIV/AIDS, malaria, among others. In fact, it is not life-threatening. Medical experts are however united in their view that the success or otherwise in the cure for the disease, especially through surgical operation, lies with where it is done and who does it.

Dr. Aigbedo enthused that “Myomectomy (a form of cure) is quite a common procedure. So, there are a lot of good hands out there. Women die either from complications such as sepsis, or shock as a result of blood loss.”

Speaking in a similar vein, Dr Roberts noted that those who are down with fibroid “dread the surgery because they think they can die as a result of the surgery. It’s such a common condition; it is known as laparotomy. It is the process of opening the abdomen.  It is so safe, as long as the preparation for it is adequate. I have hardly heard of mortality from it here (UCH). In some cases, they are so bad that it will require the removal of the womb instead of removing the fibroid alone.  So, the choice of operation matters, and that is the one that is safer when the fibroid are so many; it is not that the operation kills, but excessive loss of blood could be fatal,” he said.

Victims
Dr Roberts also identified those who are at high risk of having fibroid as those in the reproductive group.

“It affects virtually every woman in the reproductive group, especially women who are infertile or have never given birth or who have few children, that is the funny relation between fertility and fibroid. So, it affects some people more than others. Well, some of them might have had it from teenage and will not know until they are approaching 30 or when they are married or are looking for a baby they will discover it through a scan when they want to give birth or when they are already pregnant. We have fibroids that don’t cause anything, it is only that the sufferer does not know that she has it. It starts like a small growth, like a tumour which continues to grow. It doesn’t normally kill, but in 0.5 per cent of the cases it can become malignant, it’s not something you can rule out.

If somebody is unlucky it can take away her life. Most of the things that people say about it is not true. You don’t need to dread the operation, it is safe. But to prevent mortality due to excess loss of blood, we use a device known as toniquet,” he said.