Dr Abayomi Ajayi of Nordica Fertility Centre is a renowned obstetrician and gynaecologist. In this interview by SADE OGUNTOLA, he explains why fibroid should not be a barrier to having children and good health in women.
WhY does it seem as if a uterine fibroid is more of a problem in African women?
Fibroid is said to be commoner in African women, even then it is not only a disease found in African women. However, it tends to be more aggressive in African women and we say that the lifetime risk of an African woman having fibroid is about 50 to 70 per cent. So it’s definitely much more common in African women but it also occurs in other races as well.
When and how does fibroid occur?
We don’t know the exact cause of fibroid but there are some things that we think predispose women to it which are both genetic and hormonal. And that’s why the risk factors for fibroid include having a first-degree relative who has fibroid, like a mother or sister. But other things include late childbearing, use of oral contraceptives, having the first period before age 10 and obesity.
What are the chances of having a pregnancy with fibroid?
Many women with fibroid get pregnant but there is some risks associated with such pregnancies like miscarriage, an abnormal position of the baby which increases the chances of a caesarian section and the possibility of a retained placenta. Howbeit, a lot of women who have fibroids carry their babies to term.
Nonetheless, we need to assess each fibroid to know whether it is going to affect the pregnancy or not. We look at where the fibroid is located specifically in the womb. Fibroids that are where the baby should be, what we call submucous fibroid, are the most troublesome to pregnancies followed by the ones that are in the muscle of the womb, which we call intramural, and then the ones with the less chance of affecting pregnancy are the ones that are situated outside the womb which we call as subserous.
But of course, if a subserous fibroid grows very big, it can also disturb pregnancy in that it might not allow the baby to grow properly. It might be space-occupying. But a lot of women have fibroids and still have babies.
What’s the best method to treat uterine fibroid?
A woman was told that because she has had fibroid surgeries four times, she wouldn’t be able to conceive.
It’s difficult to say the best method, but we can look at the options that are available. What we should be doing in the year 2022 is to actually have a tailor-made solution for each woman. The four main things that we consider to tailor-make the fibroid treatment each woman needs are the fibroid’s location, the woman’s age, if the woman would still want to have more children, and what are the symptoms that she has and if these symptoms are affecting her lifestyle or her quality of life.
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Now the options of treatment include the use of medications. These medications shrink the fibroids. The problem with the use of medications is that the fibroid again starts to grow when the use of the medication is disengaged. So, usually, we use medication to treat fibroid in women that are near their menopause. Once there is menopause, the fibroid will stop growing and that will abate the symptoms. Also, the medication is used when preparing a woman for fibroid surgery.
And then of course there is the use of surgery. This surgery could be the conventional surgery, where we cut open to a keyhole surgery which we call a minimally invasive method. And then we now have the new method called the High-Intensity Focused Ultrasound Ablation of Uterine Fibroids (HIFU). It is a relatively new non-surgical and non-invasive means for the removal of fibroids in women.
Then you raise an important point where some women would have had four surgeries for fibroid. Usually, there can be a recurrence of fibroids after surgery, but sometimes it is not even fibroid, some women have what we call adenomyosis, a condition in which endometrial tissue (the inner lining of the womb) exists within and grows into the walls of the womb.
Women with adenomyosis also experience painful menstrual cramps, heavy menstrual bleeding, abnormal menstruation and infertility. Some of these symptoms are similar to those due to fibroids and so sometimes when patients go from one doctor to another doctor they tend to operate and re-operate on this. But unfortunately, adenomyosis cannot be easily treated or removed like a fibroid.
Now, each time that you have even been successful in removing fibroid, there is the chance that there will be scar tissue left, which might also make the endometrium (the lining of the womb) not to be regular and therefore might reduce the chances of implantation, which is a prerequisite for pregnancy to occur.
Many people abhor surgery, so how does HIFU come in to help such women?
HIFU is actually for women who do not want to undergo fibroid surgery. But there are eligibility criteria for women that can benefit from HIFU. One, overweight women are not eligible because of the thickness of their abdominal walls. We also look at the exact location of the fibroids.
Is it where HIFU can work on or do we need to combine HIFU with, for example, say hysteroscopy?
Howbeit, the advantages of HIFU are so enormous in the sense that it’s a day case. We will only observe you for two hours and then you can go home. You don’t need anaesthesia; we don’t cut you at all and so there is no blood loss. And of course, you can go back to work actually within 4 to 5 days. This is not possible with the conventional surgical method to remove fibroids.
Can fibroid reoccur if it is treated with the HIFU method?
Most of the time there are many fibroids. So the one that you had treated is not likely to reoccur, but some might still be there that might grow. For example, if you have some that are very small, say a fibroid that is about 2cm, HIFU might not be able to treat them. Such can still grow with time, but the good thing about HIFU is that it is ultrasound and not X-ray or another non-ionising radiation, you can repeat it again if you need to. But the ones that you have burnt off or killed with ultrasound is not likely to reoccur.
Any piece of advice for women with fibroid?
Women who have fibroid should know that is not every fibroid that needs to be removed; it is not every fibroid that needs to be treated. Sometimes, we might just need to monitor it, depending on four things. If there are no symptoms, then there is no point in trying to do anything about the fibroid, you can just monitor it. But if there are symptoms, you might need to choose which method to use to treat.
But everyone needs to know that the days that all we had to treat fibroid with surgery are gone. Now, there are more non-invasive methods for treating fibroids and they should just ask questions, they should have a good evaluation and then be sure also to differentiate between fibroids and adenomyosis before even embarking on any form of treatment.
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