Senior lecturer/Hon. Consultant, Obstetrician and Gynaecologist at the Lagos State University Teaching Hospital, Lagos, Dr A. A. Adewunmi, speaks on fibroid as black woman’s ailment, taking time to debunk the myths around it, treatments and more.
Is it true that all women are susceptible to fibroids?
Not all women are susceptible to fibroid, but majority of the women are susceptible to fibroids- particularly women of the black race. For instance, it is more prominent in black women than white women; and when we talk of prominence, we’re talking about between 7 to 8 out of every 10 women.
Are there chances that a man can have fibroid?
There is no way a man can have fibroids, because men do not have uterus.
What are the basic causes of fibroids?
Well the truth is that some people may have fibroids and may not even know. So in this case, we’re talking of those for whom it has becomes troublesome or begun to give symptoms of science. For some patients, you just stumble on it when they come to the hospital for a different reason – maybe infertility problems and we asked them to do a scan. But for now, nobody can say, ‘This is what causes fibroid’ – just like cancer. It is an abnormal growth or tumour in the womb of a woman – just that it is not a malignant tumour. Having said that, very few can become malignant – say 0.01 per cent or 1 in 100,000 cases. So nobody is definitively sure of what causes cancer, except that it is prominent in black women. It is prominent in women who marry late and in women, who delay child-bearing. Now, if we say it is more common in women, who delay child-bearing, the next question should naturally be, ‘Why should it be so?’
This is because the womb is supposed to be carrying a baby, and if the womb or uterus is not carrying a baby, something else would grow there. That’s why it is usually said that ‘bad girls have babies, while the good girls have fibroids’ – the good girls are keeping their body because they’re not yet married, so that place is left empty. But at the end of the day, when such women eventually get married say, maybe at 35 as a virgin, they may discover that they already have fibroids.
I know of a woman, who complains that the reason for her own fibroids is because she hasn’t been having sex. Her husband has been away in Europe for almost two decades, and she swears that she hasn’t slept with any other man since then?
It has nothing to do with not having sex. The only correlation may be because she hasn’t been having sex and as such has not been pregnant for a long time; hence the place (womb/uterus) has been left empty for a long time and therefore the growth of the fibroids in it. Like in the good girl illustration, if you’re not having sex, then you cannot get pregnant. And nature abhors vacuum; hence the growth of the fibroids. If a womb is not carrying a baby, then definitely, something else would grow there. To link it up a little more, if that woman has been having sex, there is a possibility that she may have gotten, even if she ends up terminating it.
How about those who started having babies early and eventually go for family planning; aren’t they making themselves susceptible as well?
For those who have babies early and stop due to family planning methods, the possibility of having fibroids is not ruled out. But it’s not likely to give them problems. The reason is because by the time you decide to stop having children, more of the time, the woman is probably close or not too far from menopause; and because we know that fibroids only grow in women who menstruates, chances are that the fibroids may not have enough opportunity to grow and become troublesome to such women. So it is very rare for somebody to develop fibroid simply because she did family planning or stopped having babies; except if that person started having babies as a teenager and stopped maybe at 25.
What is the mortality rate of fibroid surgery cases today, compared to say, 20 years ago? A lot of the women who are afraid of going under the knife are so scared because of some fatality cases they know or have heard of years back.
Mortality rate resulting from fibroid surgery is not something you can put a figure to because by the time most of these women get to competent hospitals, they would have sought help in wrong places. For instance, a woman has fibroids and is bleeding, but rather than go to a hospital, she goes to an herbalist, who gives her something to drink, something to rub and something to insert. And most times, the things they’re given to insert are usually things that may result in burnt tissues there; and when it burns off, by the time that place starts to heal, it’s going to heal the scar tissue. Even the opening where menses would pass may even be blocked in the process; but meanwhile, she would have started passing out some blood clot, and the herbalist would tell her that it is the fibroid that is coming out. Now that’s one aspect.
Another aspect is: you have fibroids and you’re going to a general practitioner, who is not a specialist. It’s not just enough for you to know how to cut. You may be operating and discover that the woman starts bleeding uncontrollably; if such doctor has not been trained in the act of operating fibroids well, that may be end of story for the patient. And that’s because at that stage, the doctor may not know what to do next. And that is the major group of people that die. However, if you come to a facility like LASUTH (Lagos State University Teaching Hospital) to operate on your fibroids, I’m not saying patients cannot die, but the percentage is so small – maybe one or two in a hundred. Usually when we want to operate on a woman, especially cases that are already complicated, we have something we call double consent, in which the patient signs that she wants her fibroids removed; she also signs a consent that in case during the procedure, bleeding becomes uncontrollable, her womb should be removed, for her to stay alive. Once you give us that consent, you make things easy for us; but that’s the aspect that actually drives people away from us. You hear such women go about saying, ‘They said I should sign that they should remove my womb, so that I’ll not be able to have a child again.’ But that is wrong. Your womb can be removed and you may still have a baby because your ovaries are still intact and you can have babies through surrogacy. The baby would still be yours, just that somebody else would be carrying the pregnancy for you – so what’s the big deal! People need to be enlightened that it is better for them to do the operation at a competent place and stay alive, than die because they’re scared and running away from certain conditions. My niece had fibroids surgery in Abuja about eight years ago before marriage; she got married about three years ago and it came back. Now that’s one of the peculiarities of fibroids in the black race, compared to the whites. So she needed a repeat surgery, but I insisted that if she was going to have a repeat surgery, it had to be at the National Hospital, Abuja, because that is the only place I could vouch for, except if she was going to come down to Lagos. So on that second occasion, they ended up removing one hundred pieces of fibroids; and within a few hours after she came out of the theatre, they noticed that she was bleeding; but because she had already consented to the second surgery, she was taken back to the theatre, and the uterus was taken out. If she hadn’t gone to such a competent hospital, the chances of her surviving would have been nil.
What are the factors that can cause it to grow again?
Because the underlying factors causing it are unknown, nobody really knows what to do to prevent it. If the woman has been lucky to have had children, then she may even take the decision to remove the womb, because really, that is the definitive treatment for fibroids. Removing the pieces is like a temporary treatment. To answer your question, if I’m to compare the mortality rate of fibroids surgery 20 years ago and today, there is a lot of difference – because there is improvement in technology; there is improvement in drugs, there’s improvement in anaesthetic techniques; everything has changed. Some fibroids can even be operated without opening up the patients, through what we call a key-hole surgery or minimally invasive surgery. In such cases, the woman goes into the theatre in the morning, and by the end of the day, she’s home with her family.
Are there drugs that can help?
There are drugs to stop the bleeding if the woman is not ready for surgery, and even stop the fibroids from growing. The only thing is that you cannot use some of those drugs for more than six months, because of the terrible side effects they have.
On point of discovery, are there drugs that can be used that can actually suppress its growth on a permanent basis?
No. It may just be suppressed on a temporary basis. Once you stop the drug, there would be a rebound.
A local herb seller claimed that it is a condition that they handle routinely and that all the patient needs do is come to them and use their herbs for a certain period of time and follow their instruction? What do you say to this?
I’ve told you already that that’s where we get most of our terrible cases. They would claim anything, and unfortunately, you journalists (he probably meant media here) are not helping us in making things better, when it comes to the health behaviour of our people. We have promoted the traditional herbalists to high heavens. I don’t understand how certain people in the name of trado-medical practitioners can buy air-time on the TV for a whole one hour, because journalists want to make money. And then he now starts telling the world that one particular drug will treat HIV, treat fibroid, treat abdominal pains. By the time I watch such programmes; it hurts me and hurts my conscience, because the question you now ask yourself is: ‘Is a journalist only after the money this man is going to pay to the television station?
Well that has to do with the business angle of the media house and is beyond the journalists working there. The owner of the media may not even be a journalist….
Let me tell you, there must be ethics that guides every profession, and the moment you throw ethics away, then integrity is not there anymore. I operate fibroids on a weekly basis here and if I tell you what I see…. A lot of cases are so hopeless, because the women have gone round and round. Some have even lost their marriage because they can no longer have sex; hence the pleasure of marriage is no longer there. I mean, when you insert a corrosive into her vagina that would burn it off, chances are that the penis may not even be able to go into the woman up to half way, and so the man abandons the woman. I have seen several cases like that, not ten, not twenty! So what are we talking about? And they keep going back, and going back. Unfortunately, these are things they cannot prove scientifically! We as Africans have to throw away sentiments and face the reality of life. It is failure to do this that is stopping us from moving forward as a people.
You’re saying claims by alternative medicine practitioners are false?
Yes. Somebody cannot have a tumour and then you turn around and say he should just rub something and it would disappear. Most times, what they see and claim to be fibroids coming out of the women’s private parts are clotted blood. I’ve been practising medicine for over thirty years, so I should be able to tell you certain things categorically.