FIBROIDS! WHAT THE HECK?

Most women at the mention of the word ‘tumour’ immediately have tremors running down their spines – the good news is that not all tumours are malignant; fibroid is one of them.

When Mrs H, a 40-year old widow walked into the grounds of Nisa Hospital, she could have easily have passed for a woman over 32 weeks old pregnant woman judging by the size of her tummy, but she was later diagnosed with fibroids the size of quadruplets.

She had had it for a long time but had been too scared to seek help until her symptoms worsened; she had severe and heavy vaginal bleeding thus resulting in her being anaemic, her blood pressure was permanently on the rise. She was looking ill as the fibroids were resting on some of her vital organs – urinary bladder, rectum and bowel loop which caused frequent urination and constipation.

Fibroid is a benign growth in a woman’s uterus; it may be asymptomatic although some people experience pain in the abdomen, lower back or pelvis. Others have heavy and painful menstrual bleeding and prolonged or irregular periods. A fibroid could be as big as a baby or as small as a guinea-corn; they can occur at any age, but most common in women between the ages of 30 and 40.

There are various types of fibroids and they are classified based on their location in relation to the walls of the uterus. For instance, when it grows and remains confined within the uterine wall, it is called intramural. Those that grow just beneath the thin layer of the uterus are called submucosal fibroids. Subserosal fibroids grow outside the walls of the uterus and finally pedunculated fibroids with a stalk-like growth outside the uterus.

Wikipedia

Fibroids have occasionally been linked to infertility; they also have been associated with miscarriages in pregnancy, abnormal positioning of the foetus, preterm delivery and sometimes even necessitating caesarian delivery.

The cause of fibroids is unknown but it is related to a high level of hormones (Estrogen and Progesterone) and therefore can be treated by the administration of anti-hormone drugs such as Gonadotropin-releasing hormone which leads to the shrinkage of the growth. However, this can be a short-term and inefficacious treatment modality as fibroids can regrow when there is a discontinuation in drug use.

Myomectomy and Hysterectomy are surgical treatments for fibroid; although the course of treatment is usually determined by age, location and size of the fibroid, and the choice to retain fecundity.

MYOMECTOMY

This is the surgical removal of fibroids without taking out the healthy tissue of the uterus. This is a treatment choice for women who still have children-bearing potential and want to retain their fertility. Research shows that fertility shoots up after this surgery.

The surgery is usually done to relieve the pains and other effects associated with having fibroids.

There are two most common ways of taking out fibroids – Laparoscopic myomectomy – a minimally invasive surgery, and the conventional open surgery.

Most of the time, the symptoms caused by fibroid are well contained with myomectomy.  This may include a return to a normal menstrual cycle and the ability to become pregnant.

Statistics reveal that some women who have had a myomectomy might have a reoccurrence because the uterus was not removed and might require a second surgery after a few years.

HYSTERECTOMY

Hysterectomy is the surgical removal of the uterus and cervix; it could be total or partial.  This procedure totally rules out reoccurrence of fibroids and cervical cancer.

For women who are done with childbearing, hysterectomy is a permanent solution for fibroids causing pain and severe bleeding.

Mrs H is a widow who already had her own children so the choice to have a hysterectomy rather than a myomectomy was an easy one for her to make. The desire for retained fertility is the most common indication for myomectomy instead of a hysterectomy.

There are various types of hysterectomy surgeries:

Abdominal Hysterectomy, Total Laparoscopic Hysterectomy, Vaginal hysterectomy, Laparoscopic Supracervical Hysterectomy and Laparoscopic-Assisted Vaginal Hysterectomy (LAVH).

A Laparoscopic Assisted Vaginal Hysterectomy was chosen for Mrs H because it had less post-operative pain and shorter convalescence. It also reduces the need for laparotomy.

Mrs H’s fibroid weighed 9.5kg when it was taken out, the size of quadruplets. For cosmetic reasons, she had Pfannenstiel incisions which give better cosmesis. She was observed post-surgery in the intensive care unit for 24 hours before being transferred to the gynaecological ward. She began oral intake of food by the second day and was discharged by the third day.

Mrs H would have been predisposed to heart problems, Urinary Tract Infection and various health deteriorations had she not had the procedure when she did.

  1. Carlson KJ, Miller BA, Fowler FJ.The Maine women’s health study: II. Outcomes of nonsurgical management in leiomyomas, abnormal bleeding, and chronic pelvic pain. Obstet Gynecol 1994;83(4):566-72

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