Fibroid is one of the most dreaded health conditions for women all over the world, especially in Nigeria. This is because of the many unpleasant experiences women have had trying to deal with the condition in this part of the world. In the far past, there used to be a belief that only married women have fibroids but a visit to the Fibroids Care Center in Lagos revealed that there are so many young and unmarried women with fibroids that are as big as 9-months old pregnancy.
From time immemorial, women have continued to dread treating fibroids with surgery because of the many post-surgery effects on the patient. A good number of women are managing their health because of fibroids but they are afraid to seek medical attention because of their fear of being put under the knife.
Last week, City People’s Brands Editor, DAMILARE SALAMI 08155134152 had an interview with Dr Abayomi Ajayi, the CEO of Fibroids Care Center in Lagos and in this chat, he revealed the dangers inherent in treating fibroids with surgery as well as other easier options available for women to treat it. Below are excerpts from the interview, enjoy.
To start with Dr, can you tell us what the relationship between fibroids and infertility is, it is usually believed that once a woman has fibroids, she will automatically have problems with childbearing.
Thank you, I hear that a lot but the first thing to say is that fibroids and infertility don’t have a causal effect relationship. What I mean is that it is not sacrosanct that the moment you have fibroids, you must have infertility but they have an association. People who have infertility are more likely to have fibroids and people who have fibroids are more likely to have infertility but why this is so might be completely difficult to ascertain. There was a study that was done many years ago at the UCH which showed that people who have fibroids have more pelvic additions but it was still an association and not a causal effect. But one thing we know is that when people who have fibroids get pregnant, the likelihood of miscarriage is higher especially when the fibroids is sub mucus. We also know that intramural fibroids can also undergo what we call red generation which also can increase the risk of miscarriage. We also know that when you have fibroids especially when it is around the cervix, it could increase your likelihood of having a cesarean section and when you deliver, it could increase the chances of you having postpartum haemorrhage; so these are some of the things that fibroids can do. We also know that fibroids can have effects on the results of IVF especially for those who have the sub mucus fibroids, the success rate of IVF is lower in them because there are always problems with implantation. We have agreed that if you have the Intramural fibroids or the Subserosal fibroids that are not more than about 6cm and you want to do IVF, you can leave them alone except when you observe that it may disturb you when you want to do OPU then that’s the only time that you may want to remove it. There are still a lot of things that we still don’t know about fibroids but the ones that we know are the things that I’ve told you about. One thing that we also see again is that sometimes when we treat fibroids with surgery, we do the patients more harm than good. I am talking in regards to fertility because some of them especially the submucous fibroids that we have to cut off, form scars that prevent implantation so they end up with what we call asherman syndrome. Even in the normal pregnancy process, these can also prevent the woman from getting pregnant. Some patients after fibroids surgery will stop menstruating and then another challenge begins again because she has exchanged fibroids for ashermans.
You mentioned earlier that you now deal with young unmarried women with large fibroids which was not the case many years back. What is the implication of this right now?
Well, I have come across a number of them both young and old and especially women who are not married and some of them are in their 40s who have fibroids and are not doing anything about it. What this is bringing to my attention is the ordeal of many people with their health. They are probably afraid of doing surgery because of some of the bad press that the surgeries from fibroids have raised. I must say this that it is not only in Nigeria, fibroid surgery anywhere in the world has issues and that’s why I went all out for this HIFU; having been a doctor now for a few years, and over the years I have seen this that sometimes when you do some fibroid surgeries, you don’t sleep very well for the first night because you are praying and hoping that everything goes well; you know our women can have very big fibroids sometimes. Anywhere in the world, some things can go wrong with that surgery and because of this, many people are afraid of having fibroid surgeries not to talk of the risk of anaesthesia. These are some of the complications that can happen all over the world, not just only in Nigeria. The only advantage is that some places are more equipped to deal with the mishaps of post fibroids surgeries than other places. That probably is the reason many women are afraid of doing surgery which also makes many women who have now realized that they don’t have to do surgery to come forward. Because like every new technology, there will be early adopters while some will still be sceptical about it. And we are happy to say those female doctors are among the early adopters, maybe because they know more about the surgery but they are happy and eager to want to know about this thing that doesn’t require surgery.
A lot of women are eager to know more about HIFU having launched it around July 2021. Between then and now, what is the success rate of this new technology that treats fibroids without surgery?
Thank you Damilare, nice question but very difficult too to answer because the success rate for every patient differs but what I will say is that we’ve satisfied almost all our patients. We’ve 64 patients because we had a break at the end of the year but I can assure you that before the end of January, we would have treated about 80. All the 64 patients have been happy with what we did because what we do is to look at the quality of life. Some came for fertility treatment but we also had to deal with their fibroids and we make them know that treating their fibroids doesn’t cure infertility and that they might need to take treatment for infertility but we have to make their uterus good enough to take the fertility treatment. The second group of people is people whose fibroids have affected their quality of life. And by this we mean women that are bleeding heavily because of fibroids. They are losing blood every month as if someone is being sluttered; for these ones, their relief is immediate because this is what the machine can do. We have a form on the quality of life for all our patients and this helped us to know how well that aspect has been improved after treatment. So success rate so far has been very good. One more thing we are trying to do is to close the gap between those treating infertility after fibroids because we observed that a lot of women treating fibroids are quite old and might be needing IVF so we have to make their uterus ready and just shortly after treating fibroids, we get them prepared for fertility.
What is the best treatment you can recommend for women living with fibroids?
In this case, there is nothing like the best treatment for anybody, what is there to do is look at your options and ask yourself what you think you need to do. What we doctors do when it comes to how to treat fibroids is that we take four things into consideration in making recommendations for patients. Before now, the only option available was surgery and when you say you have fibroids, the next thing was to cut you open but not in 2022, nobody should do that anymore. The first thing you must look at is the age of the patient, the symptoms she has, does the patient still want to have children and where exactly is the fibroid. These four things will determine the kind of methods that you can apply in treating her fibroid. For example, if a woman is 45 years old and she doesn’t want to have children anymore, the fibroid is sub mucus and her symptoms mainly are that she bleeds heavily, any doctor that says let me go and remove the fibroids as the only method in 2022 is no longer a good doctor because there are other options that are less invasive and will yield the same results. There is usually nothing like best anymore. Therapy for fibroids should be tailor-made for the patients looking at all the possible options. It could be hysteroscopic myomectomy, HIFU or embolization and so many other options now and that is what we are saying to patients now that they should understand that they have options now; rather than just the usual one-way traffic. If the woman is near menopause, you could start with the injectables and then push her into menopause and she stops bleeding. There’s nothing like best anymore, there are now options but you can look at the best option for her.
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