Zumira* sat forlornly on her bed during the teaching ward round. She was visibly uncomfortable and wished she could be somewhere else. Twelve years before, she had been in this very ward at the national teaching and referral hospital.
She was 26, young and full of hope. She had completed college and her first job was coming along quite nicely. She had even moved out of home and was excited about living independently.
However, her period was getting heavier each month, and though she had always suffered cramps during menses, the pain was becoming excruciating, needing constant medication. However, she was too busy living to make time to see a doctor until her mother intervened and forced her to seek care.
At the gynaecology clinic on a hot sunny afternoon, a young doctor put her at ease and managed to elicit a few more symptoms.
In addition to the painful and heavy periods, Zumira had not paid attention to the on and off constipation. She had also sought treatment for urinary tract infections twice the previous year.
A physical examination revealed that she was pale, with a mass in her lower abdomen that was the size of a 16-week-old pregnancy. The fibroid diagnosis was confirmed by ultrasound and she successfully underwent surgery to remove them.
Following surgery, she did well, optimistic that the worst was over. At her post-operative review, she was seen by a senior professor. The jolly old Prof teased her, but told her that the fibroids would recur with time, so she seriously needed to think about having children before this happened.
Once discharged, Zumira resumed her fast-paced life. The pain faded, the periods became lighter and the good old professor’s wise counsel was ignored.
Ten years flew by and before she knew it, the familiar old symptoms crept back like a bad weed.
One day, after a particularly rough night, Zumira knew she had to retrace her steps back to the gynaecology clinic. She told the doctor that she was sure her fibroids were back.
She could feel the uneven masses in her abdomen, two distinct mounds dwelling in her uterus. She even jokingly referred to them as visitors that had overstayed their welcome.
Things were not rosy this time round. Her fibroids were really big, the size of a 34-week pregnancy. Though the symptoms were less obvious than the last time, the prognosis was less optimistic.
The doctor was terribly unhappy to note that in the last 12 years since she had been in hospital, Zumira was still childless yet she harboured a deep desire to be a mother. After tests, she was admitted for surgery.
In the ward, she met the professor who had advised her to have her babies early. He asked Zumira what she had done with the past 12 years to fulfill her maternal desire. We, the young doctors shadowing the professor to learn the art and science of gynaecology, were taken aback by the professor’s forthrightness. We had no idea about the discussion doctor and patient had had in the past.
Zumira had extremely tough choices to make. Here she was, in a public hospital, with limited finances and hence limited treatment options. She was scheduled for a surgery where she was going to lose her womb at barely 38 years of age.
Her dream of becoming a mother was rapidly vanishing. She blamed herself for her predicament. She felt that she had set the bar too high for the potential father of her children and while she waited around for the right one to come along, unwelcome visitors had silently crept into her womb and robbed her of an opportunity to be a mother.
Right there and then, she wished more than ever, she could be anywhere in the world other than in a hospital bed surrounded by a bunch of strangers feeling sorry for her.
Fibroids are the commonest tumours that occur in the reproductive system of women. They are three times more common in black women than white women.
They are abnormal growths in the wall of the uterus that may occur singly or in multiples, but they are not cancerous. They occur during reproductive age and thrive on oestrogen, tending to shrink after menopause as hormone levels decline.
They may cause heavy, painful menses; a dragging sensation in the pelvis; obstructive symptoms such as constipation and incomplete emptying of the bladder that results in recurrent urinary tract infections; and infertility.
Treatment options are tailored to the patient’s desires, age, number of children, symptoms and present complications. These include no treatment especially if the fibroids are small and asymptomatic; surgery to remove the fibroids (myomectomy) or removal of the uterus (hysterectomy).
Medication to cause a temporary state of menopause to shrink them and uterine artery embolisation which cuts off blood supply to individual fibroids, causing them to die off and shrink, are other treatment options.