When Rose Wharton (not her real name) went to the Queen Elizabeth Hospital to have surgery for fibroids, she was amazed at the scores of black women who were there being treated for this silent epidemic.
While every woman’s name was different, they each had similar complaints, the bloated stomachs, sometimes making the women seem as though they were at least six months pregnant. Then there were the bouts of irregular and prolonged menstrual cycles, with bleeding that left some of them severely anaemic. In some cases, women complained of pelvic pressure and pain, but for many of them it was the extensive bleeding that drove them to take medical action.
Scientists are unclear as to why fibroids seem to affect black women at earlier ages and are more problematic in black women than white women, but their growth is dependent on oestrogen production.
Fibroids are tumours that develop from the smooth muscle of the uterus. They can be multiple or exist as a single large growth. They can be located on the surface of the uterus, in the wall of the uterus or in the uterine cavity.
If these tumours are left untreated, they can increase in size, cause heavy and painful periods, urinary frequency and painful sexual intercourse and can even hinder pregnancy. In some cases, the prevalence of fibroids can lead to a hysterectomy.
“We just know there is higher incidence of fibroids in dark races, but you see it in both races,” says local gynaecologist Dr Shirley Jhagroo. “It’s very common in Africa and India, and less common in Chinese and European women.”
While Jhagroo says that the incidence of fibroids has not increased, the awareness of them and the symptoms have.
“People are more aware now and they’re going for annual check-ups now, so fibroids would be found more,” Jhagroo said.
Rose’s bout with heavy periods became so problematic that she couldn’t risk going to work when her cycle was on, because the bleeding was so heavy that sanitary napkins couldn’t contain it. It was when she started feeling lethargic and could hardly move that she sought medical attention.
“When I saw the doctor, my Hb [a measure of haemoglobin concentration] was down to five,” she said. “He asked me how I got there because I could have easily passed out. They had to give me iron tablets to build up my blood, along with a change in diet to help increase my haemoglobin so that I could have surgery.”
Treatment options
The good news for women is that many more options are available than the standard hysterectomy.
“People in their late 40s who are perimenopausal but are having symptoms from the fibroids, mostly bleeding, can use uterine artery embolization, where you inject [small particles] into the uterine artery and cut off the blood supply to the fibroids, but you would only use it at that age,” Jhagroo said. “The disadvantage is that it can’t be done in younger people because new fibroids will grow.
“We can also use a laparoscope where you crush the fibroids through the laparoscope and remove them. With that type of surgery, the hospital stay is only a day and blood loss and recovery is a lot less.
“For people with heavy periods who don’t want more children, then you have endometrial ablation and it’s done from the vagina and you ablate the uterine cavity and the two walls close up. People might have little or no period again.”
These are among the other options for treating fibroids:
• Birth control pills, which can help to regulate the menstrual cycle, control heavy bleeding and alleviate some of the pain and pressure.
• Lupron, a type of hormone, which may aid in shrinking the fibroid and stopping bleeding.
• Focused ultrasound surgery, which uses MRI-guided high-energy sound waves to target and destroy the fibroids.
• Uterine artery embolization, a procedure that destroys the blood supply to the fibroids, causing the fibroids to shrink.
• Myomectomy, a surgical procedure to remove the fibroids and leave the uterus intact.
• Hysterectomy, the removal of the entire uterus and the fibroids contained in it.
