‘Uterine fibroids surgery requires preoperative care to reduce complications’

Uterine fibroids—non-cancerous growths in the womb—remain a major reproductive health challenge for women globally, particularly in Africa, where prevalence rates are among the highest in the world. In Nigeria, studies suggest that 17.9 to 26 per cent of women of reproductive age are affected by fibroids, with the condition accounting for a substantial portion of gynecological consultations and a significant number of hysterectomy cases nationwide.

While fibroids are rarely life-threatening, their symptoms—including heavy menstrual bleeding, pelvic pain, and pressure on surrounding organs—can severely affect quality of life. Fertility complications, including miscarriage and preterm birth, also make fibroids a critical issue for women seeking to start or expand their families. In severe cases, surgical intervention becomes necessary, yet surgery itself carries significant risks if not carefully managed.

The tragic story of Mr. Samuel Eze, who lost his wife in 2023 following fibroid surgery in Lagos, underscores the human cost. His wife, in her forties, had suffered multiple miscarriages and opted for surgery to increase her chances of childbirth. Despite the medical team’s efforts, she succumbed to bleeding complications during the procedure. “If I knew my wife would not survive the surgery, we wouldn’t have gone ahead with it,” Eze recalled. “But she insisted on having the surgery to have her own children.”

Medical experts note that complications from fibroid surgery can range from haemorrhage and injury to surrounding organs, to anesthesia-related risks and infections. Prof. Oliver Ezechi, Director of Research at the Nigeria Institute of Medical Research (NIMR) and professor of Maternal, Reproductive and Child Health at Lead City University, Ibadan, emphasised that many of these risks are preventable. “Pre-operative assessment before surgery is key to identifying potential complications,” he said.

According to Ezechi, women typically opt for fibroid surgery to alleviate heavy bleeding, severe pelvic pain, suspected malignancy, or fertility issues. However, he stressed that mortality from fibroid surgery can often be averted through advanced treatments and thorough preoperative preparation. “Beyond surgery, other effective treatments include hormonal therapies like GnRH agonists, which help shrink fibroids and manage symptoms, and uterine artery embolization, which blocks blood supply to fibroids, causing them to shrink,” Ezechi explained. “There’s also MRI-guided focused ultrasound, a non-invasive method that uses ultrasound to destroy fibroid tissue, and endometrial ablation, which removes the uterine lining to reduce heavy bleeding.” The choice of treatment, he noted, should be individualised, taking into account a patient’s overall health, reproductive goals and personal preferences.

Dr. James Odofin, a consultant obstetrician and gynecologist at the Federal Medical Centre, Ebute Metta, highlighted another crucial factor: underlying medical conditions. “Most surgical complications aren’t always due to the surgical procedure itself,” Odofin said. “They can be exacerbated by pre-existing conditions such as hypertension or chronic illnesses. That’s why thorough preoperative evaluation and optimisation of a patient’s health are essential.”

Odofin explained that while emergency procedures like cesarean sections can often be performed with basic investigations, elective surgeries such as fibroid removal require comprehensive preoperative workups. “Even a simple procedure can become high-risk if underlying health issues aren’t identified and addressed beforehand,” he said.

Experts also cited late presentation as a critical challenge in Nigeria. Cultural aversion to surgery, combined with limited access to quality care, often leads patients to seek help only when symptoms become severe, increasing the likelihood of complications. Both Ezechi and Odofin urged women to seek timely medical attention from competent specialists and to be fully informed about the procedure and its risks.

Government intervention, experts argue, is equally important. Expanding access to advanced treatment options, increasing public awareness, and integrating preventive care into primary health services could dramatically reduce complications and mortality associated with fibroid surgery. “Availability of non-invasive alternatives and minimally invasive techniques should be prioritised in healthcare planning,” Ezechi emphasised.

In addition to medical advancements, public education remains crucial. Women must understand that fibroids are common, manageable, and rarely cancerous, and that early intervention can prevent severe outcomes. Incorporating routine fibroid screening into reproductive health services, alongside counseling on treatment options, could save countless lives. Ultimately, reducing complications from fibroid surgery requires a multifaceted approach: robust preoperative evaluation, informed patient choice, advanced treatment availability, and systemic improvements in healthcare delivery. With sustained effort from healthcare providers, policymakers, and communities, many of the tragic outcomes associated with fibroid surgery can be prevented, allowing women to pursue both reproductive health and quality of life safely.