“What Every Lady Must Know About Fibroids”, Fertility Doctor. ABAYOMI AJAYI

Dr Abayomi Ajayi is a consultant Obstetrician and Gynaecologist and the Managing Director, Nordica Fertility Centre, Lagos, a clinic that specialises in In-Vitro Fertilisation (IVF) and treatment of infertility for the couples facing fertility problem in marriages. In an exclusive interview with City People TESSY MOORE, Dr Ajayi revealed how fibroid causes a lot of havoc in women, why many teenagers are developing it and how fibroid can be successfully removed through surgery without any scares. Excerpt

What would you say Fibroid really is?

Fibroid is non-cancerous tumour commonly found in the reproductive system, it is so common and occurs in about 60% of women, it comes in different sizes and it occurs in different locations.However, it doesn’t show any symptoms, many times it is when the doctor examines that it is discovered.  Fibroid in blacks tends to grow faster than in whites.

Are there many types of Fibroids?

There are three types of Fibroid; the first type is Sub mucus, this one is inside the cavity of the uterus where the baby is housed, the second is intra-moral around the wall of the uterus, the other one is outside the wall of the uterus.Not every fibroid is to be operated on. Sometimes the only visible symptoms’ is swelling in the abdomen, sometimes painful menses. The doctor looks at the age of the patient, the reproductive desire of the patient because it can come back, fibroid should merit a removal, we don’t just rush to remove it.The age and size of fibroid determine it removal. In a case where it is still very small, there is no need to remove it unless when it poses a serious health threat.

Which of these three types is severe?

The one that occupies where the baby stays is the most severe, it affects pregnancy.  I wish to use this opportunity to correct a notion that people feel that fibroid can’t be operated in Nigeria, the truth is many have been done and it was successful. So people should start looking for cheap hospitals where facilities are not good.

Please tell us the cause of Fibroid?

We don’t know , what we know is that it is common in blacks than in white.

You said Fibroid can come back, shed more light on this?

Yes it can come back unless in situations where the uterus is completely removed, that way fibroid can’t find his way back.

Talking about Fibroids, what would you say are the warning signs?

Any woman of childbearing age knows the chills that run down the spine whenever the word ‘fibroid’ is mentioned.  The fibroid is a physical growth in the uterus (womb) that sometimes present without symptoms, though it may sometimes result in painful cramps and abnormal bleeding that will have to be tackled surgically.

Other symptoms, were presented at all, include prolonged menstrual periods that may last for seven days or more, pelvic pressure or pain, frequent urination, difficulty emptying the bladder, constipation, backache or leg pains and pain during sex.

What are things to know before opting for fibroid surgery?

That fibroids only cause symptoms in approximately one out of every four women of reproductive age. In other words, someone may have the tumour and be blissfully unaware!

Worse still, even after surgical removal of these growths, they may still grow back, subjecting the victim to unending rounds of physical and mental. This obnoxious growth is more common than many women may be willing to admit, what with the fact that four out of every five women have it, even when some victims have no symptoms and may not need any treatment — especially if it has not been diagnosed as being responsible for any infertility problem.

The fibroids that grow inside the lining of the womb (uterus) are medically known as uterine fibroids. Beyond the nomenclature, one worrisome trend about this growth is that by the time a woman hits age 50, her chances of developing fibroids jump up.

How big or small can fibroids be described?

Fibroids range in size — from seedling’s size to bulky masses that can distort the shape of the womb and enlarge it, making the woman look pregnant. They can be single or multiple and that in extreme cases, they can expand the size of the womb so much so that it reaches the rib cage.

Fibroids can be as small as an apple seed or as big as a grapefruit. In unusual cases, they can become very large.

What about in a case of getting pregnant?

If fibroids are located in the muscle of the womb and are not bigger than four centimetres, a woman may not worry much, as they’re very unlikely to prevent pregnancy from happening.

However, if the growth is located inside the womb where the baby is supposed to develop and it is bigger than four centimetres, the woman may have to undergo surgical removal in order to be able to conceive and carry the pregnancy to term.

Most women who have fibroids will achieve pregnancy without much hassle and they will carry the pregnancy to term and have the baby. But where fibroid has been diagnosed as being present in the womb, especially where the woman is trying for a child, then you have to be pragmatic about it. But then, fibroids can result in complications during pregnancy! “A woman who has fibroids can experience complications during pregnancy and labour and she stands six-time greater risk of undergoing cesarian section during delivery.

At what age can someone start noticing fibroid? 

You can have at any age, you have attained your reproductive age.

Age, weight, family history,  say between 20 and 80 per cent of women develop fibroids before age 50, and that after age 50 when menopause is likely to set in, the fibroids may begin to shrink where present.

Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.

Is fibroid hereditary?

If a woman’s mother had fibroids, her risk of having them is about three times higher than average.

Women who are overweight are at higher risk of developing fibroids. For very heavy women, the risk is two to three times greater than average, and that is why people are consistently advised to maintain sound dietary habits, such as eating less fatty foods and eating more fruits and vegetables. Eating plenty of green vegetables seems to protect women from developing fibroids.

So, what is the way out?

Sad to say, many women who have fibroids are sometimes ill-informed about the options of the treatment they have or how the growth affects their reproductive health, for that matter.

However,  with the deployment of high-tech equipment, women who wish to undergo surgery for fibroid removal can heave a sigh of relief.

How is fibroid treated?

Let me tell you, the only effective way of treating fibroid is through surgery. You can also administer drugs but that will help reduce the size of the growth. But for total removal, it has to be corrected or removed through surgery.One can decide to have the fibroid from the uterus or remove the uterus completely. Now we now have minimal ways of removing the two, the first one is called pinhole surgery while the second is endoscopic surgery, we can go through the vagina into the uterus, that is if the fibroid is occupying where the baby is supposed to stay. If it is in the body or outside the uterus this one we look outside the abdomen. The fibroid can also be removed through laparoscopy, this comes under the navel, more, the uterus can also be removed through laparoscopy.There are some other methods whereby pellets are introduced into the body and it causes reduction of the uterus and subsequently shoots out the fibroid. There is another method which is not yet available in Nigeria, it is called Pocus ultra-sound.

Nordica hospital deploys Hysteroscopic Morcellator, which skilled physicians use infertility treatment such as fibroid removal and in performing key-hole surgery (hysteroscopy).

With the use of this equipment, which is the first of its kind in West Africa, clients can have minimally invasive surgeries that last for 30 minutes on the average and with the little incision.

So, unlike the surgeries of yore that left a deep gash on the abdomen, what you now have is a key-hole size that heals beautifully.  When used for fibroid removal, the morcellator ‘melts off the fibroid without leaving tissues floating in the uterine cavity; and where such a client also needs to undergo IVF treatment, it makes for double assurance that the process will be successful, unlike the failure rate that would be recorded should the uterus become scarred if old procedures are employed.

The beautiful thing here is that this sort of procedure is done without taking out the healthy tissue of the uterus. It is best for women who wish to have children after treatment for their fibroids or who wish to keep their uterus for other reasons. You can become pregnant afterwards.