“Doc, I have been experiencing heavy bleeding, much more than I usually do, and about a month ago I started feeling dizzy.” This was a complaint from one of my girls recently. She had visited a general practitioner who, after taking a thorough history and examining her, referred her for an ultrasound. The scan finally provided an explanation for symptoms she had been living with for months: uterine fibroids.
While Kenya does not have a national prevalence study on uterine fibroids, an older estimate suggested that approximately 1.6 million women may be affected.
Uterine fibroids, also known as leiomyomas, are non-cancerous growths that develop from the muscle and connective tissue of the uterus. They can occur as a single growth or as multiple fibroids and may range from very small lesions to masses large enough to significantly enlarge the uterus. Their effect on a woman depends not only on their size but also on their number and location.
The exact cause of fibroids is not fully understood. What is known is that hormones, particularly oestrogen and progesterone, influence their growth. Genetic factors also appear to play a role, which may explain why women with a family history of fibroids are at a higher risk. They mainly occur during the reproductive years and often shrink after menopause when reproductive hormone levels decline. Other factors associated with increased risk include obesity and high blood pressure.
Many women with fibroids have no symptoms and may only discover them during a routine pelvic examination, ultrasound or investigation for another condition. For women who do develop symptoms, heavy or prolonged menstrual bleeding is among the most common. Others may experience pelvic pain or pressure, painful menstruation, lower back pain, pain during sex, frequent urination or abdominal enlargement.
Heavy bleeding deserves particular attention because of its consequences. Repeated blood loss can result in iron-deficiency anaemia. A woman may begin to experience persistent tiredness, dizziness, headaches, shortness of breath, palpitations or reduced ability to carry out ordinary activities. These symptoms are sometimes treated in isolation without investigating the underlying cause.
Fibroids can also affect fertility and pregnancy, although this does not happen to every woman with the condition. Their reproductive impact depends substantially on where the fibroids are located and whether they distort the uterine cavity. This is one reason treatment cannot be standardised. The presence of a fibroid is not an automatic indication for surgery.
Diagnosis usually begins with a detailed clinical history and examination. Ultrasound is commonly used to confirm the presence of fibroids and to establish their size, number and location. Depending on the clinical circumstances, additional investigations may be necessary. A woman with significant bleeding should also be assessed for anaemia.
Treatment is determined by the severity of symptoms, the size and location of the fibroids, a woman’s age, her reproductive plans and the impact of the condition on her quality of life. Women who have no symptoms may require no immediate treatment and can instead be monitored.
For women experiencing heavy menstrual bleeding, medications may be used to control symptoms. Some medicines will reduce menstrual blood loss, while some hormonal contraceptives may help regulate bleeding. A hormone-releasing intrauterine system may be appropriate for some women. Pain can also be managed with appropriate analgesics. Certain hormonal treatments can temporarily reduce the size of fibroids, although they are generally not considered a permanent solution.
Where symptoms are severe, or medication has not worked, other interventions may be considered. Uterine artery embolisation reduces the blood supply to fibroids, causing them to shrink. Other minimally invasive techniques, including radiofrequency ablation, may also be used in some cases.
Surgery may be necessary for some women. A myomectomy removes the fibroids while leaving the uterus in place and is often considered when preserving fertility is important. A hysterectomy, which involves removing the uterus, provides definitive treatment, however, it permanently removes the ability to carry a pregnancy. Surgery may also be advised when bleeding is severe or persistent, anaemia is difficult to control, pain or pressure symptoms significantly interfere with daily life, fibroids are particularly large, fertility is affected, or other forms of treatment have failed.
There is currently no guaranteed way of preventing uterine fibroids. This makes early recognition and access to appropriate diagnosis particularly important. Women should know what is normal for their own menstrual cycle and seek medical assessment when there is a significant or persistent change.
We need to become much clearer about the distinction between menstruation and abnormal bleeding. Repeatedly soaking through sanitary products, unusually large clots, bleeding for prolonged periods, feeling dizzy or breathless, or developing persistent fatigue should not simply be dismissed as having a “heavy period”.
