Uterine fibroids affect more Nigerian women than almost any other group on earth. Studies consistently place the prevalence of fibroids among Nigerian women between 35 and 50 percent by age 40. Yet the majority of Nigerian women with fibroids go undiagnosed for years, often dismissing symptoms as normal period problems or attributing them to spiritual causes.
This matters because fibroids, though almost always non-cancerous, can significantly affect quality of life, fertility, and pregnancy outcomes when left untreated. The window for conservative, minimally invasive treatment is widest when fibroids are caught early.
What Are Uterine Fibroids?
Uterine fibroids — also called leiomyomas or myomas — are benign tumours that grow from the smooth muscle tissue of the uterus. They are not cancer and they almost never become cancer. They range in size from a grain of rice to, in some untreated cases, the size of a watermelon. Fibroids are classified by location: submucosal (inside the uterine cavity), intramural (within the uterine wall), and subserosal (on the outer surface). Location determines symptoms more than size alone.
Warning Sign 1: Abnormally Heavy Periods or Periods That Last Too Long
Heavy menstrual bleeding is the most common symptom of uterine fibroids and the one most frequently dismissed as normal. Medically, heavy menstrual bleeding is defined as soaking through a pad or tampon every one to two hours for several consecutive hours, passing large clots, or having periods that last longer than 7 days consistently. Submucosal fibroids cause the heaviest bleeding because they disrupt the uterine lining and prevent the uterus from contracting properly to control blood loss.
Chronic heavy bleeding from fibroids frequently causes iron deficiency anaemia, producing fatigue, dizziness, shortness of breath, and pale appearance. Many women are treated for anaemia repeatedly without anyone investigating why it keeps returning.
Warning Sign 2: Pelvic Pressure or Feeling of Fullness in Your Lower Abdomen
As fibroids grow, they create pressure within the pelvis. Women often describe a constant sense of heaviness, bloating, or pressure in the lower abdomen — similar to feeling full even without eating, or something sitting low in the belly. This pressure is different from menstrual cramps, which are cyclical and time-limited. Fibroid-related pelvic pressure is often present throughout the month. Larger fibroids can cause visible abdominal distension, sometimes mistaken for pregnancy or weight gain before a scan reveals fibroids.
Warning Sign 3: Painful Periods That Were Not Always This Bad
Progressive worsening of menstrual pain — periods that were manageable at 20 becoming debilitating at 28 or 32 — is a warning sign that something has changed. Fibroids cause painful periods through distortion of the uterus, cramping as the uterus attempts to expel submucosal fibroids, and large clots that are painful to pass. Pain that requires prescription-strength painkillers, prevents normal daily activity, or is significantly worse than it was 2 or 3 years ago warrants investigation.
Warning Sign 4: Frequent Urination or Difficulty Emptying Your Bladder
Fibroids growing on the front wall of the uterus press against the bladder, reducing its capacity and causing a persistent urge to urinate even when the bladder is not full. Women describe needing to urinate every 30 to 60 minutes, being unable to sleep through the night, and feeling unable to fully empty the bladder. In Nigeria this symptom is almost always attributed to a urinary tract infection and treated with antibiotics — repeatedly — because antibiotics cannot resolve a structural compression problem. Fibroids pressing on the bowel can similarly cause constipation and rectal pressure.
Warning Sign 5: Pain During Sex
Pain during sexual intercourse — particularly deep penetration — is caused by fibroids through direct pressure, distortion of pelvic anatomy, and pelvic congestion from increased blood flow. This symptom is frequently not reported due to cultural attitudes around discussing sexual discomfort. If sex that was previously comfortable has become consistently painful, particularly with deep penetration, a pelvic scan is warranted.
Warning Sign 6: A Visible or Palpable Lump in Your Abdomen
Large fibroids can sometimes be felt as a firm, non-tender mass in the lower abdomen, particularly when lying flat. In some cases the fibroid is visible as an asymmetric bulge. This indicates a fibroid has grown significantly. While still non-cancerous in the vast majority of cases, a fibroid large enough to be felt or seen externally requires prompt gynaecological assessment and imaging.
Warning Sign 7: Repeated Miscarriages or Difficulty Getting Pregnant
Fibroids affect fertility when they distort the uterine cavity or block the fallopian tubes. Women who have experienced two or more unexplained miscarriages, or who have been trying to conceive for 6 to 12 months without success, should have a pelvic scan as part of their fertility workup. Treating submucosal or intramural fibroids before attempting conception — where indicated — significantly improves outcomes.
Why Nigerian Women Are Diagnosed Late
Several factors delay fibroid diagnosis in Nigeria: cultural normalisation of heavy periods, financial barriers to ultrasound scanning, attribution of symptoms to spiritual causes, and inadequate primary care screening. Fibroids are detectable on routine pelvic examination and ultrasound. In settings where these are performed routinely, fibroids are caught early.
Diagnosis: What to Expect
Fibroids are primarily diagnosed by pelvic ultrasound — a simple, painless scan that takes 15 to 30 minutes. Transvaginal ultrasound provides more detailed imaging and is the gold standard for detecting small submucosal fibroids. In some cases an MRI scan is requested to characterise multiple fibroids before treatment planning.
Treatment Options Available in Nigeria
Not all fibroids require treatment. Small fibroids that are not causing symptoms can simply be monitored with annual scans. Treatment options include:
Medication: Hormonal medications can temporarily shrink fibroids and control bleeding. Tranexamic acid and mefenamic acid help control heavy bleeding without addressing the fibroid itself.
Myomectomy: Surgical removal of fibroids while preserving the uterus. The preferred treatment for women who wish to maintain fertility. Available at most teaching hospitals in Nigeria.
Hysterectomy: Surgical removal of the uterus. Definitive cure for fibroids, appropriate for women who have completed their family and have severe symptoms.
Uterine Fibroid Embolisation (UFE): A minimally invasive procedure that cuts off blood supply to fibroids, causing them to shrink. Available at select centres in Lagos and Abuja.
When to See a Gynaecologist
See a gynaecologist if your periods are soaking through a pad every 1 to 2 hours on heavy days, you are passing large blood clots, periods last longer than 7 days, you have pelvic pressure or pain outside your period, sex has become consistently painful, you have been trying to conceive for 6 months or more without success, you have a visible or palpable abdominal mass, or you have had two or more miscarriages. A pelvic scan and full blood count are the starting point. Fibroids are common. They are treatable. The earlier they are found, the more options you have.