Their plights were the same, and although they are from different backgrounds’ and families, they are all Nigerian women. According to them, their conditions started gradually, but later metamorphosed into chronic conditions with excruciating pains that almost terminated their lives. The dawning of each day of their monthly period came with horror, as they grappled with the fear of death from the overflowing fountain of blood for weeks’ non-stop.
However, respite came their way, when they discovered an effective non-invasive treatment of fibroid and adenomyosis, even within their localities in Nigeria. Their different narratives will definitely give hope to other women in same condition, who aren’t ready to go under the knife.
The American College of Obstetricians and Gynaecologists defines uterine fibroids as benign (not cancerous) growths that develop from the muscle tissue of the uterus. They are also called leiomyomas or myomas. The size, shape and location of fibroids can vary greatly. They may be inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure.
Experts from Mayo Clinic describe adenomyosis as the condition that occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus. The displaced tissue continues to act normally — thickening, breaking down and bleeding — during each menstrual cycle. An enlarged uterus and painful, heavy periods can result.
Statistics show that black women are more prone to having uterine fibroids than their white counterparts, as developed nations have access to several preventive measures than those in sub-Saharan Africa.
Although there is paucity of data regarding the prevalence of fibroids and adenomyosis in Nigeria, a ResearchGate study titled: “Burden of Uterine Fibroids: An African Perspective, A Call for Action and Opportunity for Intervention” puts the incidence of fibroids at 29.3 per cent, with women of reproductive age mostly affected. Meanwhile, the exact pathogenesis of uterine fibroid development remains elusive.
The research conducted by P.I. Igboeli, Walker W, McHugh, A. and Sultan, A., identified the common clinical presentations of fibroids as abdominopelvic mass (100 per cent), menorrhagia (95.7 per cent), infertility (41.9 per cent), anaemia (32.9 per cent), dysmenorrhoea (12.5 per cent), abdominopelvic pain (15.8 per cent), and urinary pressure symptoms (6.8 per cent). While they noted that abdominal myomectomy was the mainstay of treatment.
True life stories of fibroid survivors
During an interactive session with three survivors of fibroid – Dr Joy Oluwatumbi; Mrs Bolaji Olasoji and Mrs Esther Ofuani – at a virtual programme organised by Nordica Fertility Centre, Lagos, they gave touching accounts of their ordeals with the condition, prior to their knowledge of the newly introduced High Intensity Focus Ultrasound (HIFU) in Nigeria.
I sat up all-night so I wouldn’t bleed to death – Oluwatumbi
Dr Oluwatumbi says fibroid was a near-death experience for her as she had to resign her job after which she bled for a month at a particular time. Due to her phobia for surgery, she had been booked twice for surgical operation but had turned it down.
According to her: “I was diagnosed of fibroid since 2013, at the age of 27. That same year, I had to resign from my job, because the symptoms were severe. At the time I resigned, I had figured out that if the next menstruation met me in the hospital, it was going to be an emergency and I didn’t want any emergency because during emergency, your life will be in the hands of doctors and you won’t have any choice than to allow them.
“I had severe symptoms, such as heavy bleeding and severe constipation and when I say heavy bleeding, it was really heavy. Sometimes when I talk about it people don’t believe me; so I just kept it to myself most times. The condition persisted until 2015 when it became so bad and I had to present myself at the hospital. Then I was booked for surgery but I defaulted because I didn’t want the option.
“In 2016, the situation continued and at a certain period, I bled for a whole month. I had to show up at the hospital again, because I suspected I might not survive the next cycle. So I was booked for surgery again and I defaulted again.
“Then my blood level was so low that the doctor had to build my blood. So I made research on how I could evade going under the knife for removing my fibroid. I came across HIFU, but back then it was not in Nigeria. By February 2021, I decided wherever HIFU was, I would locate it. There and then, I discovered that Nordica Fertility Centre had brought HIFU to Nigeria.”
She continued: “I got their contacts to try them and it was real. So I started consultation in March 2021. I did MRI, but when the MRI result came out, I was a bit devastated because I had this type zero fibroid; that is, the fibroid was inside the endometrial cavity and no one wants to go into that HIFU procedure. But after some procedures, I was finally approved, and 6 July, I did my HIFU at Nordica, Lagos.
“That same day, my menstruation commenced normally and the following day, I was on my feet, moving around. Prior to this time, when I was menstruating, I couldn’t move around because of the heavy flow. I remember some nights I had to sit up all-night so I wouldn’t bleed to death. But after the procedures, my situation improved tremendously. It was an interesting experience altogether and post-HIFU has been wonderful.”
Heavy flow restricted my movement every first three days of my period – Olasoji
Mrs Olasoji, mother of three children and a businesswoman, shared a similar experience as Dr Oluwatumbi, but the former was not as chronic as the latter. Olasoji narrated how her heavy menstrual flow restrained her movement every first three days of her period, until she met HIFU.
She explained how horrible it was to live with fibroid and adenomyosis, especially when the one is ignorant of what is happening in her system. She said that she couldn’t detect the root cause of her abnormal bleeding at the onset until she visited her doctor for diagnosis.
Her words: “I was told I had fibroid when I complained to my doctor of my heavy flow and he confirmed it. During my period, I used to spend three days at home with severe pain in my lower abdomen along with back pain. I was advised to go remove it, but I didn’t want the surgery option, because of what I had heard about it.
“Then I came across HIFU while surfing the net for solutions; but then HIFU was not in Nigeria. Along the line, I was added to a WhatsApp group where fertility issues of women seeking for the fruit of the womb were being discussed. And that was where I got to know that Nordica Fertility Centre had brought HIFU to Nigeria.
“I joined the group and at a time when I was about leaving the group due to some constraints, Nordica adopted me as a special patient. It was a special experience because I didn’t have to go under the knife, and it was relieving. The whole experience made me realise that I didn’t only have fibroid, but also had adenomyosis. However, the HIFU procedure was able to treat the fibroid and adenomyosis. The fantastic thing about the procedure is that there was no restriction after it. Even post-HIFU when my circle commenced it was just absolutely normal.”
I did surgery but got unimpressive result – Ofuani
For Mrs Ofuani, it was another ball game entirely, as she had had an unpleasant experience initially through surgery, while in search of a child. She said the fear of undergoing the surgery itself had been paralysing as she was informed that she had a 50-50 chance of survival after the operation. Although the surgical procedure turned out not to be very pleasant, she was grateful for life, as she escaped death by whiskers. Subsequently, she persisted in her search for solution, and she eventually came across the Nordica Fertility Centre.
She narrated her ordeal thus: “My own case started in 2019 when I visited the hospital in search of a child and I was told I had fibroid. Inasmuch as that my fibroid was not too big, according to my doctor, the location was dangerous for a baby to be accommodated along with it. Before then, when my doctor asked me how my period had been. Really, I had noticed that, from 2018, I was having an abnormal flow. Initially I menstruated three to four days, but before I knew what was happening, I noticed that for the next six days I was still flowing – and not just flowing, I had clots alongside my flow.
“The doctor suggested surgery, but that had been an issue, based on other peoples’ experiences; so it was scary. But it got to a time I summoned courage to go for it, if that would bring a solution. So I went in for it but the result wasn’t impressive, but I thanked God I came out alive. The fear alone of going under the knife was killing, as I was physically shaking, and it was a 50-50 chance.
“Thereafter, I continued in search of a lasting solution to my condition, as the surgery failed to provide one. I could recall on that notable day, I was listening to a radio programme, when Dr Abayomi Ajayi, MD/CEO – Nordica Fertility Centre, Lagos, was speaking on fertility matters and that was how I hooked up with Nordica Centre for my HIFU. I went in for the procedure, and my condition has never remained the same”, she stated.
Invention of HIFU
HIFU is an innovation of two brothers, William Fry and Francis Fry, in the 1950s. They had joined the Faculty of Electrical Engineering of the University of Illinois in 1946. HIFU is a non-invasive treatment for a wide range of tumours and diseases. It uses an ultrasound transducer, similar to the ones used for diagnostic imaging, but with a much higher energy. Although the Fry brothers used it in resolving brain disorders, it was later endorsed by the United States Food and Drug Administration (FDA) for the treatment of uterine of fibroids and adenomyosis.
Speaking on its introduction in Nigeria, Dr Ajayi explained how his facility launched HIFU in the country on 25 June 2021, which moved the nation to the global community of nations using High Intensity Focus Ultrasound, for the treatment of fibroid and adenomyosis. He disclosed that their partner is HIFU China, which had done their first findings on the effectiveness of the procedure and given it to Oxford University, UK, in 2002. He expressed displeasure in Nigeria’s position towards the technology, which is just coming now, while other countries had been leveraging it for decades.
“I don’t know why it is taking us a long while here in Nigeria to catch up with this technology, maybe due to cost and so many other things,” he said.
Dr Matthew Bucknor, co-director of Focused Ultrasound, at the University of California, San Francisco, gave deeper insights into how HIFU works. According to his statement on the university’s website, the transducer focuses sound waves to generate heat at a single point within the body and destroy the target tissue. The tissue can get as hot as 150 °F in just 20 seconds. This process is repeated, as many times as is necessary, until the target tissue is destroyed. MRI images are used to plan the treatment and monitor the degree of heating in real time.
Advantages of HIFU over surgery
Bucknor listed the benefits of HIFU to include non-invasiveness, non-surgical treatment, less risk, no ionising radiation, faster recovery time and precision.
Ajayi amplified Buckner’s opinion on the merits of HIFU over surgery, saying the interesting thing to him is that it prevents women from having surgical myomectomy for uterine fibroid.
“I’m not saying that myomectomy is bad, but when you consider the number of people who had myomectomy in Nigeria, they are not many. When you look at complications associated with fibroid surgery, it’s either bleeding, or anaesthetic problem. These are the two things that HIFU takes care of. When you do HIFU, you don’t lose a drop of blood and you don’t need general anaesthesia. Since we started in June, about 25 persons have had it, and we had three of them to discuss with us.”
He identified one common feature among the beneficiary women, which is quest for information on their condition, saying patients need to know that the best things belong to people who read, and especially those who do so with necessary caution.