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How to select fibroid treatment that best suits you

The growths can be as small as a pea or the
The growths can be as small as a pea or the size of a watermelon. PHOTO | FILE 

A majority of African women have fibroids and most do not even realise that they have them.

The circular or ovoid growths can develop in the wall of the womb, the lining or the outside surface and some do not present any symptoms.

But when do you seek treatment if your fibroids seem “harmless’?

“If the fibroids are pressing on the kidney drainage system which if left unchecked for a long time may lead to kidney damage, they have to be treated,” said Dr Timona Obura, a gynecologist and obstetrician.

They can also exert pressure on bladder, making women want to pass urine more frequently but only passes a few drops.They can also cause heavy menstrual bleeding, extreme pain and in severe cases, infertility.

Fibroids can be as small as a pea or the size of a watermelon and the bigger the size the more severe the symptoms.

Dr Obura says fibroids do not necessarily cause miscarriage as a woman can carry a baby to term even with growing fibroids.

However, those with fibroids pressing onto the endometrial cavity where the baby grows and those with many water melon-sized growths have a higher risk of miscarriage.

“The more fibroids that you have the more likely you are to having a miscarriage. Even if you do not have fibroids pressing onto the endometrial cavity, but the ones you have are very large the risk of miscarriage is higher,” he said.

Women planning to get pregnant through In Vitro Fertilisation (IVF) should be first checked for fibroids and the large ones should be reduced using drugs.

The fibroid shrinking drugs provide short-term relief and can only be taken in small doses and not for more than 12 months. If used for long periods, they cause reduction in bone mineral density which can lead to osteoporosis—the condition where bones become brittle.

Also, the fibroids tend to grow once the patient stops the medication.

“In most cases, medication is given as a precursor to a further treatment or surgical procedure to either reduce the size of fibroids to be able to have an easier surgery or reduce the amount of bleeding likely to occur during surgery,” said Dr Obura.

Aside from drugs, there are surgical procedures that are used to remove the fibroids— the traditional making of a large incision to surgically remove the growths (myomectomy) or the whole uterus plus the fibroids (hysterectomy).

While the procedures are slightly cheaper estimated at about Sh320,000, it takes longer for patients to recover and have higher risks.

Less invasive techniques are taking root in Kenya, where doctors use keyhole surgery methods to remove the growths. Known as laparoscopy, the surgery involves making several small keyhole incisions to allow for a minute equipment to cut out the fibroids.

The removal of the fibroids or the uterus can be done through laparoscopy with the cost averaging Sh400,000, but can be higher if the surgery takes longer and if the fibroids are big.

“However, there is faster healing, less pain and less scarring inside the abdomen and it is proven scientifically that women who have had the laparoscopic surgery are more likely to conceive than those who have had open because of there is scarring that affect the fallopian tubes,” Dr Obura said.

To undergo a laparoscopic surgery, a patient’s cardiovascular system has to be stable.

"We usually fill the abdomen with carbon dioxide gas so as to make it swell, the bowel falls back and we have a nice cavity through which we can introduce our operating instruments,” he said.

The carbon dioxide pushes up your diaphragm and that puts pressure on your heart, so patients with heart conditions cannot undergo laparoscopic surgeries.

Patients who have conditions like large diaphragmatic hernia also cannot qualify for laparascopy as they will have the gas escaping from their abdomen right into their lungs causing them to collapse because they can’t get any oxygen in as it is all filled with carbon dioxide.

Another type of treatment for fibroids is hysteroscopic fibroid resection, where the doctors remove the fibroids through the cervix and uterus without making any incisions. This mainly works for fibroids that are in the cavity or pushing into the cavity.

Uterine Fibroid Embolisation (UFE) is another treatment but relatively new in Kenya. It has the shortest recovery period and is especially used in women with heavy bleeding problems.

The procedure entails blocking of blood supplies to the fibroids and not the uterus, making them shrink in size and immediately stopping the symptoms.

“UFE is a suitable alternative for women who generally do not want to have surgery because the procedure is done in a catheter lab where the woman lies on a couch and we use imaging techniques to manoeuvre through her blood vessels instead of cutting her open,” he said.

A three millimetre tubing is inserted into the blood system either through the groin or arm passing all the way to the pelvis and into the uterine arteries.

An embolic material, gel foam is then released to block the small vessels that are feeding the fibroids with blood. Denied of blood supply, the fibroids degenerate and depending on position in the womb, they can fall off, that is why doctors do not recommend the procedure for those on the outer uterine wall.

The procedure which costs about Sh360,000 takes between 20 and 40 minutes to complete and patients are often discharged after an overnight stay at the hospital.

Nine out of 10 women who undergo the procedure immediately are relieved of symptoms and they are unlikely to recur.

A study of 137 women who we had the treatment at Aga Khan Hospital Nairobi showed 87 per cent reduction in size of the growths.

“UFE is not a fertility treatment so if you have problems conceiving because of fibroids that are causing miscarriages this is not your treatment. You have to look at other treatment options especially the surgical ones,” Dr Obura said.

UFE is also convenient for women who are a surgical risk like those who have had pulmonary embolism—a condition where the blood forms clots that can travel to the lungs, heart or brain.

If such patients undergo surgery, during the recovery stage lying in bed for a long time would increase risk of clot formation.

Patients with bleeding disorders like haemophilia or whose blood does not clot easily are also best suited for this procedures.

Deep Vein Thrombosis patients who are on anti-coagulants who are required to be off medication for at least a week before surgery is performed can opt for UFE as they will stop taking drugs for fewer days before embolization.

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