By Sola Ogundipe

Nigerian women living with fibroids have been advised to consult qualified fertility experts before opting for surgical removal.

A fertility expert, Dr. Abayomi Ajayi, who gave the advice, said that not all fibroids need to be treated or removed and that surgery is no longer the best approach to managing fibroids.

Ajayi, who is Medical Director, Nordica Fertility Centre, Lagos, said a technological advancement known as High Intensity Focused Ultrasound (HIFU),  a non-surgical procedure, had made the need for surgical removal of fibroids obsolete.

His words: “Fibroids are the commonest reason why women have surgery in their pelvis. About 50–70 percent of women will have fibroids before they are 50 years old, and quite a number of them, because of their age group, would still want to have children, so it is very important to try to manage this common condition.

“Fibroids can be tackled non-surgically, surgically, and with drugs. The way fibroids present most of the time is to affect the quality of life, and they cause many women not to function at their best.”

According to Ajayi, some women with fibroids have infertility, some bleed all the time, and some are probably unable to consummate their marriage because they just do not have the confidence in themselves and have been stigmatised.

“It is not all fibroids that can be treated; some we apply what is called watchful waiting; for others we continue to monitor to see how the fibroid is doing, especially in the age group of people who are near menopause.” The woman is often probably just worried that there is a mass in her abdomen, and as such, there is no need to rush to surgery for such a woman.

“I keep saying that for any woman who has a fibroid, you need to look at some factors. How old is the woman? Does she still want to have children?

“Does she have symptoms at all? Where exactly are these fibroids? It’s when you have answered these four questions that you can now say, Okay, this is the best way to treat these fibroids.

“We have some non-surgical methods of treating fibroids, one of which is, um, embolization, uterine atrial embolization, and of course there is HIFU.

“The problem, the only thing you try, is that, actually, embolization is a very good method of treating fibroids without surgery. The only question mark is, for people who still want to have children, is it an ideal method? That is, I think the jury is still out on that, but HIFU does not have that issue; HIFU does not affect your ovarian reserve in any way, and that’s why we are talking more about HIFU.”

Ajayi noted that the only HIFU machine in Nigeria that is in the Nordica Fibroid Clinic in Lagos has done over 400 successful fibroid removals, and that Nordica was taking delivery of the second machine in Abuja.

“For women who undergo surgery, he explained that sometimes there’s scar tissue that results from this surgery.

“So they could have scars inside the womb, and therefore these might prevent them from getting pregnant to have their own children like they wanted to do, and now they can’t because of the surgery that they’ve had.

“In our own experience, we saw over 20 percent of patients who have fibroids and also have adenomyosis. And I just read a paper recently that says that in America, up to about 87 percent of people who have fibroids also have endometriosis.

“Sometimes, people may think that it’s the fibroids that are making them not have children, when actually it is endometriosis. Sometimes they go together, that is, adenomyosis, endometriosis, and fibroids.

For this kind of person, a myomectomy might not be the solution.”

He said that after many surgeries, some women say they have a recurrence.

“This is because sometimes they also have adenomyosis with the fibroid, and the doctor could not remove the adenomyosis.

And even when trying to remove the adenomyosis, it might actually deform the uterus in such a way that it might not be able to support a pregnancy anymore.

“Now that we know that it is not very fibroid that must be removed, for a long time, we have been treating fibroids, but I think it’s high time we started treating the people who have the fibroids.

“My take is that when a woman has fibroids, you must go through her history, know what her aspirations are, examine her, do a scan, and look at what the fibroids really are before you can now say what the best way is or the options available for treating your fibroids. Not just every fibroid must undergo a myomectomy,” he insisted.