Pattern of fibroid presentation and management in ESUT Teaching Hospital, Enugu: A 5-year review

Abstract

Background: Fibroids are usually under-reported. It is the most common benign pelvic tumors in women. Most women may have uterine fibroids before the age of 45 to 50 years yet, its actual prevalence is unknown. It is much commoner among women of black race and has become a major presenting pathology in many gynaecological clinics. Aim: The aim of this study was to audit the pattern of presentation and the management of uterine fibroids in ESUTH Methodology: This was a 5-year retrospective study conducted in ESUT Teaching Hospital, Enugu. A total of 9,588 folders were retrieved but only 596 had adequate information needed for the study and were used for the study. Data was collected from gynaecology clinics, theatre registers and patient’s case notes using a structured proforma. The data was analyzed using Statistical Products and Service Solutions version 25.0 Results: At the end of the data collection, 9,588 women were seen at the gynaecology clinic over the 5-year period. Out of these, 596 patients diagnosed with uterine fibroids and whose case files contained the requisite information needed for the study were recruited. From the figures above, the prevalence of uterine fibroid in ESUT Teaching Hospital, Enugu, over the period was 6.2%. According to socio-demographic distribution of the patients; majority of them were aged 31-35 years (37.8%), followed by those 36-40 years (34.2%). Very few of them were aged 25-30 years (9.2%). Most of the population studied were of the Igbo ethnic group (81.7%) and majority of them (81%) were nulliparous. The major presenting symptoms among the studied population were heavy menstrual bleeding, (55.4%), abdominal swelling, (54.5%), inability to conceive, (36.4%), abdominal pain, (18.6%), incidental findings (17.8%), and polyps, (9.4%). However, some had more than one presenting complaints. Regarding treatment options, majority (64.4%) had myomectomy, 27.3% had procoagulants like tranexamic acid, 18.8% had progestogens, 18% had NSAIDs for pain and bleeding, 9.4% had polypectomy, 8.6% had GNRH-analogue, while only 1% had hysterectomy. However, 19% did not receive any treatment, while many receive more than one treatment. There were varying degrees of influence by age and parity on the clinical presentations and treatment options accepted by the patients. Conclusion: The prevalence of uterine fibroid was found to be more among nulliparous women aged 24 to 30 years. A significant number presented with menorrhagia and inability to conceive. Majority of them chose myomectomy as an option of treatment.