Nowadays, women with fibroid drink all sorts of herbal concoction just to avoid surgery, however, the Chief Consultant Obstetrician, Gynaecologist/ Reproductive Medicine at the National Hospital, Abuja, Dr Chris Agboghoroma, in this interview with Health Reporter, MARCUS FATUNMOLE, says herbal medicine does not remove fibroid. He also speaks on the prevalence, causes, prevention and management of fibroid. Excerpts:
How would you describe fibroid as a disease?
Fibroid is an abnormal growth that could occur on the uterus. That is why we call it uterine fibroid. Uterine fibroid is a form of benign growth. When we say it is benign, it means it is not malignant; that is, it does not spread to other parts of the body and should normally not kill. That is why we call it benign and it grows on the uterus of the womb. The size of a fibroid can vary from a small noddle to as big as a football. It is very common in this part of the world, especially among the blacks than the whites. In fact, it is said that if you view the womb of every woman, you will find that fibroid is present in up to 40 percent of them. But, the good thing about fibroid is that it does not cause problem to many people that carry it. It is symptomless. In fact, many fibroids are diagnosed or they are found accidentally when a woman is being investigated for other complaints or purposes.
A woman comes, complains of not being able to get pregnant and she decides to do the various tests. One of the tests taken could be a scan where you could find fibroid. You might decide to take the woman to the theatre for an operation for some other conditions of the pelvis. You open the womb and you find that the woman has fibroid. So, fibroid, to a large extent, could be symptomless. But, there are other fibroids that can cause symptoms. The symptoms that could manifest from fibroid vary from pain, pressure, excessively bleeding. The woman could come down with not being able to get pregnant. These are the common symptoms that people present with when they have fibroid. What causes fibroid? The truth is that up till now, we still don’t know the exact cause of fibroid. Why is fibroid more common among black than white? We are still are not very sure why this is so. But, the only thing we can tell is that fibroid tends to be commoner in women who are still within the reproductive age group; that is from the age around 15 to the age of about 45. That is the time you could get fibroid commonly. For a woman who does not have fibroid up till the age of 45 to develop a new fibroid is not common.
By the time you see a woman who is 50 years not having any symptoms of fibroid; she is not likely to develop any other one again, except if there are complications that she has which are not fibroid-related. So, we believe that fibroid could have something to do with hormone, especially the oestrogen, the hormones that are secreted in the ovaries of a woman. The hormone could be a factor why some women develop fibroid. There are other theories that have been advanced by different authors as to the possible cause of fibroid. But, like I said, nobody knows the complete cause of fibroid.
How can we manage fibroid?
Fibroid is without symptoms. If you come across fibroid that does not give any problem to the woman, what to do is to leave it alone. Most women that carry fibroid, the treatment is ‘do nothing, just watch’ and follow up on the woman. For example, if you see a woman at the clinic today and you find out that she has fibroid, you will not rush her to the theatre to be operated upon and remove the fibroid, especially if the fibroid is not causing any symptom. You will say, ‘ok, let me observe you; let me see you in three months’ time. Three months’ time, she comes again and the fibroid is not causing any problem. You tell her come back in about six months and you continue to give such a woman some form of follow-up visits. But, there are some fibroids that cause pain, heavy bleeding.
If you see some women, they bleed so heavily because of fibroid; you may want to admit them and give them blood transfusion and possibly undergo the surgery for them as soon as possible. That is the real problem. The issue now is how do you manage a woman with fibroid? Like I said, the first one is: do nothing for those that have symptomless fibroid, the second one is use some drugs; there are injectable drugs that a woman can be given which can help to shrink the fibroid. But, the problem with such injection is that after the fibroid has been shrunk for some time, you stop the injection, the fibroid can grow again. This is one of the limitations on the use of the drugs. There are other drugs that are used that don’t have such limitation. But, by and large, you find that the drug treatment is not as efficient as we expect. So, many people rely on surgery; that is the operation. The commonest surgery we do is referred to as myomectomy. Myomectomy means cutting into the line of the uterus and removing the fibroid.
Apart from myomectomy, the other method we can use is to remove the womb. If the womb is there, the fibroid will grow on the womb. So, if you go and remove the womb, you will remove the fibroid and the womb together. In fact, that is the only real cure for fibroid. If you use myomectomy, the fibroid can grow back. But, if you remove the womb and the fibroid together, there will be no womb for the fibroid to grow on; you have cured the woman. So, when we talk about cure for fibroid, you are talking about the use of hysterectomy. Hysterectomy means removing the womb; and by removing the womb, you also remove the fibroid. There are other new methods of treating fibroid. We call them imaging technique, radiology imaging techniques. There are different types of imaging techniques that could be used to treat the fibroid. But, those ones are unfortunately not available in this part of the world. We only talk about them, we do not have them. Is it possible for a woman whose womb is removed to be pregnant again?
If you have removed the womb, the woman cannot deliver a baby again. But, that does not mean that the woman cannot have a baby.
She cannot deliver a baby because the womb is not there to carry a baby. For a woman to deliver a baby, she needs to carry the baby and deliver it. The baby needs to grow within the womb for the woman to deliver it. But, when we remove the womb, we don’t remove the ovaries. Since the ovaries are there, it is possible through advances in reproductive medicines to go and collect the ovaries of that woman, mix it with the sperm of her husband in what we refer to as IVF, then transfer the growing embryo into the womb of another woman. And, by so doing, that woman now become the surrogate mother of the child.
Is surrogate motherhood practised in Nigeria?
When you talk about ‘being practised’ in Nigeria, yes, we now have IVF which is assisted conception unit in this country that has done a lot.
What surrogate mother does is for another woman to stand in to carry your child for you. Yes, it is being practised even though we don’t have law yet that regulates it. Sometimes last year, there was this proposed bill by a member of the House of Representatives to introduce, in form of a framework on assisted reproductive technique. But, unfortunately, the bill did not scale through because it was made in such a way that the Medical and Dental Council should set up guidelines and regulations on how IVF should be practised. But in some advanced countries, there are specific agencies that government has that actually regulate this practise as to what the expectations are from the people who are contracting the surrogate mother and for those who have accepted to carry the baby. So, there are laws that regulate the practice. But, in this country for now, we don’t have laws that do that. Many people who practice it do it without any real regulation.
Could fibroid be genetic?
I think there is a possibility that fibroid has some elements of genetics in it because it is found that it tends to run in families. When you see a woman with fibroid, if you look closely, the children are likely to have fibroid. And, if you see fibroid in a family and you look closely at other members of the family, there is high chance of fibroid being found in women in the family.
As a result of this, we assume there are some genetic bases to fibroid, even though the actual gene that is responsible for carrying fibroid from one generation to the other is not yet fully recognized.
What is your opinion on the use of traditional means to treat fibroid?
I do not believe that applying leaves on the abdomen just because you have fibroid and you want the fibroid to be cured. I don’t see that as medicinal. I see it as not effective, I will not recommend it, I will not uphold it and I will not believe it works; except if they think it is magical in practice. I don’t believe in it, I have never recommended it and I have never seen anybody who tells me that by giving a herb treatment or putting leaves on somebody’s tummy or through drink that the person’s fibroid was dissolved. I have never seen that. I have no real evidence to prove that. At least, among the ones I manage, I have never seen one say she used herbs for her fibroid and she was cured. So, I do not believe in traditional medicine in respect to tumour. Fibroid is a tumour; that is abnormal growth, though it is benign.
Are there any associated diseases to fibroid?
There are none. Fibroid is just a growth. If somebody has fibroid and you remove the fibroid, you have cured the person, especially if you do a hysterectomy for her.
By: Marcus Fatunmole
National Mirror News
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