NUTRITION:
An 18-year-old girl (pseudonym) was an unmarried college student. In the past year, she began to have menstrual disorder in which amount of menstruation increased.
She was very weak and pale due to excessive blood loss. Moreover, her mother found that her abdomen was gradually swelling, and the family was very upset, so they referred the case to Mnazi Mmoja Hospital for emergency treatment.
In another development, a 34-year old woman had been in the marriage lock for 10 years. Her husband had gone out for work last year, but recently her mother-in-law found that her belly had grown. She told her husband, who rushed home to question her.
In the face of the gossips among her friends, her mother-in-law’s being difficult, and her husband’s distrust, she was extremely wronged and overwhelmed by rumors and she could not take it all.
Under the advice of a friend who was a doctor, she went to Mnazimmoja Hospital for medical checkup.
After examinations, the above two patients were found to have uterine fibroids, a common benign disease of Zanzibari women. Fortunately, both ladies’ uteruses were preserved while over 20 fibroids of different sizes were removed.
At the explanation of the doctors, her husband finally knew and regretted his misunderstanding of his wife. The surgery brought them back together. He took good care of his wife after the operation and her pregnancy has been smooth.
What is uterine fibroid?
Uterine fibroids are the most common benign tumors of the female uterus. It occurs in women of childbearing age between 30 and 50 years old. About 1/5 of the women are detected to have uterine fibroids after a physical examination.
Most of these women are asymptomatic, but have one or more small protrusions on the uterus. These are as common as acne on our face, and will not cause any danger to our health.
We don’t need to be too nervous. However, these fibroids have a risk of growing up before women’s menopause, so the most important thing is to check them regularly every year.
According to the growth site of fibroids, it is divided into uterine fibroids, cervical fibroids, and sometimes broad ligament fibroids. As for the relationship between fibroids and uterine muscle walls, they are divided into subserosal fibroids, interidional fibroids and submucosal fibroids.
When the volume of subserous fibroids is large, they can be easily felt by hand from the abdomen, which generally does not affect the menstrual cycle; if intermuscular fibroids grow close to the intima, they can lead to increased menstruation, shortened cycles, prolonged menstruation, etc., which is the main cause of most patients’ visits; submucosal fibroids are often small in volume, but due to the growth in the uterine cavity, most patients can have symptoms such as menorrhagia and abdominal pain, and some fibroids can be rejected by the uterus and protrude into the vagina.
Symptoms of uterine fibroids
The most common symptoms are increased menstrual flow and prolonged menstrual periods, and even abnormal bleeding during non-menstrual periods, or increased vaginal discharge. Long-term increased menstrual flow can cause anemia, dizziness, fatigue, and palpitations.
Symptoms of compression
When fibroids gradually increase, especially in the front of the uterus, you can feel the mass from the abdomen by yourself. Fibroids growing in different parts can also cause different neighboring organs to be compressed.
When fibroids are large enough: when the bladder and ureter are compressed, you often feel the urge to urinate or have a feeling of inexhaustible urination, which can even damage the function of the kidneys.
Compression of the rectum can cause constipation or diarrhea, and a feeling of bulging in the lower abdomen, also a common symptom; compression of the fallopian tube can cause infertility.
Infertility, dystocia
The uterus is the organ for women to give birth to the fetus. The impact of uterine fibroids on pregnancy is related to the location and size of the fibroids. If the uterine fibroids grow deeper, it may affect the implantation of the fertilized egg, leading to early miscarriage or infertility.
Excessive tumors can squeeze the growth space of the fetus and compete for the nutrition of the fetus, which can easily cause miscarriage.
Fibroids with a low growth position can hinder the fetal decline, causing abnormal fetal position during late pregnancy and delivery, placental abruption, obstruction of the birth canal, etc.
After the fetus is delivered, women with uterine fibroids are prone to postpartum hemorrhage due to large placenta attachment or difficulty in expelling and poor uterine contractions.
In addition, uterine fibroids are prone to degeneration during pregnancy and puerperium, leading to abdominal pain and fever in pregnant women. Taking into account the safety of both mother and baby, conservative treatment is usually taken to relieve symptoms.
Pregnant women with uterine fibroids can give birth naturally, but postpartum hemorrhage should be prevented. Although uterine fibroids do not necessarily require cesarean section, when it hinders the fetus from descending, cesarean section should be performed.
Whether the fibroids should be removed during the operation depends on the size, location and specific conditions of the fibroids.
Complications
Uterine fibroids can cause some complications. For example, fibroids that grow on the outermost layer will protrude like mushrooms on the surface of the uterus if they have a pedicle. If we suddenly change our posture, the torsion of the uterine fibroids will cause severe abdominal pain and vomiting. If it is not treated in time, it will cause pain and fever, and even necrosis.
Why do uterine fibroids occur?
Which people do uterine fibroids “prefer”? First of all, it is mainly related to genetic factors. Studies have shown that 25%-50% of patients with uterine fibroids have genetic abnormalities.
Secondly, women with endocrine disorders, such as women with obesity, menstrual disorders, unhealthy lifestyles, and excessive stress. Thirdly, women who consume more estrogen in their daily diet. For example, many health products contain estrogen, and some meats also contain estrogen. In addition, estrogen in the body increases rapidly when a woman is pregnant.
Therefore, many women want to know how to prevent the occurrence of uterine fibroids, or how to control the growth of already existing uterine fibroids, and patients who have undergone uterine fibroids removal operations want to know how to avoid the recurrence of uterine fibroids.
But to be honest, there is no way to completely prevent uterine fibroids. The occurrence of fibroids mainly depends on the personal physique, especially the level of estrogen and progesterone in the body.
Do uterine fibroids need treatment?
What kind of uterine fibroids need treatment? There is no strict definition of the size of uterine fibroids. Uterine fibroids that are generally less than 5 cm in diameter or do not cause any symptoms do not require surgical treatment.
Especially for women who are near menopause, a gynecological B-ultrasound is recommended every 3 to 6 months. If the patient’s symptoms are mild, near menopause or the general condition cannot withstand the operation, medication can be taken.
If you have menstrual abnormalities or severe abdominal pain, please seek medical advice immediately. To avoid delaying the condition, do not take hemostatics and painkillers by yourself. If other discomforts occur, such as increased menstrual flow and prolonged menstrual periods, masses in the lower abdomen, compression symptoms, and abnormal leucorrhea in women of childbearing age, seek medical advice in time.
Surgical treatment is usually the first choice. It is suitable when medical treatments are ineffective, or when menorrhagia causes anemia or abdominal pain, or when fibroids grow too fast, suspected of malignant transformation, or causing compression symptoms.
The probability of malignant transformation of uterine fibroids itself is very low, only 1/400 will occur. Normal uterine fibroids increase by 1 to 2 cm in diameter each year is a reasonable rate. If they suddenly grow very fast, such as increasing by 1 to 2 cm per week, we should be alert to the occurrence of malignant transformation. Malignant uterine fibroids will more likely cause menstrual disorders. Under normal circumstances, fibroids stop growing or even shrink after menopause. If they are still growing after menopause, it may be a problem.
Surgically treat uterine fibroids
Based on the patient’s age and fertility requirements, the surgical treatment of uterine fibroids can be divided into: uterine fibroid removal, subtotal hysterectomy, and total hysterectomy.
These three surgeries can currently be performed in Zanzibar in three ways: 1. open surgery; 2. porous laparoscopic surgery; 3. single-hole laparoscopic surgery. The latter two are minimally invasive surgeries that need to be decided comprehensively based on the number, location and nature of fibroids.
Two successful surgical operations were performed in Mnazimmoja Hospital in November 2021, the first single-hole laparoscopic surgery in Tanzania and neighboring countries.
Prevention
First, control your diet to avoid the intake of hormones, such as not eating health products and supplements containing natural estrogen, such as royal jelly, soy products, and placental products; fasting spicy and stimulating foods, and going on light diets; avoiding high cholesterol, high-fat diet, and controlling the intake of fried foods and desserts; avoiding the intake of seafood contaminated by heavy metals. It is recommended to eat more seaweed foods and more vegetables.
Second, ensure a normal sex life; do not give birth too early; and it is not advisable to have too many children. But women who do not have children have an increased risk of uterine fibroids.
Third, take multivitamins to lower the risk of uterine fibroids, promote normal metabolism of the body and shrink fibroids especially Vitamin D in combination.
Vitamin D is known as the main regulator of calcium homeostasis. Studies have demonstrated that Vitamin D3 is a potent antitumor agent that shrinks uterine fibroids.
Diet rich in Vitamin D are Cod liver oil, milk, oil fishes.
Fourth, review regularly, eat a balanced diet in daily life, take appropriate rest, maintain a good mood, and cooperate with the doctor for treatment.
All in all, we should correctly understand the common disease of uterine fibroids, do not underestimate or panic, take regular physical examinations, and cooperate with doctors for treatment.
