FIBROIDS: THE ANNOYING GUESTS

Zumira* sat forlornly on her bed during the teaching ward round. You could tell she was wishing she could be anywhere but here. She was uncomfortable, feeling like a specimen under the microscope.

It was twelve years since she was last in this very same ward at the national teaching and referral hospital. She was 26 years old then, young and full of hope. She had completed college and her first job was coming along quite nicely. She had even moved out of home and was very excited to be living independently.

However, she noticed that her period was getting heavier each month, and though she had always suffered from crampy pain during menses, it was getting to excruciating levels needing constant medication. She was too busy living her life to make time to see the doctor until her mother intervened and forced her to seek care.

At the gynaecology clinic on a hot sunny afternoon, the young doctor put her at ease and managed to elicit a few more symptoms. In addition to the crazy periods she was having, Zumira had not paid attention to the on and off constipation dogging her. She had sought treatment for urinary tract infection twice in the previous year too.

A physical examination revealed that she was pale, with a mass in her lower abdomen that was literally the size of a 16-week-old pregnancy. This was a revelation to Zumira that got her thinking of just how much she had neglected herself! She was now a statistic, a part of the nearly one in two black women with uterine fibroids.

Zumira’s diagnosis was confirmed by ultrasound and she successfully underwent surgery to remove the fibroids from her uterine walls. Following surgery, she did well, optimistic that the worst was over. At her post-operative review clinic, she was seen by a senior professor. The jolly old Prof teased her a lot but categorically let her know that the fibroids were bound to recur with time and she seriously needed to think about having children in the near future before this happened.

Zumira was discharged from the clinic and resumed her fast-paced life. The pain faded off, the periods became lighter and the good old professor’s wise counsel was involuntarily ignored. Ten years flew by pretty quickly in Zumira’s life and before she knew it, the familiar old symptoms were creeping back like a bad weed.

One day, after a particularly rough night, Zumira knew she had to retrace her steps back to the very clinic she had avoided for years. She did not hesitate to tell the doctor that she was sure her fibroids were back. She could feel the uneven masses in her abdomen, two distinct firm mounds that were dwelling within her uterus. She even jokingly referred to them as her uterine visitors that had overstayed their welcome.

Things were not as rosy this time round. Her fibroids were really big, right up to 34 weeks in size. Though the symptoms were less obvious than the last time, the prognosis was less optimistic. The doctor was terribly unhappy to note that in the last 12 years since she had been in the hospital, Zumira was still childless yet she harboured a deep desire to be a mother. She went through the tests and was eventually admitted to the wards for surgery.

It was during the ward round that Zumira met the very same professor who had advised about having babies. He was completely unamused. He bluntly asked Zumira what she had done with the past twelve years that she had to fulfill her maternal desire. For us younger doctors in the rounds who were avidly studying the art and science of the gynaecology specialty, we were taken aback by the professor’s forthrightness. We had no idea about the discussion they had in the past.

Zumira had extremely tough choices to make. Here she was, in a public hospital, with limited finances and hence limited treatment options. She was scheduled for a surgery where she was going to lose her womb at barely 38 years of age. Her dream of becoming a mother was rapidly vanishing before her eyes.

She blamed herself for her predicament. She felt that she had set the bar too high for the potential father of her children and while she waited around for the right one to come along, these alien visitors to her womb had silently crept in and robbed her of an opportunity to be a mother.

Right there and then, she wished harder than ever, she could be anywhere in the world other than the alien hospital bed surrounded by a bunch of strangers feeling sorry for her.

Factfile:

1.      Fibroids are the commonest tumors that occur in the reproductive system of females.

2.      They are three times more common among black women than the white women.

3.      They are abnormal growths within the wall of the uterus that may occur singly or in multiples and they are not cancerous.

4.      They occur during the reproductive age and thrive on oestrogen hormone, tending to shrink after menopause as the hormone levels decline.

5.      They may cause heavy, painful menses; a dragging sensation in the pelvis; obstructive symptoms such as constipation and incomplete emptying of the bladder that results in recurrent urinary tract infections; and infertility.

6.      Treatment options are tailored to the patient’s desire, age, number of children, symptoms present and complications present. These include: not treatment especially if small and asymptomatic; surgery to remove the fibroids (myomectomy) or the entire uterus (hysterectomy); medication to cause a temporary state of menopause to shrink them; and uterine artery embolization which cuts off blood supply to individual fibroids, causing them to die off and shrink.