Given the alarming rate of infertility in the country, TUNDE AJAJA, in this report, writes about the incidence of fibroid as one of the major causes of infertility among women
With her bulgy stomach and loosely-tied headgear that seemed to have seen better days, Mrs. Anifowose Eunice (not real names), walked slowly to the Obstetrics and Gynaecology section of the Teaching Hospital that morning.
Accompanied by her 15-year-old niece, the 39-year-old appeared to be in pain as she clutched at the lower part of her protruding belly. Then she gently took the only vacant space on the bench close to the entrance of the ward, joining other expectant mothers taking turns to see the doctor.
Even though she arrived in the middle of a discussion by other pregnant women, as they spoke and laughed at intervals, the mother of one, who looked emaciated but fairly neatly dressed, seemed rather too weak or uninterested to join the fray. And at close intervals, she excused herself to use the restroom, perhaps to do some cleanups.
Whether at close range or seeing her from the distance, one would conclude that her agony could only be due to the complications that come with pregnancy, especially close to the expected date of delivery, given how big her stomach was.
But, as our correspondent later found out, what Eunice had been carrying about in her womb for the past five years was a fibroid, which had become so big that she looked like someone ready to be delivered of a set of twins in another few hours or days.
In a later conversation with our correspondent, it was observed that she was going through pain and more pain as she sat on a sofa on a walkway in the hospital.
Eunice said she had been living each day with fresh rounds of pain for the past few years, hoping she could wish all her pains away.
With incessant excessive bleeding, pain during urination that had become very frequent, back pain, pain during and after sexual intercourse, frequent painful menstruation and of course inability to conceive, Eunice said living had become an unattractive “privilege”.
“It all began five years after we had our first child, Simi, and that was a year after we got married,” she began. “We decided to give it some time before having another one. My husband and I wanted adequate spacing so that raising them wouldn’t be too stressful since we both go to work early and return home late.
“I discovered that I was having series of miscarriages, and at a point, I started having pain below my abdomen. When my stomach was gradually getting bigger, I then felt the pregnancy would stay and that there was nothing to worry about. But I lost the pregnancy again and the pain persisted in-between my abdomen and my thighs until it became unbearable.
“Then I knew something was wrong because I was still menstruating, especially with heavy bleeding. It’s very abnormal to menstruate during pregnancy. I also realised that I was menstruating in the space of two to three weeks. Over time, other symptoms started showing and that was when I rushed to the hospital where it was discovered that I had five fibroids.”
That was the beginning of a truly challenging period for Eunice, and till date, she could count the few moments she had been happy with her life.
Fibroid, every woman’s fear
It is interesting to note that Eunice’s case is not extraordinary; it’s just one out of many, because according to a consultant endocrinologist, Dr. Michael Olamoyegun, over 80 to 90 per cent of women have fibroids, even though not all grow to such an absurd level as to cause infertility. And according to scientific studies, it is more common in Africans than in people from other parts of the world.
According to him, there is no known cause of fibroid, but that it’s a tumour that could either be benign or malignant. He added that while the former is not cancerous, the latter is, but that no one knows the precise cause of fibroid, known as fibromyoma, which could be as tiny as a grain or as big as ninth-month pregnancy.
However, he explained that fibroid could cause infertility if the growth is in the endometrium because, after fertilisation in the tube, it would come to the uterus for implantation, which is where the foetus would develop until delivery.
“So, if you have fibroid in the cavity, that means the fibroid is already occupying the space where the foetus would develop. That could lead to a miscarriage. That is why some people say fibroid on its own cannot cause infertility.
“Although anybody can have fibroid but, it is believed that people who are infertile have more chances of having fibroid than those who are fertile. People say that nature abhors a vacuum. The uterus is meant for babies and if the uterus is empty, then something else could occupy it.”
Also, the Director of Robotic Gynaecologic Surgery, West Boca Medical Centre, Fort Lauderdale, Florida, United States, Dr. Lanalee Araba Sam, said in a previous interview with Saturday PUNCH that fibroids “are disproportionately common in black females, affecting up to 80 to 90 per cent of black women” but that not all result in complications.
But, to this ailment, some women have lost their womb, some their homes, some their joy, some their lives and some others, the hope of ever having a child again. Whereas, in this part of the world, having a child is considered as integral to having marital bliss, the absence of which could breed conflicts in the home and in some cases, lead to the separation of the couple. This underscores the attention people now pay to issues of infertility.
Notably, in the past, women used to take all the blame for the inability of a couple to have a child, but according to medical experts, infertility could be caused by either the man or the woman.
Olamoyegun said findings have shown that 40 per cent of infertility issues are due to male factors, while another 40 per cent are due to female factors. Ten per cent are said to be due to both male and female factors and the remaining 10 per cent are still unknown.
But speaking about the import of fibroid in female infertility, a consultant gynaecologist, Dr. Naheem Deen Ekemode, described it as a “major” cause of infertility in women, despite that there is no known cause.
This implies that, apart from natural causes, the previous incidence of sexually transmitted infections, which has been found to be a major cause of infertility, and endometriosis, is another main cause of infertility in women.
Before now, people gave this ailment all sorts of names. Yoruba people used to call it Oyun iju and that informed the medication they would give the woman, even if she suffered from haemorrhage or any other complication that could have arisen from it. But with modern medical services and increased awareness, fibroid became known.
Ekemode added, “It’s a great cause of infertility, particularly when it grows in the linen of the womb. It prevents the implantation of the fertilised oven to develop, and then it leads to miscarriages. So, it’s a major cause of infertility, even though we don’t really know what causes it. What we know is that oestrogen (female hormone) enhances the development of fibroid.”
In a telephone interview with our correspondent, Ekemode, who has over 49 years experience as a gynaecologist, added, “You find that it is prevalent in women who avoid pregnancy for quite some time, because as they say, nature abhors vacuum, it is not very common in those who get pregnant at reasonable intervals and we realise that it starts developing around the late 20s and early 30s.
However, beyond the inability to be pregnant, which is significant, some women who have fibroids told our correspondent that it had been a hellish experience.
Ekemode, a former Chairman of Lagos State Hospitals Management Board, identified pain and bleeding as some of the symptoms of fibroid. He said women, especially those who had not reached menopause, who notice unusual pain or excessive bleeding before or during their menstruation, should see a doctor.
He said, “Fibroid is a growth in the lower part of the stomach. It presses on organs surrounding it, and as a result, this pressure would give pain, particularly when the woman’s period is approaching, because of vascular congestion. Also, it gives congestive dysmenorrhoea, which is the pain associated with menses.
“Depending on the size, it also presses on the bladder, which is directly in front of the womb. When such a woman wants to urinate, if the fibroid has grown big, it presses on the bladder and then results in pain. It can also give pain during sexual intercourse, and in some cases, lovemaking can become a nightmare for women with fibroid.
“It also causes bleeding and that is the greatest sign of fibroid. It causes heavy bleeding during menstruation, and it is called menorrhagia. It increases the bleeding, shortens the menstrual cycle and makes women menstruate more regularly. For example, if the woman menstruates every 28 days, it could reduce to every two or three weeks. It becomes more recurrent and the bleeding could be very heavy that the patient becomes very anaemic. So, the bleeding is one of the first signs one would observe.”
It is equally important to note that in a small percentage of the instances, it has been found that it can turn into cancer. But since there is no exact way to know which one could turn into cancer, experts say that is a good reason to remove it on time.
Notably, according to experts, having fibroid is not a death sentence, neither does it mean such a woman cannot conceive again; fibroids are removable through surgery and if successful, such a woman could be fertile again, provided the infertility was initially caused by fibroids.
Making all efforts to ward off tears that were on standby to roll down her cheeks, Eunice said she would not contemplate a surgery because one of her friends lost her womb to the operation, while another distant relative of hers died in the process.
“I can’t risk it; I would rather keep managing it than subject myself to that uncertainty,” she said.
At the moment, Eunice is preoccupied with overcoming the pains and having a baby seems to be the last thing on her mind because, with fibroids, there is little or no chance for a foetus to survive, as the fibroids occupy the cavity where the foetus is supposed to develop.
Pains and more pains for victims
Findings have also revealed that fibroids make no distinction between women who are married and those who are not.
A young woman, who was single, told our correspondent that she was a survivor as she had to opt for surgery so that it wouldn’t block her chance of being fertile when she eventually got married.
While people readily come across women with protruding belly, it’s hard to say which is as a result of pregnancy or on the other hand, fibroid. Perhaps, this underscores the popular saying that it is only the woman who knows what is in her belly and to whom it belongs, in case it’s a baby.
Also, when Mrs. Chinasa (surname withheld) noticed some changes in her tummy, given that she and her husband had concluded to have their second child, four years after their first daughter, Chinenye, she thought their prayer had been answered.
But her joy was short-lived when she started seeing her menses again, this time, with serious pains and severe bleeding. She recalled that on getting to the hospital, their family doctor examined her and it was found that what she had in her stomach were fibroids of varying sizes and not pregnancy.
After about six months, neighbours started wishing her safe delivery, but only she and her husband knew that she had fibroid and not pregnancy.
Her husband, who preferred to be identified simply as Chidi, recalled that his wife’s bleeding became too much that it led to heart failure.
“We bought several sanitary pads but they were never enough. She was weak and I felt I was losing her. The doctors had to do a blood transfusion to save her life.
“I remember that at a point, she took six pints of blood because she was always bleeding and her menstruation was coming out every two weeks. Of course, we can’t even think of having a child while the fibroid is still there and my wife doesn’t want to go for surgery because of the uncertainty of the outcome,” he said.
A relative of Chinasa also told our correspondent that the husband’s family was already mounting pressure on him to take another wife or at least, impregnate a young lady, so he wouldn’t be known as a ‘father of one’.
But while some women in this situation have supportive husbands and family members, some have not been so lucky. Some women have to face the stigma and the emotional trauma that could come with such situations alone.
Until some months ago when she finally relocated from where she lived with her husband before he travelled, Mrs. Ajayi (first name withheld) said she had almost become a subject of pity and ridicule in her neighbourhood.
For over 10 years, the 41-year-old woman said she had been living with fibroid. Now with a protruding stomach, looking like she was nine months’ pregnant, she said beyond the cost of taking care of herself, she had lived a life of pain and sorrow.
She said, “In the first couple of months that my former neighbours started noticing some changes in my stomach, they used to wish me safe delivery. But when after two years, three years, it kept rising, some of them asked what was wrong with me and I had to confide in them that I had fibroid because it was very abnormal.
“Then, occasionally, due to the severe pain and fatigue resulting from the loss of blood, there were days I would be indoors and I would be unable to go out. But I had to leave the area because I was no longer comfortable with the way people started looking at my stomach, especially since my husband has not been around. Doctors said the rate of growth had slowed down because of my age.”
Perhaps, long spacing also had a role to play in Ajayi’s case because she said she had a baby when she was in a higher institution. “I wasn’t really prepared for it then, that was about 15 years ago; I was 26 then, but it happened.”
Speaking on the impact of spacing, Ekemode said, “People can space their babies; like one or two years is okay. But when the womb is dormant for years and nothing happens, the hormone, oestrogen, enhances the growth of fibroid.”
Perhaps one other worry Mrs. Ajayi has at the moment is the fear of losing her man. She said the fact that she already had a child before the fibroid challenge came up sometimes made him feel disadvantaged. “It’s not something I like to think about, but I have decided to watch things unfold; I can’t add those worries to what I’m going through now.”
Fibroid not the end of the road – Experts
Given the way the issue of fibroid has caused disaffection in many homes, it is worthy of note that it is curable, especially through surgery, experts have said.
Responding to certain reports that there are drugs such women could take to get rid of it, Ekemode said some orthodox drugs could dry the water in the fibroid, which would make it shrink, but warned that it is for a limited period.
He said, “It is not a permanent cure. Most treatments are done by surgery, sometimes preceded by injecting the person to reduce the size of the fibroid if it’s very big, and we have different kinds of surgery. We have a straightforward laparoscopic myomectomy, in which they open the tummy and remove the fibroid in two small incisions.
“But it can recur and that is why the doctor doing the operation must be meticulous and look out for small seedlings because if left behind, they can grow later.”
Most of the women, who spoke to our correspondent, said they were afraid to go under the knife. According to them, this is not only because of the fear of losing their womb or paying so much but also because of the uncertainty of the outcome.
The cost of the surgery is estimated to be between N350,000 and over N1m, depending on the hospital and severity of the case. But according to Ekemode and Olamoyegun, it is possible for women to still conceive after their fibroid has been removed, depending on the expertise of the doctor and the technique used and if the cause of the infertility was found to be the fibroids.
Ekemode said, “The success rate of fertility after myomectomy depends on the expertise and the technique employed by the doctor.
“In some hands, people die during or after the operation and some develop complications because it wasn’t handled properly or due to lack of experience.”
Olamoyegun stressed that most women have fibroid but that it is when it has been proven to be the cause of their infertility that its removal could translate to such women being fertile again.
While advising women on how not to be a victim, Ekemode said women should get married early, avoid unnecessarily long spacing in-between childbirth and see a doctor as soon as they have any strange feeling in their body.
“People should not get scared because surgeries are very safe nowadays and it’s when people reach menopause and there is no more oestrogen that it could stop growing on its own,” he said.
Also speaking on the need for women to embrace treatment, Araba Sam said people who had gone beyond the childbearing age should consider surgery, even if it involved removing their uterus.
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Given the alarming rate of infertility in the country, TUNDE AJAJA, in this report, writes about the incidence of fibroid as one of the major causes of infertility among women With her bulgy stomach and loosely-tied headgear that seemed to have seen better days, Mrs. Anifowose Eunice (not real names), walked slowly to the Obstetrics […] Read Full Story