Management of Fibroids in Resource-Limited Settings
- 38 Downloads
Purpose of Review
Uterine fibroids (leiomyomas) are the commonest pelvic tumors in women worldwide. The presenting symptoms are variable and can have a devastating impact on the life of women. Most fibroids are asymptomatic. If symptomatic, the symptoms depend on the location and size of the fibroid. Accurate diagnosis is possible when proper diagnostic modalities and experts are available and accessible. Management of fibroids depends on the availability of health care options.
The purpose of this review is to address the treatment options and extent of the problem in settings where there is scarcity of health resources. This article reveals that limited data are available regarding the prevalence, treatment, and extent of the management of uterine fibroids in such settings. Myomectomy is the most common procedure used for fibroids’ treatment and it can be done during cesarean sections under certain circumstances. Medical treatment and new technologies of fibroids treatment are rarely available for use.
Management and treatment of fibroids needs continuous efforts in research and innovation into finding cost-effective solutions. Media should play a major rule in increasing the awareness of the problem among women. On the other hand, training programs for health care providers, midwifes, and gynecologists will help in reducing morbidity and mortality in women with fibroids in resource-limited settings.
KeywordsUterine fibroid Leiomyoma Myomectomy Hysterectomy Resource-limited settings
Compliance with Ethical Standards
Conflict of Interest
Bassam Nusair, Maher Maaita, Omar Taso, Anas Almasaleha, Ibrahim A. Abdelazim, and Mohannad Abu Faza declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Unkels R (2012). A textbook of gynecology for less-resourced locations. Retrieved from https://www.glowm.com/pdf/Chap-19_Unkels.pdf
- 2.Nusair B, Al-Gudah M, Chodankar R, Abdelazim IA, Abu Faza M. Uterine fibroid mapping. Curr Obstet Gynecol Reports, 5:2. 2016:73–80.Google Scholar
- 4.Bouwsma EVA, Hesley GK, Woodrum DA, Weaver AL, Leppert PC, Peterson LG, et al. Comparing focused ultrasound and uterine artery embolization for uterine fibroids—rationale and design of the fibroid interventions: reducing symptoms today and tomorrow (FIRSTT) trial. Fertil Steril. 2011 Sep;96(3):704–10.Google Scholar
- 6.Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Women’s Health. 2014;(6):95–114.Google Scholar
- 9.Butt JL, Jeffery ST, Van der Spuy ZM. An audit of indications and complications associated with elective hysterectomy at a public service hospital in South Africa. Int J Gynaecol Obstet. 2012 Feb;116(2):112–6.Google Scholar
- 11.Wallach EE. Myomectomy. In: JD Thompson and JA rock (Eds.). Te Linde's operative Gynaecology. New York: JB Lippincott company, 1992, 647–662.Google Scholar
- 12.Agboola A., “Tumours of the corpus uteri,” in Textbook of Obstetrics and Gynaecology for Medical Students, A. Agboola, Ed.,pp.235–247,UniversityServicesEducational,Lagos,Nigeria,1stedition,1988.Google Scholar
- 13.•• George AV, Allaire C, Laberge P-Y, Leyland N. The management of uterine leiomyomas. J ObstetGynaecol Can. 2015;37(2):157–78. It provides a very good review of the pathophysiology, prevalence, and clinical significance of fibroids and the latest available treatment modalities. Google Scholar
- 14.Patricia Sealy. FIBROIDS: A silent health problem affecting women in Trinidad and Tobago. Journal of the Department of Behavioural Sciences. Vol. 2, (1), December 2012.Google Scholar
- 16.Aymara Mas, Marta Tarazona, Joana Dasí Carrasco, Gloria Estaca, Ignacio Cristóbal, Javier Monleón. Updated approaches for management of uterine fibroids. Int J Womens Health 2017; 9: 607–617.
- 17.• Ndububa VI. Uterine fibroids: experience with 100 myomectomies in Orlu, South East Nigeria. Port Harcourt Medical Journal Sep-Dec 2016,Vol.10, Issue 3, 124–129. It provides the real facts about fibroids treatment in resource-limited settings. Google Scholar
- 18.Boosz AS, Reimer P, Matzko M, Römer T, Müller A. The conservative and interventional treatment of fibroids. DtschArztebl Int. 2014;111(51–52):877–183.Google Scholar
- 21.Moroni RM, Vieira CS, Ferriani RA, Candido-dos-Reis FJ, Brito LGO Pharmacological treatment of uterine fibroids. Annals of medical and health sciences research. Sep-Oct 2014, Vol 4, Special Issue 3: 185–192.Google Scholar
- 23.Okezie O, Ezegwui HU. Management of uterine fibroids in Enugu, Nigeria. J ObstetGynaecol. 2006;26(4):363–5.Google Scholar
- 25.Adegbesan-Omilabu MA, Okunade KS, Gbadegesin A. Knowledge of, perception of, and attitude towards uterine fibroids among women with fibroids in Lagos, Nigeria. Scientifica Volume 2014, Article ID 809536, 5 pages.Google Scholar
- 27.Steven Nonde. Uterine fibroids, an African problem. African health news, May, 2016. https://africahealthnews.com/478-2/.
- 28.Ifijeh, M. AllAfricanews: Nigeria, US, GE Launch US$20 Million women’s health initiative. Available from: http://allafrica.com/stories/201603100528.html
- 29.•• South Africa government news agency. New technology to speed up fibroid surgery. Available from: http://www.sanews.gov.za/south-africa/new-technology-speed-fibroid-surgery. A proof that introducing a new technology for fibroids treatment is positively effective in resource-limited settings.