Being overweight, not having children, or experiencing heavy menstrual bleeding are among the factors that increase a woman’s risk of developing uterine fibroids—non-cancerous growth in or around the womb. In Rwanda, the condition is underdiagnosed, with some women unaware they are living with it. ALSO READ: 30% of women get fibroids, but few know about them According to Dr. Kenneth Ruzindana, a consultant at Kigali University Teaching Hospital (CHUK), these growths, common among women aged 30 to 50, are often only discovered during routine checkups. He explained that fibroids are composed of muscle and fibrous tissue, and these growths can range from tiny nodules to large masses as large as a watermelon. ALSO READ: When to worry about uterine fibroids “They are particularly common among Black women, being more prone. While exact statistics for Rwanda are unavailable, research from neighbouring countries indicates that over half of women will develop fibroids at some point in their lives,” he said. He noted that many women in Rwanda live with fibroids unknowingly. Often, fibroids are discovered incidentally during medical visits such as antenatal care checkups, when the women had no prior knowledge of their condition. Dr. Shakhnoza Abdukhalilova, a gynecologist in Kigali, said that the patients she receives fall into two categories, those who always go for preventive examinations and get tested regularly, and those who come only when they already have symptoms. “I am in favor of women taking care of their health and coming for preventive examinations once a year,” she said. Causes Dr. Ruzindana explained that the exact cause of uterine fibroids is unclear, but reproductive hormones, especially estrogen and progesterone, are known to play a crucial role in their growth. Certain risk factors increase the likelihood of developing fibroids. He added that women of African descent, for example, tend to develop fibroids at a younger age compared to others. A family history of fibroids, such as having a mother or sister affected, also raises the risk. Other risk factors, he said, include being overweight and not having children. Early onset of menstruation is another factor linked to increased chances of fibroids. Also, low vitamin D levels, often due to limited sun exposure, have been associated with fibroid development. Dr. Ruzindana added that symptoms vary widely among women; for instance, some may carry large fibroids with few or no complaints, while others with smaller fibroids may experience discomfort. The difference depends largely on the fibroids’ size, location, and a person’s body sensitivity. Why are some women more affected than others? “Two main factors influence the severity of symptoms, for example, size and location of the fibroids. Larger fibroids generally cause more pain or pressure, however, fibroids located inside the womb tend to cause heavy menstrual bleeding, while those growing outside the womb may press on adjacent organs like the bladder or bowel, triggering symptoms related to those organs,” he noted. The consultant added that when fibroids press on the bladder, women may experience frequent urination or a sudden urge to urinate, and pressure on the bowel can lead to constipation. He noted that some women’s bodies react more strongly even to small fibroids, resulting in symptoms despite the fibroids’ small size. Symptoms Not all fibroids cause symptoms; many women remain asymptomatic and live healthy lives without knowing they have fibroids. However, as fibroids grow, or depending on their location, symptoms can develop. The most common forms are linked to menstruation, Dr. Ruzindana explained. “Heavy or painful periods are usual complaints as women may report bleeding heavy enough to soak through sanitary pads quickly or having periods lasting more than seven days. Some describe needing to change pads during the night due to continuous bleeding,” Dr. Ruzindana said. According to Dr. Abdukhalilova, normal menstrual bleeding volume is around 30–50 milliliters (two–three tablespoons) over the entire period, which usually lasts three–eight days. However, some women may bleed slightly more or less and still be within the healthy range. The bleeding is often heaviest in the first couple of days and then gradually decreases. World Health Organization (WHO) states that abnormal uterine bleeding occurs more frequently than every 21 days or less frequently than every 35 days, bleeding that lasts longer than seven days, or excessive volume over 80 mL per cycle, or bleeding that interferes with a woman’s physical, emotional, social, or daily quality of life. Dr. Ruzindana added that pelvic pain or pressure is another frequent symptom. Women often feel a heaviness or swelling in the lower abdomen or pelvis, accompanied by persistent pelvic pain that does not resolve. “Pain during sexual intercourse is another concern for some women. Fibroids pressing on the vaginal wall or cervix can cause discomfort or pain, which may affect intimacy and relationships. Fertility challenges are also linked to uterine fibroids. Some fibroids block the fallopian tubes or change the shape of the uterus, making conception difficult or increasing the risk of miscarriage. Women with fibroids inside the womb may experience recurrent pregnancy losses, particularly during the first trimester,” Dr. Ruzindana stated. Impact on women’s lives He added that while some women experience no symptoms, many suffer from pain, heavy bleeding, and fertility difficulties that disrupt daily life. Heavy and prolonged bleeding often means changing pads or tampons every two hours and passing large blood clots. This can lead to anemia, a low blood count condition causing fatigue, weakness, dizziness, and pale skin. Women with anemia may struggle to work, care for their families, or participate in community activities due to exhaustion. Dr. Ruzindana said that pain and pressure from fibroids can disrupt routine activities such as walking, standing, or sitting, often accompanied by lower back and leg pain, adding that urinary symptoms like frequent urges and incomplete bladder emptying add to the discomfort. Pain during sex may cause women to avoid intimacy, potentially causing marital stress or relationship difficulties, which can in turn affect sexual satisfaction, confidence, and emotional well-being, he added. He also mentioned that fertility issues further impact women’s well-being as fibroids that block fallopian tubes or distort the uterus complicate conception and pregnancy. Women may try for years without realizing fibroids contribute to their infertility or recurrent miscarriages. Pregnancy with fibroids can bring complications such as early labor, abnormal fetal positioning, or severe pain.
