The rising scourge of fibroid in Nigeria

The number of deaths from fibroid, a term used for non-cancerous (benign) tumours that grow from the muscle layers of the uterus has been on the increase across the country, creating worry and anxiety. Cases abound of people who go for treatment and before you know it, they are dead. GEORGE OKOJIE writes on this phenomenon and how to tackle it.

Mrs. Tolani Ayeni has been married for 12 years and lived with her husband consistently in their home in Lagos. Though she had enjoyed marital bliss all these years, the major problem currently rocking her marriage is the series of miscarriages she has experienced and her inability to bear children.

It got so frustrating and she blamed the spontaneous pregnancy losses on several factors until she was diagnosed with fibroid in the uterine cavity, occupying the space meant for the developing foetus.

Still under the illusion that she might have been placed under a spell by her enemies, she resorted to visiting prayer centres to solve her problem. Rather, the swolen mass located in the lower part of her abdomen continued to increase, causing recurrent miscarriages.

“I was always having lower abdominal swelling but I could not say it was a growing baby because I did a pregnancy test and the doctors said I was not pregnant. The swelling persisted for years. I decided to see a physician when I was also having frequent and painful urination, after using antibiotics as the first line of treatment without any improvement in symptoms.

“I will eat and it will not digest; I always had constipation. Even though I ate early and took fruits, it was always a case of recurrent constipation. When it continued despite adequate treatment, I went to another hospital where I was also diagnosed with fibroid. The doctor said the fibroids in my womb were compressing my rectum thereby causing constipation.

“I resorted to the use of natural supplements to shrink and remove the fibroids. I had no option because I'd not been able to get pregnant for my husband and bear children and I was under tremendous pressure from my in-laws to undergo surgery for fibroid. I have been afraid of doing the surgery for two main reasons: I have friends who did the surgery and still didn't get pregnant, while some lost their lives in the course of doing the operation,” she told LEADERSHIP Sunday.

For Clara Amodu, it is like a death sentence because her marriage to Daniel her heartthrob of many years was annulled and engagements cancelled as a result of the ailment.

Describing the ailment as a sad reflection, she said, “Ordinarily, I don't like talking about having fibroids because of the psychological trauma it caused me when I was about to get married. My suitor dumped me simply because I told him I had fibroids.”

“I used to have heavy vaginal bleeding during menstruation or before the onset of my next menses. Sometimes, there were cases of inter-menstrual bleeding. So I went to the hospital for treatment and was diagnosed with fibroid. I came back and told my suitor what transpired in the hospital and that was it.

“I later discovered that because the aliment is synonymous with infertility, he was scared that I may not be able to give birth. It abounds in our society. A woman diagnosed with fibroid is treated like one with a contagious disease that any man in his right senses should avoid. But I cannot blame him because he believes since I have fibroid; I may not be able to raise a family for him.

“Fibroid is a serious issue in Africa. I remember that my parents and many of our friends made efforts to make him change his mind but his own parents advised him to end the relationship. I later got married to my present husband and we have been together for two years now but I'm yet to conceive. I have been in and out of the hospital. They recommended surgery but because of the fear of losing me in the process, my husband has been so scared of allowing me go through fibroids surgery. A lot of people that go for fibroid surgery in Nigeria die in the process or shortly after,” Amodu narrated.

As fibroid assumes one of several gynaecological problems facing women in Africa, herbalists and other spiritualists seem to have capitalised on the prevalence of the ailment to rip-off women and families desirous of getting out of the problem.

For lack of knowledge about the ailment, a herbalist identified Ayenoro Funsho, was alleged to have damaged a woman's womb in Lagos in a bid to remove fibroid from her uterus.

The herbalist, who runs Dinah Natural Herbal and Maternity Clinic located at 81 Abeokuta Street, Ebute Metta, Lagos, allegedly forced pepper and other mixtures into one of his victim's private parts after he collected close to N170,000 from her for removal of fibroids through spiritual means.

LEADERSHIP Sunday gathered from the victim that by the time her husband took her to a specialist hospital on Lagos Island when she could no longer cope with the pains, doctors confirmed that her private part and womb had been badly damaged.

Miffed by the damage done to his wife's womb, the victim's husband reported the case to the police and they later arrested the herbalist, shut the clinic and threatened to press criminal charges against him.

Narrating a near similar case, Mr. David Ogechukwu, who lost his wife to uterine fibroid told LEADERSHIP Sunday that “the management of the hospital told us they needed to operate on her to remove a fibroid growth before embarking on the delivery. Both operations were successfully done and she was responding to treatment before finally giving up the following day.”

Report links use of hair relaxers to fibroid
The report of a Boston University study published in the American Journal of Epidemiology indicated that hair relaxers which are used by millions of black women, possibly expose them to various chemicals through scalp lesions and burns, may not be unconnected to high incidents of fibroids in black women.

According to the study, chemical hair relaxers many black women use to straighten their hair may be linked to the development of fibroids.

In the course of the study, scientists followed more than 23,000 pre-menopausal Black American women from 1997 to 2009 and found that the two- to three-times higher rate of fibroids among black women may be linked to chemical exposure through scalp lesions and burns resulting from relaxers.

Findings of a separate study published in the Annals of Epidemiology also showed that women who got their first menstrual period before the age of 10 were also more likely to have uterine fibroids, and that early menstruation may result from hair products black girls use.

300 African American, African Caribbean, Hispanic, and White women in New York City were studied. The women's first menstrual period varied anywhere from age 8 to age 19, but African Americans, who were more likely to use straightening and relaxers hair oils, also reached menarche earlier than other racial/ethnic groups.

Findings by LEADERSHIP Sunday revealed that so far, there is only an association rather than a cause and effect relationship between relaxers, menarche, and fibroid tumours.

“Hair relaxers (straighteners) have been used by millions of US black women, often for long periods of time. Hair relaxers can cause burns and lesions in the scalp, facilitating entry of hair relaxer constituents into the body. The main ingredient of “lye” relaxers is sodium hydroxide; no-lye relaxers contain calcium hydroxide and guanidine carbonate, and “thio” relaxers contain thioglycolic acid salts. No-lye relaxers are advertised to cause fewer scalp lesions and burns than lye relaxers, but there is little evidence to support this claim. Products may also contain hormonally active compounds such as phthalates, which are not required to be listed separately as ingredients and are often reported under the term “fragrances” or “perfume”. Cosmetic products are not subject to premarket approval by the Food and Drug Administration, and a complete list of ingredients is not mandatory, making it unclear what types of chemicals they contain. However, because the vast majority of hair relaxers list “fragrance” as an ingredient, and 100% of popular fragrances tested in a 2002 study were found to contain phthalates, most hair relaxers likely contain these chemicals. In addition, some hair relaxer products directly list phthalates as one of their chemical ingredients.

“Phthalates from cosmetic products can be absorbed by the skin or inhaled, and they have been shown to have estrogenic effects in cell models and experimental animals. Although the role of phthalates in humans is less clear, cross-sectional data from the Third National Health and Nutrition Examination Survey (NHANES) show that self-reported history of uterine leiomyomata was positively associated with urinary levels of monobutyl phthalate and inversely associated with urinary levels of mono (2-ethylhexyl) phthalate. In contrast, a case-control study found significantly higher levels of total urinary monoethylhexyl phthalate in uterine leiomyomata cases than controls. Additional studies investigating the association of putative endocrine-disrupting chemicals (e.g. diethylstilbestrol, polychlorinated biphenyls, and dioxin) with uterine leiomyomata risk have also found positive associations, but others have shown inverse and null associations,” a part of the report read.

What really causes fibroids?
Physicians, who spoke to LEADERSHIP SUNDAY in separate interviews, said the incidence of fibroids in black women of reproductive age is as high as 75 per cent.

Although not all are diagnosed, available statistics also showed that fibroid affects at least 20 per cent of all women at some time during their life, with women aged between 30 and 50 tipped as the most likely to develop the ailment.

As hopeless as the situation seems to be, the medical director of Cedarcrest Hospitals Ltd, Dr. Felix Ogedengbe, said Uterine Artery Embolisation also called Uterine Fibroid Embolisation (UFE), has rekindled hope of treating the ailment successfully across the world.

He said the establishment of a medical centre to carryout Uterine Fibroid Embolisation (UFE) in Lagos has brought relief to many women in the state and environs.

The medical expert said the new hospital was established in the state to stem the increasing rate of Nigerians traveling out of the country to seek medical treatment.

Speaking to LEADERSHIP Sunday, he said, “we have believed and continued to believe that Nigerians do not need to go through the rigours and attendant risks of travelling abroad to access high quality healthcare. Having trained and worked in other more advanced parts of the world and seeing that Nigerians form part of the best crop of doctors worldwide, we undertook to come back home to establish Cedarcrest Hospitals to treat ailments such as fibroids and others killing people in the country.”

To make the centre big enough to accommodate more victims, he explained that plans are afoot to expand the 20 bed facility in the specialist hospital to a 100 bed facility that can accept helicopters and bring trauma patients into the hospital.

Harping on treatment of Fibroids, he said, Uterine Fibroids Embolisation (UFE) is the modern way of looking after fibroid.cover story pix

“Fibroid is very common amongst Black women and we are getting a lot of women coming in to have this procedure done. In doing fibroid embolisation, women who have fibroids, can have a needle passed through their blood vessel to get to the fibroids and those fibroids are then burnt there. Certain items are put on the fibroids over a few weeks to month and all the fibroids burnt are melted away. So, women do not need to have open operation to have fibroids removed anymore. We have done many in our Abuja hospital.

“It is safe and the patient we have done this for goes home on the same day of the operation or the next day. So they don't need blood transfusion, they don't need big surgery, big expanse of surgery, risk of infection, long stay in the hospital and all of those things that the traditional fibroid operation comes with. This is safe and proven to be beneficial to lots of women,” he explained.

Dr. Israel Adesugba, of St. Paul Medical Centre, while reacting to the rising incidents of fibroids however said fibroid is not a death sentence. According to him, medical advancement has provided solutions to the problem.

He noted that the current trend in Nigeria is that with the advent of ultrasound scan, when small fibroid seedlings are discovered, the woman is frightened with the report that she has fibroid

“This is being done intentionally by some physicians with a view to stampede the patient to part with money by recommending an unnecessary operation. This is unethical,” he stated.

According to him, with uterine artery embolization, a newer medical technique which entails minimally-invasive without a large abdominal incision, treatment of fibroids is no-longer a big deal.

He explained that with this method of treatment, the arteries supplying blood to the fibroids are identified then blocked off (embolised).

“It is the embolisation that cuts off the blood supply to the fibroids, thereby shrinking them. It has provided better option of treatment and it has been very successful,” he added.

(This article was originally published by Leadership Fibroids: Killer Ailment On The Prowl)