Uterine fibroids: signs younger women should not ignore

Some of these signs have been attributed to accompany menstruation and have been checked as innocuous by women, but experts say they may be more to these signs than meets the eye. VERA ONANA writes about these pointers and why younger women should be wary of them.

Adaobi (not her real name) was perplexed. The words that came out from the mouth of her gynecologist hit her like flashes of thunder strike. Her mouth fell agape as a silent protest, hesitantly crawled out of her lips. “Fibroid, how can that be? I am barely 25 years old. There must be some mistake!”

Most times and erroneously, uterine fibroids may be associated with older women but according to consultant obstetrician and gynaecologist, Dr Daryl Daley, Senior Resident at Department of Obstetrics and Gynaecology University Hospital of the West Indies, Jamaica, uterine fibroids can affect any woman in the reproductive age group, which means that women who are within the sexually reproductive age are at risk of developing fibroid.

Reiterating that fact, Dr Michael Ezeanochie, said uterine fibroid has become common among younger women and not older women alone as is the general perception.

Ezeanochie, who is a Consultant Obstetrician and Gynaecologist at the University of Benin Teaching Hospital, said “it usually affects women in the reproductive age range usually above 20 years until menopause. It is rare after menopause.”

According to Dr Jide Oyetunji of the Federal Medical Centre, Kastina, uterine fibroids are clinically referred to as Leiomyomas, which are tumours of the smooth muscle of the uterus. They are usually also benign in nature and are not cancerous.

Oyetunji said that fibroids may present with Menorrhagia, which is heavy and prolong menses, Dysmenorrhoea, which is painful menses and other signs could be abdominal swelling and the presence of mass.

Elucidating on the signs and symptoms, Dr Ezeanochie said “The tumours can go unnoticed for many years because they do not have any symptoms in some women and are often discovered ‘incidentally’ while a woman is being evaluated by a doctor for other things.”

Dr Daley, while speaking with All Woman magazine, further explained that symptoms of fibroids usually depend on its location. However, he lamented the fact that the subtle indicators are carelessly overlooked by younger women, saying: “Painful and heavy periods, bloating and constipation are common indicators of women with fibroids. Unfortunately, many young women ignore these symptoms because of the common misconception that fibroids only affect older women.”

Fibroids, Daley said can occur at any level of the uterus and cause any or all of these different symptoms. “Heavy bleeding is usually associated with fibroids in the endometrial cavity and other symptoms include cramps before and after periods; constipation which usually occurs when fibroids rest on the rectum; increase in the desire to pass urine which happens when the fibroid compress the bladder and increased abdominal growth.”

Daley added that a thorough medical investigation has to be carried out to determine if a woman has fibroids, “The symptoms that a patient presents with, while they may point in the direction of fibroids, cannot be the basis upon which a diagnosis is made.”

Corroborating the medical fact, Dr Ezeanochie said “Fibroids can be diagnosed by eliciting information from a patient and by clinical examination. Ultrasound scan of the abdomen and pelvis is an investigation that can be of assistance in detecting fibroids.”

The experts went further to stress that though the signs are not definitive, they should not be ignored by younger women because there is a link between fibroid and infertility in women.

Dr Oyetunji, explained that the relationship between fibroid and infertility is like a two-way street. “Fibroid can cause infertility and infertility can cause fibroid. There is a common phrase that a womb that does not carry a baby may carry fibroid.”

On the contrary, Ezeanochie, speaking on the link between fibroids and infertility in women, said, “fibroids usually do not cause infertility. However, if it is very big or its position obstructs the entrance of the womb (uterus), it can cause a delay in getting pregnant. Fibroids located inside the cavity of the womb can lead to miscarriage.”

While discussing if being affected by uterine fibroid may disturb a woman’s sex life, the gynaecologist said “Fibroids ordinarily do not have a direct effect on a woman’s sex life. The exact cause of uterine fibroid is not known but it is more common among black women and women who are menstruating. Sex hormones produced by the ovary- progesterone and oestrogen– increase the risk. Sometimes it may be common in certain families.”

According to Oyetunji, fibroid treatment options ranges from non-surgical to surgical but definitive treatment is dependent on the patient’s age, future fertility desires, the number and the size of the fibroids and the symptoms present,” explained Daley.

Speaking further on the treatment options, Oyetunji stated that non-surgical treatment involves the use of drugs that are capable of causing shrinkage of tumours. He explained that “Gonadotropin releasing hormone anaologues (GnRH) are associated with fibroid shrinkage and they act by shutting down the ovarian function and oestrogen levels and can be administered monthly.”

On the other hand, he added that surgical management may include myomectomy for large symptomatic fibroids. A myomectomy, he said, “involves the removal of the fibroids through an abdominal incision. These fibroids can also be removed laparascopically or robotically through small incisions in the skin with the aid of multiple ports.”

“Also, there is another procedure called uterine arteries embolisation. It involves the blockage of the uterine arteries which mainly supplies blood to the uterus in order to gradually decrease the size of the fibroid,” Oyetunji explained.

Hysterectomy, he added, “is also another treatment option for the removal of giant mass. But since it involves the removal of the entire uterus via an abdominal incision or vaginally, it is usually advised or reserved for women who have completed their reproductive careers.”

He explicitly stated that though myomectomy is preferred for younger women that still desire to bear children, there is a possibility that fibroids removed in that manner may regrow even after. Myomectomy is used to treat woman who has fibroid and may not be the cause of infertility in the woman.

Experts therefore advised younger women on early marriage and conception so as to reduce the chances of such happening while admonishing them on good diet that is low in unsaturated fatty acid and to also prioritise exercise.