Most commonly asked questions about fibroids, endometriosis and PCOS

This month, EVE has focused on reproductive health with a particular focus on conditions such as endometriosis, fibroids and polycystic ovarian syndome. We interviewed Dr. Ikol Adungo Allan, a consultant obstetrician and gynaecologist at Kenyatta National Hospital, who answered some of the most commonly asked questions around these conditions. 

What is the difference between fibroids, endometriosis and PCOS?

Fibroid is an abnormal growth or a tumor of the muscle layer of the uterus that can lead to women having pain in their lower abdomen, abnormal vaginal bleeding, heavy menstrual period or inability to conceive. Endometriosis is abnormal location of the inner layer of the uterus that you normally shed as menses on the surface of the reproductive organs either ovary, the pelvic wall, vagina, cervix or even the intestines. It presents with symptoms of women having severe pain in their lower abdomen, pain during menses, pain during sex or on passing stool and inability to conceive. Some women can have this abnormal tissue present on the scar tissue where surgery to your abdomen was done or on their naval. This can result to pain and swelling of scar tissue or bleeding from the navel when one is having their menstrual flow. PCOS fully stands for polycystic ovarian syndrome. This is an abnormality of the metabolism hormones affecting the female reproductive system that presents with symptoms of acne, irregular periods, absence of periods, abnormal hair distribution in women either beards or hair around the arms and legs. When we do an ultrasound in this woman, we get that their ovaries are enlarged. These women mostly experience challenges when they wish to conceive.

How common are these conditions becoming among Kenyan women?

Fibroids is common in women who have a small family size or have delayed childbirth to years above 30. There is also a history of fibroids running in close family relatives. 10% of the population. Endometriosis is common in women who have had severe pain in their tummy with no available explanation to that. Its common in women who visit multiple doctors always with symptom of chronic pelvic pain and have been constantly treated for pelvic inflammatory disease yet they have no abnormal discharge. PCOS affects around 10-15% of women of reproductive age.

What kind of treatment actions are taken for these conditions?

Not all fibroids require treatment. Some we just monitor, as you age they shrink in size or undergo degenerative changes. The fibroids that need treatment are the ones that give you symptoms of either heavy menstrual bleeding, severe abdominal pain, inability to conceive or having miscarriages. If we want to reserve fertility we always remove the fibroids through a procedure called myomectomy. If one has achieved desired family size and has fibroids the uterus may be removed in totality.

When one is diagnosed with endometriosis they can either undergo a minimal invasive surgery procedure called laparoscopy to remove the abnormal implants of cells of the uterus. Some we may give some hormonal drugs to control their symptoms. There are multiple drugs in the market for that. Of note endometriosis has no definitive treatment most time we administer treatment to help alleviate the pain.

In PCOS, treatment is designed based on the symptoms the patients present with. There is no cure for PCOS. If one has excess hair on their body they will be given either combined contraceptive pills to help. Women with difficulty in conceiving can be given ovulation induction drugs and supplements to aid them have regular cycles and improve fertility.

What factors put women at risk for these conditions?

Fibroids occur due to family history of fibroids, small family size, delaying childbirth to extreme of age. Endometriosis and PCOS have no know cause but there is an aspect of genetics.

Is it possible for one woman to suffer from all these conditions?

Highly unlikely buts it’s possible to have fibroids and either of endometriosis or PCOS. Fibroids mostly occurs in women with delayed or with small family sizes, most women with either endometriosis or PCOS have infertility or subfertility.

These conditions have sometimes been connected to cancer. Is this factual?

They are not connected.

Are these conditions avoidable? Are there lifestyle habits that would decrease their occurrence?

The symptoms and signs of PCOS can be exacerbated by obesity. We advise women to exercise to keep fit and eat healthy food. For dietary needs, we advise women need to visit a nutritionist as they are the professionals who can advise one on their caloric intake that keeps them healthy.

Many of the women with any of these conditions have pointed out that they experienced excruciating periods from teenage hood. Are there efforts by the medical profession to try and engage teens with these symptoms that could lead to fibroids, endo or PCOS later in life?

Pain in teenagers is most probably associated with endometriosis. We advise that any teenager or young adult to seek the services of a gynecologist whenever they experience any abnormal pain or vaginal discharge. We have a youth/adolescent’s clinic that are available countrywide to help the youth deal with puberty and any condition that needs treatment.

There has also been a mention of hormonal imbalance as a common diagnosis. What exactly is it and how can women and girls deal with it?

To the layman, hormonal imbalance is when one has irregular cycles or has abnormal vaginal bleeding, so any person who skips menses or experiences heavy bleeding needs to be reviewed so that we are able to get the right diagnosis. The term hormonal imbalance mostly indicates the symptoms of the patient but it is not a diagnosis.

Are birth control methods a contributor to these conditions?

There has not been any link between any hormonal contraception and either of the above conditions. Sometimes we use birth control pills to manage some symptoms related to the above diseases.

A significant number of women struggling with fertility have admitted to paying a fortunes to traditional healers, religious leaders and other avenues. How does the medical field educate women to avoid spending money in some of these non-medical avenues?

We always try to use any opportunity we have to advocate for better services for all Kenyans by equipping and staffing of all public hospitals as they have a wider reach compared to private hospitals. At national level we are currently training more doctors with almost 6 medical schools actively training at the moment. We also have doctors who visit vernacular channels to offer professional advice and encourage women to go for breast, cervical cancer screening. Annually the global community Kenya included always celebrates cancer awareness day and most hospitals and private doctors offer free screening for women.

These conditions have been attributed to fertility issues among women. Has Kenya come up with policy and guidelines on treatment options such as IVF as well as adoption services such as surrogacy?

IVF bill had been captured earlier under the reproductive health care bill 2014, which has been discussed in parliament. Amendments were made and it became the assisted reproductive technology bill, 2016. It was passed in parliament on 10th march 2016 and endorsed for presentation to the senate. The bill has been in senate to date. Another draft document that caters for IVF and surrogacy in Kenya was sent to senate health committee by the Kenya obstetrics & gynecology society in partnership with fertility & andrology society of Kenyan this year 2020 but there hasn’t been discussions yet.

The biggest concern from women dealing with these conditions is the cost implication. Are there measures in place in the medical field to try and make diagnosis and treatment affordable? Are government facilities equipped to help women who cannot afford private care?

Government facilities have the required personnel and equipment’s to diagnose these conditions. Unfortunately, most Kenyan’s have been stereotyped to think government hospitals lack these services. The cost of services offered is subsidized in government institutions compared to private institutions. We advise all Kenyans to be registered with NHIF as this will assist when they are paying for any services offered as an impatient in all government hospitals.

Is the government making efforts to focus on these conditions? both in policy or health care access for women even in the remote areas?

All subcounty and county hospitals have the personnel a medical officer and a gynecologist who are adequately trained to diagnose these conditions.  These hospitals are also equipped to perform surgery and treat above conditions.

What is the future of care and treatment in the area of fibroids, PCOs and endo?

The future for care in these conditions is minimal invasive surgery or laparascopy/ key hole surgery. This is where we make very small incisions on a women’s tummies to remove fibroids or diagnose endometriosis by directly looking inside her abdomen and removing a small tissue to be taken to the lab for histology. We also have interventional radiology as an upcoming field whereby for women with fibroids we block the blood vessels suppling the uterus with blood and this results to shrinkage of fibroids.

Dr. Ikol Adungo Allan is a consultant obstetrician and gynaecologist at Kenyatta National Hospital

 

This month, EVE is focusing on reproductive health, you can follow the conversation and content on https://www.standardmedia.co.ke/evewoman/topic/reproductive-health.

Are you suffering from endometriosis, fibroids or PCOS? You can share with us or send your questions on [email protected] or inbox us on Facebook (@evewoman) or Instagram (@evewomankenya).