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Understanding Fibroids

08 Nov 2012

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Fibroid is one medical condition that comes in different shades and symptoms (although a number of cases come symptomless) depending on its size and location. It is a growth that develops within the confine of the wall of the womb (uterus).

Fibroids can vary in size from very tiny to larger than a six month pregnancy. In addition, fibroids, although considered a tumor, are not cancerous, virtually never develop into cancer, and do not increase a woman’s risk for uterine cancer.

Uterine fibroids are made up of muscle and fibrous tissue. Although

what causes fibroids to develop is unknown, however, fibroids have been linked to genetic predisposition and hormone stimulation. For example, it is commoner in blacks than in other races.

Types of Uterine Fibroids

There are four types of uterine fibroids:

Subserosal Fibroids: these develop under the outside uterine covering, thus growing outward into the upper abdominal.

Intramural Fibroids: these develop within the uterine wall.

Submucosal Fibroids: these develop under the uterus lining.

Pedunculated Fibroids: these develop on a stalk or stem-like structure attached to the inside or outside of the uterus; when these are attached outside the womb, they can be felt as mobile freely moving round object – more like a moving baby – inside the tummy

Symptoms

Fibroid does not necessarily lead to major problem of infertility and or other serious symptoms – this will depend on it size and site of location.

Most fibroids generally may give no particular symptom or cause very minor symptoms, however, 1 in 4 women will develop symptoms severe enough to affect their quality of life and require treatment in the long run. These include the following:

•Excessive, prolonged or painful menstrual periods

•Bleeding between periods

•Anemia

•ncreased menstrual cramps

•Lower abdomen pressure and bloating

•Difficult or frequent urination

•Constipation

•Pain during sexual intercourse

Although, it should be noted that these symptoms may be signs of problems not associated with uterine fibroids but due to some other medical conditions. Should one experience any of these symptoms, the doctor should be contacted.

Treatment Options

The treatment of choice for uterine fibroids depend on many factors including childbearing status, type and size of fibroids, patient’s age, and general health. When diagnosed with uterine fibroids, any or a combination of the following treatment options may be advised by attending doctors.

Watchful Waiting

Close observation without treatment may be an appropriate therapeutic option for women who do not have symptoms or problems associated with fibroids.

This option is especially important for reproductive age women who have not completed their family. Also, fibroids tend to shrink as women complete menopause, usually between the ages of 45 and 55. Many women can treat occasional pelvic pain or discomfort with over-the-counter pain medication.

Gonadotropin-releasing Hormone Agonists (GnRH) Medications When taken, GnRh, a synthetic hormone, stops the natural production of estrogen inducing temporary menopause in women who are still menstruating thus stopping fibroid growth stimulation. GnRh is also used temporarily to shrink larger fibroids allowing for less invasive surgery or as a temporary measure when menopause is imminent.

Myomectomy

This is the most popular treatment option for fibroid in Nigeria. This procedure is the surgical excision (i.e. removal) of fibroids without removing the womb altogether. Myomectomy can be performed in various ways depending on the fibroids size and location.

Laparoscopic Myomectomy

Removes subserosal fibroids utilizing a laparoscope, which is a tiny camera connected to a long slender telescope used for viewing inside the abdomen in conjunction to long slender instruments used for performing the operation. Only 4 or 5 small, less than one-half inch, abdominal incisions are required to perform the surgery. A few centers in Nigeria are venturing into this procedure but at relatively higher cost.

Hysteroscopic Myomectomy

Removes submucosal fibroids via the use of a hysteroscope, a thin telescope-like instrument, inserted into the uterus through the vagina and cervix (the neck of the womb).

Laparotomy Myomectomy

In this surgical procedure, numerous or large fibroids are removed. Since it involves larger abdominal incision, laparotomy allows thorough inspection of the uterus to ensure complete uterine fibroid removal; this is the most common type of operation for fibroids in our environment.

Embolization

Uterine fibroid embolization, also known as uterine artery embolization, is a relatively new uterine fibroid treatment approach. Interventional radiologists perform this minimally invasive procedure blocking the blood supply to the fibroids. Through an incision, less than one-quarter of an inch in size, a catheter is placed into a blood vessel (femoral artery) at the thigh; the interventional radiologist, with the aid of a fluoroscope, guides the catheter into the uterine artery. Tiny plastic or gelatin sponge articles, the size of sand grains, are slowly injected into the relevant branches uterine artery blocking the blood supply feeding the fibroids. As a result fibroids begin to shrink and die. This procedure is reserved for women who no longer desire childbearing capabilities, as this procedure many times causes early menopause.

Hysterectomy

Hysterectomy is complete removal of the womb with or without the egg-producing ovaries. A number of hysterectomies performed each year are due to severe bleeding or discomfort and high levels of pain caused by uterine fibroids.

Subtotal Hysterectomy

Only the upper uterus body is removed leaving the cervix, fallopian tubes and ovaries intact. This procedure is always done through the abdomen.

Total Hysterectomy

Total hysterectomy can be performed through the vagina when medically appropriate, however, in the case of large fibroids or when the surgeon deems a necessity total hysterectomy is performed through the abdomen.

This procedure removes the uterus body and the cervix; usually the uterine tubes and ovaries remain intact.

Total Laparoscopic Hysterectomy (TLH)

This is a hysterectomy performed using a laparoscope. Physicians use a laparoscope to see inside the abdomen and perform all surgical functions. Patients usually go home the same day, however, some patients require an overnight hospital stay. Generally patients return to normal activities within a few days.

However, it is important to note that each treatment option offers comparable results with varying degrees of side effects. Certain patients may not be candidates for one or more of these treatment options. Hence, each case goes with different review and the appropriate option is thus enlisted, sometimes cost is also a limiting factor on the option chosen.Depending on the treatment option, most services are performed on a same day basis. In cases involving fibroid embolization and hysterectomy, patients usually require a few days hospital stay and pain medication.

Federal Ministry of Health

The Honourable Minister of State for Health; Dr. Mohammed Pate will lead discussions at a Thought Leadership Breakfast Series on Sustainable Development tagged: Sustainable Conversations™. The theme of the event which is the third in its series is tagged: Public Healthcare: Tackling Challenges for Effective Service Delivery. Sustainable Conversations™ is a Thought Leadership series shaped to elevate and make mainstream, the discourse on Sustainable Development in Nigeria and Africa. This third in the series is dedicated to Nigeria’s Public Health Sector and seeks to discuss solutions to challenges hampering effective service delivery. The event will again bring together policy makers, experts and stakeholders in the sector and allied industries with an underlying aim of engaging, understanding, interrogating and supporting the road-map towards achieving sustainable primary health care in Nigeria. The outcomes of this event will be produced as a Resource Paper and forwarded to the Federal Government through the Ministry for Health, all State Ministries of Health and also widely circulated for concerted efforts at achieving the discussed objectives for National development. The event which is billed to hold on Saturday, November 10, 2012, at Four Points by Sheraton, Oniru Estate, Oniru-Lekki, Lagos State, will parade experts on issues relating to health care as discussants.

NAFDAC at Trade Fair

The National Agency for Food and Drug Administration and Control (NAFDAC) has carried its product monitoring surveillance to the exhibition ground of the on-going Lagos International Trade Fair at the Trade Fair Centre, Onikan in Lagos Island, to ensure that no unregistered products is exhibited at the fair.

The Agency is at the 2012 trade fair exhibition to bring its full fledged regulatory activities at the disposal of organizers, manufacturers, marketers, importers, and exporters of food, drug and other regulated products. A major plank of this year’s participation is the Agency’s focus on education and enlightenment as part of awareness creation to enhance public understanding of requirements and processes needed for the registration of NAFDAC regulated products as well as creating awareness on the newly introduced technology (text messaging system) of identifying fake Drugs.  

The Agency has fully deployed  its cutting edge technology  ( Truscan mechines ) to instantly determine the status of some  regulated product on exhibition when necessary. These activities which provide full range coverage of the entire market bolster the confidence that shoppers visiting any exhibition stands will  have  access to  wholesome products.

Breast Screening Advice

Women invited for breast cancer screening in the UK are to be given more information about the potential harm of being tested. An independent review was set up to settle a fierce debate about whether the measure did more harm than good. It showed that for every life saved, three women had treatment for a cancer which would never have been fatal. The information will be included on leaflets to give women an “informed choice”, the government said.  Cancer charities said women should still take up the offer of screening. Screening has been a fixture in diagnosing breast cancer for more than two decades. Women aged between 50 and 70 are invited to have a mammogram every three years. It helps doctors catch cancer early so treatment can be given when it is more likely to save lives.

However, the national cancer director Prof Sir Mike Richards said it had become “an area of high controversy”. The debate centres around the concept of “overdiagnosis”, that is screening which correctly identifies a tumour, but one which would never have caused harm. It leads to women who would have lived full and healthy lives having treatments,  such as surgery, hormone therapy, radiotherapy and chemotherapy - which have considerable side-effects.And since at least 1998, there has been a strong seasonal pattern of dengue fever, transmitted by mosquitoes, during periods of heavy rainfall in tropical and subtropical areas, killing about 15,000 people a year.

Tags: Health, Fibroids

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