Category: Sunday magazine

• Why black women are more susceptible to benign tumour

• Why many are falling into trap of fake herbal remedies

At a time when many women are supposed to be at their elegant best, reveling in their feminism and enjoying the beauty of motherhood, usually come the unwanted guest called uterine fibroids, intruding their tummy and causing them excruciating pains, alongside emotional and physical distortion. Usually, the mass, a non-malignant tumour, if left untreated, can grow to a size larger than a 10-month pregnancy, putting their life at risk, even denying them the joy of motherhood. Unfortunately, financial hindrances, culture and fear of surgery have also combined to make the condition a Herculean one. EKAETTE BASSEY reports.

Mary Ali, 26, is a bread seller in Lagos. Her story, as shared in confidence by a gynaecologist and head doctor at a private hospital in Isolo, is a harrowing account of desperation, misinformation, and a crushing burden of healthcare inequality.

“She was brought in almost unconscious,” the doctor said in an exclusive interview.

“Her abdomen was severely distended. We ran several tests, including scans, and confirmed that the fibroid had grown to a massive size, far beyond what we typically see. It had compromised her reproductive organs, and the only option was to remove the womb entirely.”

The doctor explained that the lady had been diagnosed with fibroids at age 22 but opted against surgery after being overwhelmed by the projected cost. Instead, she turned to herbal concoctions advertised as natural remedies capable of “flushing out” fibroids.

“She told us she didn’t have the money for surgery at the time, so she turned to herbal alternatives. One of the sellers had promised her the concoction would ‘flush out’ the fibroid naturally.”

Ali believed them, and for four years, she reportedly tried numerous herbal mixtures from various herbalist/vendors, sometimes taking combinations so bitter and unregulated that she would vomit for hours. But none of them worked. Instead, the fibroid worsened – kept growing silently and aggressively in size, taking more space, and pressing dangerously against her internal organs.

“She came in very weak, severely anaemic,” the doctor continued.

The turning point

After conducting a battery of tests, the medical team concluded that the fibroid had grown to such a size that her uterus would need to be removed completely to save her life – a procedure known as a hysterectomy. She was informed she would need at least nine pints of blood due to anticipated blood loss and a total of N2 million to cover the cost of surgery, transfusions, medications, and aftercare.

“On hearing this, she burst into tears,” the doctor recalled.

“She said she didn’t even have N5,000 to her name, let alone over a million naira. I sell bread from morning to night. Where will I get one million naira? I’ve spent everything I have on those herbs. She quietly left the hospital and we were afraid we might not see her again.”

But the story didn’t end there. Driven by the urgency of the case, the hospital contacted a network of NGOs known for supporting critical medical interventions for indigent patients. After reviewing her case and medical records, the groups agreed to sponsor the surgery in full.

“She was called back and told the good news. She was stunned. She wept and kept thanking everyone,” the doctor said.

“We quickly scheduled the operation.”

A new lease of life

According to the doctor, the procedure which lasted about four hours was carried out successfully, and although the fibroid was too large to allow for uterus preservation, the operation saved Ali’s life.

“The surgery lasted several hours. We removed a massive fibroid and her uterus. It was a complicated case, but thankfully, everything went well,” the doctor said.

Despite the permanent loss of her womb which translates to an inability to bear children, the 26-year-old, the doctor, recalled still expressed gratitude for life.

“I’m just thankful I can breathe again, eat without pain, and walk around without people staring at me like I’m pregnant,” she was quoted as saying after her surgery.

“I never thought I would survive this. I thank the hospital and everyone who helped me.”

What is uterine fibroid?

Uterine fibroids, medically refer to as uterine leiomyomas, are rapidly emerging as silent but widespread health crisis among women in Africa, particularly Nigerian women. Though benign, these growths cause significant distress, fertility issues, and even life-threatening complications, disproportionately affecting women of African descent. The burden of this disease, according to medical experts and recent studies, is not just biological but also social, economic, and environmental.

A prevalent yet underreported condition

According to a PubMed Central report, uterine fibroids are the most common benign tumors found in reproductive-aged women of all races and may affect up to 70 per cent of all women by menopause. However, the statistics are even more alarming for black women.

The report also says the highest burden of this condition affects black women, occurring at rates 3–4 times greater compared to their counterparts in other races. It is estimated that 70–80 per cent of black women will harbour fibroids over their lifetime, emphasising a stark racial disparity.

According to the Nigerian Journal of Pharmacy (2024, Vol. 58, Issue 2), the incidence rate in Nigeria ranges from 17.9 to 26 per cent, which is significantly higher than the 11 per cent reported in developed countries –

Types of uterine fibroids

According to Cleveland Clinic, uterine fibroids vary based on their location and how they attach to the uterus. The most common type is Intramural fibroids, which are embedded within the muscular wall of the uterus. These fibroids can cause significant discomfort, heavy bleeding, and pressure symptoms depending on their sizes.

Another type, Submucosal fibroids, develops just beneath the inner lining of the uterus. These fibroids can interfere with fertility and often lead to prolonged and heavy menstrual bleeding. In contrast, Subserosal fibroids grow on the outer surface of the uterus, sometimes expanding into the pelvic cavity. When they become large, they can exert pressure on surrounding organs, leading to symptoms such as frequent urination or constipation.

The least common type is pedunculated fibroids, which are attached to the uterus by a stalk or stem. Often described as mushroom-like, these fibroids can either grow inside the uterine cavity or extend outward. Due to their attachment on a thin stalk, they may cause pain or discomfort if the stalk twists, cutting off blood supply to the fibroid.

Understanding these different types of fibroids is essential for proper diagnosis and treatment, as their locations and sizes often determine the best course of medical intervention.

The impact on fertility and quality of life

For many women, fibroids go beyond heavy bleeding and discomfort; they can directly affect fertility, according to a surgeon and public health advocate, Dr Benjamin Olowojebutu, who described how the location of fibroids within the uterus determines their impact on pregnancy.

Describing intramural fibroids which grow inside the endometrium, where a baby should develop, he said: “When a fibroid competes for space with a growing fetus, it can cause repeated miscarriages.”

Similarly, he noted Submucous fibroids, which grow inside the uterine muscle, prevent embryos from implanting, making conception difficult.

He said: “Imagine a tiny groundnut trying to grow inside a space with a hard coconut, it simply cannot expand beyond the size of the coconut,” Olowojebutu illustrated.

“This is similar to how a growing baby struggles for space when a Submucous fibroid is present in the uterus. The fibroid, much larger and rigid, restricts the baby’s development. As a result, many women with this condition experience habitual miscarriages, often losing pregnancies around four to six weeks because the fibroid prevents the embryo from growing properly.”

Complications, costs, and delays

Olowojebutu, who is also the Executive Director/Founder of the Benjamin Olowojebutu Foundation (BOF), described fibroids as “non-cancerous benign tumours that affect women, primarily in the uterus.” He noted that their impact can be wide-ranging.

“These growths can cause complications like heavy bleeding (menorrhagia), severe menstrual pain (dysmenorrhea), pain during intercourse, and an increase in the number of menstrual days,” he explained.

In severe cases, fibroids can lead to intestinal obstruction and acute kidney injuries.

Olowojebutu highlighted why many women delay treatment.

He said: “Two primary factors contribute to women delaying treatment for fibroids: fear and financial constraints. The fear of losing their womb, not getting better, or even the fear of death can deter women from seeking early treatment. The high cost of medical care can also be a significant barrier.”

In Lagos, the cost of open surgeries including abdominal myomectomy, and hysterectomy, which remain standard options in the country range from N500,000 to N2 million, making access to care difficult for many women.

The cost of non-invasive treatments, including Uterine Fibroid Embolization (UFE), Laparoscopic surgery, and High-intensity Focused Ultrasound (HIFU), typically range in cost from N3 million, with some procedures reaching as high as N5 million.

The steep cost of healthcare in Nigeria presents a significant barrier to timely fibroid treatment, particularly for women from low-income backgrounds. Factors such as out-of-pocket expenses, the absence of insurance coverage, limited access to specialists, and the high cost of alternative treatments exacerbate the financial strain on fibroid sufferers.

Olowojebutu, however, noted that BOF provides discounted and even free treatment to bridge this gap.

Benson, another survivor story

Like Ali, surviving uterine fibroids for Ojuolape Benson, an English Language teacher, became a decade-long nightmare. Initially dismissive of her doctor’s recommendation to undergo surgery in her early diagnosis, her fears of medical costs and surgical scars led her to delay treatment. However, by 2021, the fibroids had expanded, mimicking a five-month pregnancy.

“The remarks from people were unbearable. Strangers would congratulate me on my ‘pregnancy,’ while others whispered behind my back. It crushed my self-esteem,” she shared.

Benson’s fibroids also caused her excruciating pain, irregular bleeding, and pressure on her bladder. Though she found solace in her family’s support, the stigma, depression, and fear of surgical risks took a toll on her mental health.

Weight of social and cultural barriers

Financial hardship is only part of the problem. Cultural beliefs and social stigma also contribute to dangerous delays in seeking help.

For Benson, the reality of financial hurdles hit hard. When she first sought medical advice in 2018, she was given an initial estimate of N100,000. However, due to financial constraints and fear of the surgery, she postponed the procedure. By the time she was left with no choice in 2023 and now suffered from multiple uterine fibroids, the cost had ballooned.

“The price had more than quadrupled,” she recalled.

Beyond the financial implications, social and cultural beliefs further complicate access to treatment. The fear of scarring is a major deterrent for many women, especially in a society where physical appearance plays a significant role in self-esteem and marital expectations.

“I was afraid of living with a permanent scar,” Benson admitted.

“In our society, scars carry a stigma, especially for women. People start asking questions, and sometimes, you’re even judged for it.”

In some cases, traditional beliefs and misinformation contribute to delays in seeking medical help. Many women turn to herbal remedies or faith-based healing, believing that fibroids can shrink naturally. However, medical experts strongly caution against these unverified treatments, stressing that fibroids do not disappear on their own without medical intervention.

The combination of financial hardship, social stigma, and misinformation keeps many Nigerian women trapped in silent suffering – until their condition reaches life-threatening stages.

Dangers of unregulated herbal remedies

The desperation to find effective solutions has led many to explore unregulated herbal remedies. Heavily marketed in local markets and across social media platforms, these treatments promise quick, painless, and “natural” cures for fibroid-related issues. However, medical experts warn that these so-called remedies often exacerbate the condition rather than offer any real relief.

A gynecologist and surgeon, Dr. Ola Silver, with over 12 years experience of treating more than 10,000 fibroid patients, has witnessed the harmful impact of these unverified treatments.

“These herbal drink sellers know the truth,” Silver remarked.

“They exploit vulnerable women for profit, selling false hope in a bottle. By the time these women realise the deception, the fibroids have grown even bigger, leading to more complications. And guess what? These same herbal remedy sellers eventually refer them to hospitals when the damage is done.”

Benson recounts a shocking revelation by a popular herbal remedy distributor: “This woman swore by the efficacy of her herbal mixture, telling everyone that she had cured herself. Women lined up to buy from her, believing they had found a miracle solution. But behind closed doors, she was secretly undergoing In vitro Fertilisation (IVF) because she knew the herbs wouldn’t work. She had convinced others to trust what she never trusted herself.”

In return, the producers of the herbal mixture gifted the woman a brand new car and an all-expenses-paid trip abroad with her husband after the pregnancy of her twins, which she attributed to the mixture, led to a surge in demand for the product.

However, Silver warned that the spread of these misleading treatments not only delays appropriate medical care, it also leads to severe complications, including excessive bleeding, anemia, and in some cases, infertility.

While some women turn to herbal remedies as a last resort, scientific evaluations are raising the alarm. A recent article in the Nigerian Journal of Pharmacy assessed a local herbal remedy used in South-West Nigeria for fibroid treatment. The study found insufficient evidence of its effectiveness and highlighted safety concerns, urging caution among users.

Professor Olowojebutu echoed this sentiment: “Herbal remedies and home treatments cannot shrink fibroids. In fact, these remedies may do more harm than good, potentially affecting the liver, kidneys, and even causing fibroids to grow larger.”

The journal also cautioned that even some FDA-approved medications, such as selective progesterone receptor modulators and gonadotropin-releasing hormone antagonists, may cause side effects like “hot flashes, depression, decreased libido, insomnia, joint pain, androgenisation and bone loss.”

It noted further that tumours often regrow once therapy ends.

Available treatments in Nigeria

According to experts, a variety of treatment options are available for managing uterine fibroids in the country, ranging from conservative approaches to advanced surgical interventions.

These include medical therapies such as gonadotropin-releasing hormone (GnRH) agonists and tranexamic acid, which help manage symptoms and reduce fibroid size.

Minimally invasive procedures like uterine artery embolization, hysteroscopic myomectomy, and high-intensity focused ultrasound (HIFU) are also gaining traction.

For more severe cases, surgical interventions such as myomectomy, particularly abdominal myomectomy, which is commonly performed in Nigerian tertiary hospitals and hysterectomy remain standard options.

Surgery: A life-changing experience

After years of hesitation, Ojuolape Benson, the English Language teacher, fondly called Ojuola by close relatives, underwent a surgery, using the epidural approach, which numbs the lower body while the patient remains conscious. Despite her initial fears, the procedure was uneventful.

“The anesthetist, Adekunle Ibrahim, was incredibly gentle. I felt no pain during the operation,” she recounted.

She revealed post-surgery recovery included managing pain, addressing surgical wounds, and emotional healing.

“I was so relieved to finally feel free of the burden,” Benson confessed joyfully.

Unlike 26-year-old Mary Ali who had a hysterectomy, 37-year-old Benson was relatively fortunate. Although she battled uterine fibroids for nearly a decade, the growths were not aggressive. As a result, doctors were able to perform a myomectomy, preserving her womb in the process.

Race, hormones and lifestyle: The surge of fibroids among African women

The rising prevalence of fibroids among African women has become a growing health concern, with experts pointing to a complex interplay of genetic, environmental, and lifestyle factors behind the surge. While the condition is known to have a genetic predisposition, new studies are shedding light on modern triggers that may be fueling the increase in cases.

Olowojebutu observed that fibroids appear to have a genetic predisposition, and they are more prevalent in African populations.

A series of studies confirm this disparity. A five-year study in Abuja revealed nearly a quarter of all major gynecological surgeries were due to fibroids, and in Ghana, 36.9 percent of women referred for abdominal scans were diagnosed with the condition.

In Cameroon, the rate among pregnant women was 16.8 percent, while in the United States, 25 percent of African-American women aged 18–30 are diagnosed with fibroids, compared to only 6 percent of their white counterparts. By age 35, the rate rises to 60 percent among African-American women.

Furthermore, fibroids in African women tend to develop faster, grow larger, and are more likely to require surgical intervention than in women of other races. These statistics underscore the importance of understanding both the genetic and environmental factors at play.

A growing body of research suggests that modern risk factors including lifestyle choices and exposure to environmental toxins are contributing significantly to the rise in fibroid cases. Studies point to the frequent consumption of processed foods, red meat, and products containing monosodium glutamate (MSG) as key dietary culprits.

One study noted: “The administration of MSG for a long period of time has been reported to induce uterine fibroid in female Wistar rats,” raising concerns about the everyday ingredients commonly used in African households.

In addition to diet, factors like physical inactivity, emotional stress, and exposure to endocrine-disrupting chemicals in household items, cosmetics, and personal care products further compound the risk. Dr. Ruth Ebe-Emordi, highlighted the role of these environmental and lifestyle exposures in fibroid recurrence.

“A lot of these things have to do with our lifestyle—what we eat, what we apply on our skin, and what we use on our hair. Loads of these things contain hormone disruptors, and they interfere with our hormonal balance,” she explained.

Ebe-Emordi emphasised the risks posed by everyday items like non-stick cookware, plastic containers, and synthetic hair extensions.

“Non-stick pans contain a chemical called Teflon. It’s nicknamed a ‘forever product’ because the body doesn’t excrete it. It stays in the body,” she said.

She also expressed concern about hair relaxers and synthetic extensions: “Most relaxers are toxic to women’s health. A science research has finally been published as facts that even synthetic extensions, hair extensions, have compounds in them that leach into our skin and will cause potential issues.”

Racial disparities in fibroid susceptibility are also significant. Ebe-Emordi was emphatic when asked if it’s a myth that African women are more prone to fibroids: “It’s not a myth. Because there are loads of diseases that different races and different categories of people are more predisposed to. It is not a myth that black women can be a lot more prone to fibroid.”

She attributed this disparity to the lack of tailored products for black women. She stressed the need for African representation in global cosmetology and health regulatory boards to ensure that products cater to the unique physiological needs of black women.

She said: “Loads of the products that we consume as black women were not made for us. We are using face creams; we are using sunscreens that were made for Caucasians. They don’t have melanin like we do.

“I am thankful for a friend of mine who has a skincare brand that stocks only products made by Africans. These are products made by Africans with African women in mind.”

Ebe-Emordi, who is also a mental health advocate and PCOS awareness champion, shared a personal anecdote about a friend who developed symptoms of Polycystic Ovary Syndrome (PCOS) shortly after relocating to Canada.

“She began to grow chin hairs and was later diagnosed with PCOS. When she spoke about it, others shared similar experiences. It turned out the hormone-loaded chicken they were eating was a likely trigger,” she stated.

In light of these findings, Ebe-Emordi called for a shift towards healthier, more informed lifestyles, urging: “We have a wealth of resources, and I hope that every woman takes responsibility. Read labels, research ingredients, ask questions, and have informed conversations with your doctors.”

She also encouraged adopting antioxidant-rich diets, engaging in regular exercise, and embracing traditional African food systems to mitigate the risks of fibroids.

Ultimately, she stressed the need for a cultural shift towards conscious living.

“Pay more attention to what you’re eating and using on your body. It plays a role in your health; and not many people will tell you that if you don’t take responsibility,” she warned.

Need for early detection, holistic response

Medical experts are urging women to be more vigilant about changes in their bodies, especially concerning their reproductive health.

Olowojebutu reinforced the importance of early detection, noting that “women should be alert to the possibility of fibroids if they experience changes in their menstrual cycles. Painful and heavy menstrual flows should also be a red flag.”

He explained that fibroids are not just a reproductive health issue but a barrier to fertility as well.

“Fibroids are one of the leading causes of infertility because they can block the womb, making it challenging for sperm to reach the egg,” he said.

Olowojebutu further emphasised that tackling fibroids goes beyond individual responsibility.

“The government can contribute significantly by making insurance coverage accessible and compulsory. The government should also invest in public awareness and advocacy programmes to encourage early treatment for uterine fibroids,” he said.

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Ebe-Emordi also highlights the broader picture. She draws attention to the role of environmental and lifestyle factors in fibroid recurrence, especially hormone disruptors in daily-use products—ranging from cookware and body creams to hair relaxers and synthetic extensions.

“We need to dissociate our minds that consumption is just what we eat. Consumption is everything that comes into us through our skin, through our nostrils, through our ears. These things play a role, even our mental health,” she warned.

A call to action

With a mix of genetic predisposition and increasing environmental triggers, African women are confronting a silent epidemic. Fibroids are not only causing severe health challenges but are also inflicting emotional and financial strain on millions.

With fibroids now affecting African women earlier and more aggressively than ever before, the health community believes a multi-sectoral approach spanning healthcare, government, industry, and culture—is urgently needed to confront this growing reproductive health crisis.

Health professionals continue to call for increased public awareness, greater access to affordable healthcare, and a cultural shift in how women’s health is perceived. According to them, only through education and systemic support can more women receive the treatment they need before it’s too late.

Stakeholders agree that the way forward must be comprehensive. This includes expanding access to affordable healthcare, implementing policy reforms, and raising public awareness.

“It’s essential for women, particularly in Africa, to be proactive about their health, not only for their appearance but to prevent hormonal complications that fibroids can bring,” Olowojebutu advised.

Environmental reform, public health education, and stricter regulation of food and personal care products are also necessary. Experts recommend a return to traditional African diets, increased physical activity, and a shift toward natural alternatives in daily living to minimise exposure to harmful chemicals.

With a lack of regulation in the herbal medicine industry, experts call for stronger oversight and public awareness to protect women from exploitation. Meanwhile, many victims continue to pay the price both financially and with their health, learning too late that what seems like an easy fix can be the deadliest deception of all.