Uterine Fibroids – A Major Cause of Infertility in Women
Naisha Maheshkumar Tanwani, Raffles Girls’ Secondary School, Singapore
Uterine fibroids are the most common benign tumours of the female reproductive organs, associated with significant morbidity and quality of life impairment. They present as a major cause of infertility in women globally, especially in Sub-Saharan Africa, as women of African descent are more likely to have larger fibroids. Currently, there are treatment methods used for inhibiting the growth of the fibroids as well as removing them. These include drug therapy and surgery. However, the women in Sub-Saharan Africa need these methods to be more effective, safe and accessible to them, as Sub-Saharan Africa is a region without highly skilled surgeons and adequate laboratory products. Hence, more research is necessary for suitable treatment to be provided to these women in order to promote global healthcare equity. Non-medical interventions are also necessary, such as educating women about the preventive measures which can be taken, such as having a more balanced diet.
Infertility is a reproductive health issue affecting 15% of couples of reproductive age worldwide (Sun et al., 2019). One cause of the high rates of infertility is the presence of uterine fibroids. Uterine fibroids are noncancerous growths of the uterus that often appear during women’s reproductive years. Fibroids range in size, from microscopic aggregations to bulky masses that can distort and enlarge the uterus. It is possible to have a single fibroid or multiple (Mayo Clinic, n.d.). Many women have asymptomatic uterine fibroids. However, the symptoms include heavy and prolonged menstrual bleeding, and pain in the pelvic area (Mayo Clinic, n.d.). They may significantly affect patients’ quality of life.
Fibroids may cause infertility in several ways. For example, changes in the shape of the cervix can affect the number of sperm capable of entering the uterus. Changes in the shape of the uterus can interfere with the movement of the sperm or embryo. Fallopian tubes can also be blocked by these fibroids (American Society for Reproductive Medicine, 2015). Uterine fibroids may also increase pregnancy complications and delivery risks. For example, fibroids may cause increased chances of preterm birth or miscarriage (American Society for Reproductive Medicine, 2015). Research has shown that the rate of a miscarriage in women with uterine fibroids is two to three times higher than that of women without fibroids (Royal College of Obstetricians and Gynaecologists, 2017). Pregnancy complications include the placenta separating from the uterine wall before birth (placental abruption) and preterm delivery (Shields, 2020).
Other than being at reproductive age, other factors can impact fibroid development, including race. Bigger fibroids are more prevalent in women of African descent. Tens of thousands of women are in the emergency department every year for uterine fibroids in the United States, but the rate of hospitalization for fibroids is three times higher for black women than white women (Mostafavi, 2021; Black Women’s Health Imperative, 2019). In addition, African American women are likely to have fibroids at younger ages, more or larger fibroids, and more severe symptoms as well. Other factors such as Vitamin D deficiency also appear to increase the risk of the development of uterine fibroids (Mayo Clinic, n.d.).
Currently, there are some common treatments for uterine fibroids, including drug therapy and surgery. An example of drug therapy is the use of Gonadotropin-releasing hormone (GnRH) agonists to stop ovulation and the production of oestrogen, and reduce fibroid size (Mount Sinai, n.d.). There are many surgical options, which include removal of the fibroid (myomectomy), removal of the endometrial lining (endometrial ablation), shrinking the blood supply to the fibroid (uterine artery embolization), and removal of the uterus (hysterectomy) (Mount Sinai, n.d.).
There are limitations to these current methods. Firstly, they are not as effective and may have adverse side effects. The use of GnRH may cause osteoporosis from oestrogen loss (Mount Sinai, n.d.). If a woman becomes pregnant during the use, there is some risk of birth defects. A myomectomy is not necessarily a permanent solution for fibroids as they can recur after these procedures (Mount Sinai, n.d.).
Another limitation is that these methods are not accessible enough. As mentioned earlier, African women carry the burden of uterine fibroids at a much higher rate than their racial counterparts. In developed countries, women can seek treatment through surgical and non-surgical means. However, in the African Sub-Saharan region, there is limited access to quality hospitals with regulated standards of care and highly skilled experts/surgeons, as well as adequate laboratory and blood products (Igboeli et al., 2019).
Moreover, little attention has been given to conducting research for more practical methods of treatment for the unique cultural needs and challenges of Sub-Saharan African women, even though they bear such a significant burden of uterine fibroids. In Africa, hysterectomies are the least accepted by patients due to cultural norms and beliefs. Most women would prefer to die than have a hysterectomy because their culture holds the belief that they need their womb for childbearing in the next life (Igboeli et al., 2019).
Another intervention could be providing a low-cost alternative, such as daily vitamin D supplementation since Vitamin D deficiency is highly prevalent among black populations (Igboeli et al., 2019). According to some sources, vitamin D deficient women who take oral vitamin D supplementation experience reduced fibroid growth. Though promising, these results are not conclusive. Moreover, It is unclear if vitamin D can shrink fibroids in volume (Lalezarian, 2021).
A low-cost, effective and accessible known intervention which can be implemented globally includes education as to the nature and symptoms of uterine fibroids. This could improve the quality of life, remove negative social stigma, and reduce morbidity and mortality rates in women who seek medical care with advanced uterine fibroids (Igboeli, P. et al., 2019). Moreover, since effective medical interventions for women with severe uterine fibroids in Sub-Saharan Africa are not well-known yet, these women can be educated about healthy eating choices which may inhibit/prevent fibroid growth. For example, it has been found that women who have four fruit or vegetable servings per day have a lower risk for developing uterine fibroids (Tinelli, A. et al., 2021).
In summary, further research on the methods that can cater to women all over the world is necessary, and more resources need to be allocated towards the cause. The development of low-cost, safe, effective, and accessible medical interventions for uterine fibroids will be greatly beneficial in reducing infertility rates and ensuring the globalisation of human health in the future, so that everyone, regardless of racial and socioeconomic background, can have equal access to health care.
American Society for Reproductive Medicine. (2015). Fibroids and fertility. Reproductive Facts. Retrieved January 28, 2022, from https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/fibroids-and-fertility/#:~:text=There%20are%20several%20ways%20uterine,can%20be%20blocked%20by%20fibroids
Bhakua. (n.d.). WordPress.org. Openverse. Retrieved June 2, 2022, from https://wordpress.org/openverse/image/ed0a1796-a539-4561-b05d-803553a48ecd
“Dr Patel holding a huge fibroid taken out in Mission Hospital, Nuagaon”
Blount, L. G. (2019, April 3). It's not normal: Black women, stop suffering from fibroids. Black Women's Health Imperative. Retrieved March 6, 2022, from https://bwhi.org/2019/04/03/its-not-normal-black-women-stop-suffering-from-fibroids/#:~:text=Black%20women%20have%20higher%20rates%20of%20hospitalization%20for%20fibroids%20compared,of%20one%20or%20more%20fibroids
The health disparities of uterine fibroid tumors for African American women: a public health issue. American journal of obstetrics and gynecology, 210(3), 194–199. https://doi.org/10.1016/j.ajog.2013.08.008
Institute for Health Metrics and Evaluation. (2020, October 15). Uterine fibroids - level 4 cause. Institute for Health Metrics and Evaluation. Retrieved January 28, 2022, from https://www.healthdata.org/results/gbd_summaries/2019/uterine-fibroids-level-4-cause#:~:text=Summary%20Uterine%20fibroids%20caused%20a,with%20uterine%20fibroids%20in%202019.
Igboeli, P., Walker, W., McHugh, A., Sultan, A., & Al-Hendy, A. (2019). Burden of
Uterine Fibroids: An African Perspective, A Call for Action and Opportunity for Intervention. Current opinion in gynecology and obstetrics, 2(1), 287–294. https://doi.org/10.18314/cogo.v2i1.1701
Lalezarian, D. M. (2021, December 16). Does vitamin D shrink fibroids? Dr. Lalezarian answers. Fibroid Specialists of University Vascular. Retrieved March 5, 2022, from https://www.fibroidspecialists.org/post/can-vitamin-d-shrink-fibroids
Mayo Foundation for Medical Education and Research. (n.d.). Uterine fibroids. Mayo Clinic. Retrieved January 28, 2022, from https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288#:~:text=Uterine%20fibroids%20are%20noncancerous%20growths,almost%20never%20develop%20into%20cancer
Mostafavi, B. (2021, May 28). Tens of thousands of women turn to the emergency room for fibroid symptoms. University of Michigan. Retrieved May 5, 2022, from https://labblog.uofmhealth.org/rounds/tens-of-thousands-of-women-turn-to-emergency-room-for-fibroid-symptoms
M Zou, L Chen, C Wu, C Hu, Y Xiong (30 August, 2017). Pregnancy outcomes in patients with uterine fibroids treated with ultrasound-guided high-intensity focused ultrasound. Royal College of Obstetricians and Gynaecologists. Retrieved from https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.14742#bjo14742-bib-0004
Sun, H., Gong, T. T., Jiang, Y. T., Zhang, S., Zhao, Y. H., & Wu, Q. J. (2019).
Global, regional, and national prevalence and disability-adjusted life-years for infertility in 195 countries and territories, 1990-2017: results from a global burden of disease study, 2017. Aging, 11(23), 10952–10991. https://doi.org/10.18632/aging.102497
Shields, J. (2020, March 31). Can uterine fibroids harm my pregnancy?: Cancer: Your pregnancy matters: UT southwestern medical center. Cancer | Your Pregnancy Matters | UT Southwestern Medical Center. Retrieved April 9, 2022, from https://utswmed.org/medblog/fibroids-options-pregnancy/
Tinelli, A., Vinciguerra, M., Malvasi, A., Andjić, M., Babović, I., & Sparić, R. (2021). Uterine fibroids and Diet. International Journal of Environmental Research and Public Health, 18(3), 1066. https://doi.org/10.3390/ijerph18031066
Uterine fibroids: Symptoms, causes, risk factors & treatment. Cleveland Clinic. (n.d.). Retrieved February 4, 2022, from https://my.clevelandclinic.org/health/diseases/9130-uterine-fibroids#:~:text=Fibroid%20clusters%20can%20range%20in,even%20on%20the%20outer%20surface
Uterine fibroids and hysterectomy. Mount Sinai Health System. (n.d.). Retrieved January 28, 2022, from https://www.mountsinai.org/health-library/report/uterine-fibroids-and-hysterectomy
World Health Organization. (n.d.). Infertility. World Health Organization. Retrieved January 28, 2022, from https://www.who.int/health-topics/infertility#tab=tab_2 https://www.who.int/news-room/fact-sheets/detail/infertility