Gyn Chronicles
The Fibroids Phenomena!
By Dr. Maureen Owiti
The festive season is nigh and most of us are gearing up for another exciting Christmas season or at least I hope you are, as with this‘ Rutonomics’ things have been quite thick for many a people!
Due to public demand, I will delve into a topic we have covered previously on this column, and I believe I may have to cover again and again due to the high prevalence of the disease and therefore interest in it- fibroids. Fibroids are noncancerous( benign) muscular tumors that grow in or on the wall of the uterus. Also known as uterine myomas or leiomyomas, they can range in size from very small to as large as a melon and may occur singly or in groups. While many women with fibroids have no symptoms, those who do may experience heavy or painful periods, pelvic pain, and pressure on the bladder or rectum.
We all have a friend or a relative, whom we know is suffering from fibroids. Being African this is very common as one of the risk factors for getting fibroids is just being of African race. The highest incidence of fibroids is in Africans.
Other risk factors are age- the older one is the higher the risk, and family history of fibroids- having a mother or sister with fibroids increases risk of getting fibroids.
Other associated factors include obesity, high blood pressure, early menarche, and diets high in red meat but low in green vegetables and fruit. Factors like Vitamin D deficiency and alcohol consumption may also increase risk.
Wendy is a 36year old executive working with one of the big local insurance companies. She has never had children and has primarily come for a consultation on the same. She is as expected superbly dressed and looking the picture of success- very beautiful and very well put together. She saunters into the consultation room, after she has been guided by my team to come in. I greet her in my notorious cheerful manner and request her to have a seat as we explore what could be ailing her.
“ Hello Doctor my name is Wendy” she quips after she takes her seat.“ Karibu Wendy! How can we assist you today?” I reply. Like most patients she is like“ Where do I begin?” I normally joke and imitate Jacob Zuma“ at the beninging!!”
She thinks pensively for a moment and then begins to narrate her story.“ I have been married for the last 5 years and we have been trying to conceive. We thought that with time we shall conceive.” I get excited as this is my forte. I quickly go into fertility mode to establish relevant details associated with fertility.“ It takes two to tango! Where is your spouse?” She laughs and says he is waiting in the reception for her as the gynaecologist is for women only. I’ m horrified at the thought and ask her if it is okay for him to come in and after her consent, we get Sam( her spouse) in the room. We need men involved in the process.
Fibroids do not necessarily cause infertility but can make infertility treatment challenging. The most important issue for fibroids with fertility is the location and subsequently the size. A very small fibroid located in the uterine cavity may cause infertility and is usually associated with torrential bleeding during the period, yet a huge fibroid on the outer surface of the uterus will not interfere with fertility but give other symptoms.
Wendy has a regular cycle but the first red flag comes up that her menstrual flow has gradually been getting heavier and longer. Again, like most people she just thought that these were age related changes. She lives with her husband Sam and they have a pretty decent sex life. They are active as required at least three times a week though again she has noticed some slight discomfort occasionally during intercourse but not enough to make her stop.
Wendy only used contraception during the first year and subsequently stopped to try and conceive. Let me dispel one of the greatest myths and misconceptions at this point. All reversible modern contraceptives DO NOT make women infertile. The moment one stops using
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