FIBRIOD: WOMEN BARRIER TO PREGNANCY

BRIEF DISCRIPTION OF FIBRIOD AND HOW IT DEVELOPS:

Fibroid is an abnormal growth of muscular tissue of the uterus. It is a benign tumor of the uterus. It is a benign tumor of the uterus and the cervix which may become cancerous with time. Fibroid is called with different names in the medical practice depending on the tissue involved in the growth or formation. It is called as fibroma when the growth or tumor is composed chiefly of connective tissues, while it is called myoma when the growth is composed of muscle element. Its other names are fibromyoma, Leiomyoma.

Fibroid are the commonest abnormal growths of the uterus and is one of the most common tumour of the women. The disease is more common in black women. In fact it occurs three times more frequently in black women than white women, and occurs at an earlier age. The reason for this is not known. In the Africa, countries like Nigeria as statistics collated from hospital shows, over 400,000 Nigerian women are affected and fibroid has been a major cause of infertility and the various pregnancy related deaths in Nigerian women.

Fibroids usually arise in the muscular wall of the uterus and vary in size from minute seedling growths to large masses which occupy nearly the whole abdomen. They are often multiple. At the onset, they lye in the substance of the uterine wall. They arise far more often in the body of the uterus (the womb) than in the cervix, and can remain exclusively within the muscle (the myometrium) of the womb for as long as 5 to 10 years growing silently and progressively and can project to other parts of the uterus (womb) more especially to the mucous membrane (the endometrium) which lines the uterus where it distort the normal shape of the inner cavity of the womb and disturbs pregnancy. However, it may project to the outside lining of the uterus and become stalked (pedunculated) in the abdomen. Such growth (fibroid) into the abdomen may be so big in the abdomen that it may be mistaken for normal pregnancy. Many women have carried such fibroid for many years regarding it as pregnancy.

Few cases (two per cent) of fibroid arise in the cervix. These are called cervical fibroids. They are usually single, although there may be other tumour growth in the body of the uterus. They cause distortion and elongation of the cervical canal and displace the body of the uterus (womb) upwards. A large cervical fibroid may cause complete obstruction and blockage of the cervix.

Fibroids are composed of smooth and fibrous tissue. They grow slowly; in some cases there may be no evident change in size for many years. In few cases growth is more rapid and secondary changes may cause swelling of the tumour.

FACTORS CAUSING FIBROID:

ACTIONS OF OESTROGEN: Clinical evidence suggests that the development of fibroid is related to the action of oestrogen, hormone produced by the ovary. Fibroids arise during the periods of menstrual activity. They do not originate as a new formation once menstruation has ceased.

NON-UTILIZED AND UNDER UTILIZED UTERUS: The disease fibroid is commonest in women that has never given birth to any child (nulliparous women) and in women who have not been pregnant for some time (under-utilized uterus) as in sexually active women who are barren, infertile or not getting pregnant easily i.e. women who have not been pregnant for some time and are in the productive age.

EFFECTS OF CONTRACEPTIVE PILLS: contraceptive pills are oestrogenic and fibroid occurs more in women that are on oestrogenic pills.

SIGNS AND SYMTOMS OF FIBROID

·        INCREASED ABDOMEN (ABDOMINAL TUMOURS): This is sometimes the first thing that the victims of fibroid notice. The increased abdomen is so hard that it often attracts attention. The tumour is not tender (unless complicated) and rarely gives rise to pain, but occasionally causes local discomfort and a feeling of weight.

·        EXCESS MENSTRUAL FLOW MENORRHAGIA): This occurs as a result of the distortion and elongation of the uterine cavity. A woman with fibroid can bleed heavily during her menstruation for days. Some women become anaemic- and faint as a result of heavy bleeding. Excessive menstrual flow is common sign that makes victims top seek advice or help. The menstrual periods increase in amount and duration, they may be accompanied by the passage of clots.

·        MULTIPLE MENSTRUTION IN ONE MONTH: This can occur and is common with fibroid.

·        FREQUENT URINATING: The pressure exerted by fibroid may affect bladder function. If the uterus is enlarged by fibroid and lies on the fundus of the bladder there may be frequent micturition particularly on standing.

·        RETENTION OF URINE AND DIFFICULTY IN MICTURITION: when the pressure exerted by fibroids, especially cervical fibroid displaces the neck of the bladder upwards and elongate the urethra or when pressure exerted by fibroids on the posterior wall of the uterus push the cervix and body of the uterus upwards and forwards, difficulty in micturition and retention of urine results. This may be of gradual onset or sudden onset. Retention may occur at onset of a menstrual period, caused by slight engorgement of the pelvic structures; after establishment of the menstrual flow the retention may disappear, to return again with the succeeding period.

·        CONSTIPATION, HAEMORRHOIDS AND VARICOSE VEINS (SWOLLEN AND KNOTTED VEINS: this may occasionally occur, especially if the tumour (fibroid) remain confined to the pelvis, and with very large tumours, gastro-intestinal symptoms such as abdominal discomfort, etc. can arise.

·        PAIN: this is not a common symptom of fibroid. But it occurs when the tumour is infected and when there is pelvic inflammatory disease or some complications of the tumour.

·        ENLARGEMENT OF THE UTERUS: fibroid enlargement of the uterus is harder and generally more irregular than the pregnant uterus, which is soft and elastic and contracts from time to time.

·        OTHER SIGNS: There will be no stoppage of the menstrual discharge/flow. No sign of baby kick that occurs in normal pregnancy.

EFFECTS OF FIBROID ON PREGNANCY, CHILD BEARING

·        Miscarriage

·        Increased risk of abortion. Large and Multiple fibroids tend to cause abortion.

·        Bleeding from threatened abortion. This may be mistakenly attributed to the menstrual bleeding if the signs of pregnancy are obscured or masked. Many women nearly bleed to death every month from threatening abortion caused by fibroid.

·        The signs of pregnancy are sometimes masked.

·        Confusion may arise about expected date of delivery because the uterus is larger than expected for the period of the menstrual discharge.

·        Pain during pregnancy.

·        Pre-mature labour: A pregnant fibroid woman may go into labour before her term because of over distension of the uterus by the tumour.

·        Malposition and malpresentation of the child to be delivered: Cervical fibroid prevents the head of the baby from engaging and may equally cause abnormal presentation of the baby.

·        Obstruction and complication of labour. Labour may be obstructed in a pregnant fibroid or due to poor contraction of the uterus caused by the presence of fibroid in the uterus. This complicates labour.

·        Excessive bleeding after childbirth (postpartum haemorrhage). These has killed so many women. This cases occurs particularly if the placental attachment is over the tumour.

·        Pain after delivery: fibroid may cause pain after child delivery.

·        Sterility: Fibroids commonly causes sterility in women and it is the major cause of sterility in black women.

·        Pregnancy may result in increased growth of an existing fibroid. After the menopause the tumour cease to grow, and many of the fibroid atrophy, sometimes becoming calcified.

·              FIBROID PREVENTION        Avoid the abuse of contraceptives. Contraceptive pills should be chosen on your doctor's advice or on the advice of family planning experts. Contraceptive gives addition oestrogen to your system which apart from the possibility of causing fibroid also put the women at a higher risk of getting breast cancer.

·        Avoid delay of pregnancy for too long a period during the reproductive age.

·        Stay clear of veneral diseases.

·        Avoid frequent and excessive D&C.

·        Prevent menstrual abnormalities.

·        Treat your menstrual abnormalities if any.