FIBROID: THE NEW PANDEMIC FOR 21ST CENTURY WOMEN
Fibroid has turned out to be the 21st Century's women's pandemic. Consultant, Obstetrician and Gynaecologist, Dr Gabriel Akilo, says that fibroid can grow alongside a baby in the womb and does not affect the size of the baby.
In this interview, he spoke on all common questions asked about fibroids.
What is fibroid?
Fibroid is a common condition in women. It is an abnormal tumour or swelling of the womb. It is either inside the women which means it is attached to the inner wall of the womb or the body of the wall of the womb itself or outside it. In short, Fibroid can grow in or outside the womb.
Fibroid is made up of a meat-like material and in the form of a ball, peanut, tangerine, lemon, orange or cricket ball which grows, either to the size of the head of a baby or bigger.
When fibroid is cut into two, right in the middle, it has a whirled formation. In other words, it is in the form of a rope which has been tied round and round. It has the impression of an onion.
About 15 percent to 20 percent of the world's women have fibroid of various sizes. Some fibroids are not visible while others are big. Strangely, some small ones cause much problem to the women while others which are big cause no problem and vice versa.
Some women have fibroid but they are not aware of it because it does not cause them any problem and they have no symptoms too. Some have big fibroid but it does not prevent them from being pregnant but others have fibroid that gives them infertility problem.
However, there are other tumours inside the womb that are not fibroid because they do not have the characteristics mentioned above.
Can you confirm that some women with fibroid can be pregnant?
Sure. The pregnancy and fibroid can grow together.
If fibroid co-grows with pregnancy, what happens during delivery?
As soon as the baby comes out, the womb automatically shrinks. But if the fibroid is in the lower part of the womb it complicates delivery. It causes obstructed labour as the baby is prevented from coming out because the fibroid acts like a mechanical obstruction. The woman will require caesarian section operation to deliver the baby.
In some cases, if fibroid co-exists with pregnancy then we have what is called post partum haermorrage. This means that the fibroid may not allow the womb to contract to make the foetus receive the required blood transfusion from the mother.
What other complications can fibroid cause in pregnancy?
In early pregnancy, fibroid can cause pain like ovariancyst. This is one swelling not in the womb but that of the ovary. (egg-box).
In other cases, fibroid can begin with severe pains, degeneration. The pain can be so excrutiating that the patient may think she has ectopic pregnancy or twisted ovarian – cyst which may require surgical operation.
Later in pregnancy it can also cause excessive bleeding and also threatened abortion but at any rate it does not allow pregnancy to thrive. Fibroid can cause pain again in the middle of pregnancy and destroy the foetus before degeneration.
What are the chances of safe delivery in the traditional set up when the baby co-existed with fibroid?
As I said earlier, when fibroid acts as a mechanical obstruction during delivery a caesarian section operation would have to be perform, this happens luckily at the orthodox medical centre. But, I am afraid in the traditional health set up about 90 percent of these cases might result to loss of life.
Is fibroid the cause of some women having abdominal pains during their menstrual period?
This is one of the presumptuous symptoms. Fibroid causes pains especially during menstrual periods. In some cases the pain is centred in the lower abdomen and even in the back (back-ache). Then, also, the usual swelling of the stomach when the fibroid gets bigger and bigger.
When fibroid co-exists with pregnancy, does it affect the size of the baby?
It does not affect the size of the baby in any way. While the fibroid grows the baby also grows at the same time. You can see that some women can bring forth triplet, quadruplets or more. A woman has sufficient blood to service all of them together.
What is the cause of fibroid?
The main cause is not yet known but doctors have noticed that it is commonest in women who wish to have their first babies late especially from 30, 35 years or more.
Nature hates vacuum, so I believe when the womb is left empty for sometime it turns to produce something due to accumulation of hormones. Fibroid is not common with women in the age bracket of 20 – 25 years.
However some doctors are of the view that fibroid is fed by estrogen because they grow bigger and bigger during the child bearing period of women only to decrease in size when these women reach their menopause from 40 – 45 years of age.
Fibroid growth is at its height during the child bearing age of women. Hardly can you see any woman who has reached her menopause suffering acutely from fibroid.
When is the ideal time for a woman who has undergone fibroid operation to go for a baby?
We usually recommend six to 12 months after the operation when the womb would have gone back to its normal shape and might also have regained its strength to carry a baby.
Do you mean the woman could be pregnant six months after the operation or sexual intercourse could not begin before six months?
Six months post-operation period should be the ideal time to start sex. But the couple could start just before that time, after all there is no harm in trying.
Usually we recommend one year but since there is no assurance as to the exact time when the woman can take in so you can start just before six months.
Can we then regard all those women who have are 'pregnant' for over two to three years 'pregnancies' as jokers?
Women do make different claims of carrying pregnancies which are over two or more years. It is difficult to categorise them but what happens is, most of them have been taking native drugs which contain tetesteron, a male hormone drug.
As a result, their menstrual period seizes. If you examine the clitoris of some of these women, it is like a small penis whereas clitoris is supposed to be small. This can be found on nine out of ten women in this category no matter their profession. With the effects of menstrogen and tetesteron, some of these women start to grow hair all over the body like men.
However, there are some women who are naturally hairy but in most cases when their menstrual period seized because of these native drugs the native doctors pronounce them pregnant. But when the so called 'pregnancies' outlive two or more years some native doctors attribute the delay of delivery to the work of the devil or witchcraft.
How come that some of these women who had been visiting these native doctors deliver babies after some two or three years?
The fact is some of these women after using these native drugs for sometime become fed up and thereby stop using them. But by stroke of luck, some of them start to ovulate again because they have stopped these drugs and by God's grace they become pregnant after meeting a man. Definitely during the time of the false pregnancy sex does not stop but continues.
This does not categorically mean that the foetus had been there all these years but rather the women started ovulating during the time they had stopped using those drugs.
Is it true that some women become pregnant after visiting prayer houses?
There can be few cases of spiritual explanations to this problem which cannot really be generalised. Of course, with prayers there can be miracles. But the fact remains that most of these infertility problems can be easily regarded as medical rather than spiritual ones.
Is it right to assume that not all women who are within child bearing age should think that they are pregnant when their periods seized?
It must be right. There are many of them who while nursing fibroid continue to have their period irregularly but because their tummy gets bigger and bigger they always insist that they are pregnant.
How can a woman know that she is carrying fibroid or how do you diagnose it?
A woman who carries fibroid may have chest and waist pains. She may also complain of lower abdominal pains in addition to excessive and irregular vaginal bleeding which is one of the commonest symptoms of the disease. Some of these women bleed even twice or thrice in a single month. Others too bleed in five to ten days intervals while some may not have any symptom at all.
Some fibroid carrying women have infertility problems so upon reporting this to the doctor with the history of complaints, a doctor can determine a fibroid case.
Fibroid can also be diagnosed when the tumour grows and the patients abdomen becomes distended and instead of people sympathising with her out of ignorance they rather congratulate her for being pregnant.
On physical examination of a woman suffering from fibroid a doctor can know what is happening especially when the vagina is carefully examined. In some cases too, a doctor can see signs of growing fibroid like peanuts when he performs a caesarian operation on the woman with obstructed labour. At times signs of growing fibroid can be observed near the uterus.
Above all, the best confirmation for fibroid diagnosis is by doing the scan test. x-ray too may be useful or helpful but scan is better for the fact that when the fibroid is not inside the womb proper, the x-ray will not be able to pick it as scan can.
Can a woman have a baby again when she has developed fibroid after the birth of an earlier baby?
Some of these women can have a baby, again when fibroid has developed after the 'birth of an earlier baby whereas others may not. This situation of course depends on the type of fibroid and also the exact position which it occupies in the woman.
As I have already said, some of these fibroids can grow in the womb which can distort the shape of the cavity of the uterus. This results in heavy and irregular menstrual periods a condition which does not augur well for pregnancy. The heavy bleeding alone could make a woman anaemic if blood transfusion is not given at the right time. Some of the patients could even go into shock.
This is a very dangerous condition, because as an anaemic, she can be exposed to all sorts of diseases bearing in mind blood transfusion during this AIDS era. The heavy bleeding type of fibroid does not allow foetus to stay since the latter has nothing substantial to feed on.
Can a woman who has undergone fibroid operation suffer same again?
It is possible for a new fibroid to shoot up after an operation to remove an earlier one. The fact is some of these tumours are like peanuts while others are big. If care is not taken to remove the tiny ones in addition to the big one during the myomectomy, there is the possibility for them to grow big after sometime and the woman's problem will start all over again.
This can send the woman back to the operation table for another myomectomy. It can continue on and on. This is really a vicious circle.
What kind of operation is performed for the older woman who is suffering from fibroid?
The best that can be done for a fairly old woman who is not interested in having children again is for her uterus to be removed entirely. Without the womb, fibroid cannot grow again. Unlike myomectomy this kind of operation is known as hysterectomy.
Are there other tests for diagnosis of fibroid?
Women who suffer from fibroid are usually anaemic and iron deficient. There can be a blood test to determine this.
Even at that stage, some of them will be reluctant to visit a gynaecologist for vaginal examination. They prefer having solution to their problem either at a shrine, revival church or a native doctor to attend to them.