Causes, Symptoms And Treatment Of Enlarged Uterus

 

A women’s uterus is the size of a clenched fist but can grow as big as a soccer ball or larger during pregnancy. In addition to pregnancy, there are many other reasons why a woman’s uterus may become enlarged.

An enlarged uterus can be the result of a medical condition that not only causes it to grow but also to bleed and become painful. A condition that results in an enlarged uterus may require treatment.

Causes and risk factors

A woman can be unaware that she has an enlarged uterus. Most often, women discover they have a problem during a pelvic exam.

It is possible a woman may notice a bloated belly or that clothes seem too tight, but for most, a diagnosis of an enlarged uterus is unexpected.

There are multiple reasons why the uterus may become enlarged. An enlarged uterus may be more common in menopausal women, but women in their childbearing years can develop this condition too.

Fibroids

Fibroids are one of the most common causes of an enlarged uterus. Fortunately, fibroids are noncancerous. Fibroids are small lumps that can weigh up to several pounds. They are found along the walls of the uterus.

According to the Office on Women’s Health (OWH) of the U.S. Department of Health and Human Services, between 20 or 80 percent of women develop fibroids before the age of 50. They are most common in women who are in their 40s and early 50s.

Fibroids may be asymptomatic, or may cause pain and heavy menstrual cycles.

Fibroids also put pressure on the bladder and the rectum, causing frequent urination and rectal pressure. If they get too big, fibroids may cause the uterus to become enlarged.

Adenomyosis

Adenomyosis is a noncancerous condition that mimics symptoms of fibroids. It results in the lining of the uterus becoming embedded directly in the muscle wall of the uterus. During the menstrual cycle, the cells of the muscle bleed, causing pain and swelling.

The adenomyoma is the swollen part of the uterine wall. Upon examination, the adenomyoma feels like a fibroid, and it may even be confused with one on an ultrasound.

Adenomyosis may not cause any symptoms. In other severe cases, it can lead to heavy bleeding and cramping during menstruation.

One study of 985 women reported in the medical journal Human Reproduction found that adenomyosis was present in approximately 20 per cent of participants.

However, all participants in the study had attended a gynecology clinic with existing symptoms. It is possible, then, that the prevalence of adenomyosis is higher in the general population.

Polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) also causes an enlarged uterus. It is the result of hormonal imbalances in menstruation and the shedding of the endometrial lining of the uterus. It affects 1 in 10 women of childbearing age, according to the OWH.

The body typically sheds the endometrial lining during the menstrual cycle, but in some women, the lining is not entirely discarded and interferes with their monthly cycle.

The accumulation of the endometrial lining causes inflammation and enlargement of the uterus.

Endometrial cancer

According to the National Cancer Institute (NCI), endometrial cancer is most often diagnosed in women ages 55 to 64. The NCI estimates there will be 61,380 new cases in 2017.

One of the symptoms of endometrial cancer is an enlarged uterus, although it can also be an indicator of advanced stage cancer.

FG Commits Over N4bn Towards Humanitarian Projects In North-East

Chioma Umeha

The Federal Government through the Ministry of Health has spent over   N4 billion over the humanitarian crisis in the North-East region of Nigeria.

A statement signed  by Boade Akinola, Director, Media and Public Relations, Federal Ministry of Health, Prof. Isaac Adewole, the Minister of Health made the statement during the Commemoration of the 2017 World Humanitarian Day in Abuja, recently.

Prof. Adewole noted that four billion naira was used in purchasing relief materials including drugs and medical consumables, hospital equipment, capacity building and deployment of volunteer health workers.

He added that a two-pronged approach was adopted solely to provide basic medical services to the affected population and strengthen the pillars of the health system.

He affirmed that the Federal Ministry of Health has responded to the humanitarian situation within Nigeria by strengthening the Special Project Department and appointing a Substantive Director to coordinate health related response to the on- going humanitarian crisis within the country.

He pointed out that the on –going humanitarian crisis was unprecedented and protracted with Borno State as the epicentre ,adding that a broad North – East Health Sector  Humanitarian Crisis Response Strategic Plan (NEHSHRSP) was developed with a primary objective of repositioning the health system within the region, he said.

He informed that there was a Rapid Response Team tasked with the responsibility to develop a six month health and nutritional plan in Borno State to address the rapid decline in health and nutritional indices being experienced, adding that the plan was developed, approved, implemented and now been extended by another six months due to the giant strides achieved such as increased access to quality healthcare to communities.

He enumerated the achievements of the project which included diagnosis and treatment of about 15,000 cases of malaria in host communities and IDP camps and others.

Investment In Rural Water Supply Will Curb Diarrhoea Diseases - UNICEF

Lagos – Nigeria can reduce outbreak of diarrhea and other diseases associated with contaminated water by dedicating one per cent of the national budget to rural water supply, the United Nations Children’s Fund (UNICEF) has said.

The United Nations(UN) agency for children further  tasked governments across the  Niger Delta states to invest consciously in the provision of safe water supply and sanitation for its rural populace.

The provision of such basic social amenity, according to UNICEF would encourage handwashing and other hygienic practices among school-age children and rural populace.

The international agency stated this at a ‘WASH’ media  meeting by the Federal Ministry of Information in collaboration with UNICEF in Uyo the Akwa Ibom State capital on Tuesday, noting that the chemical contaminations resulting from oil and gas exploration in the Niger Delta region has made it necessary for efforts to be made to ensure safe and constantly checked water for human consumption.

Mr. Moustapha Niang, a ‘WASH specialist,’ in his presentation, ‘Water, supply and quality in the Niger Delta’,  emphasized on the need for proper orientation of the rural populace to adopt attitude change and embrace water safe plan, from water source, storage to point of use.

He urged government at all levels to ensure provision of public toilet in public facilities as a means to discourage open defecation and consequences associated with it.

Niang also recommended constant monitoring of water quality to detect contamination, while encouraging the establishment of a water sanitation committee in all communities across the region,.

“Prioritize the potential hazards and mitigate such hazards through the entire water chain to ensure that water reaching the consumer is safe and acceptable. Develop their community plan. Avoid for citing potable water source around nearby latrines and areas fertilized for agricultural purposes,” he said

Martha Hokonya, also a WASH specialist,  in her presentation – ‘Why invest in water supply’  said such investment  in addition to job creation, reduces diseases and mortality rate, improves  productivity and also provides time for women to engage in other activities like child care and others activities which brings women together.

Hokonya said as an area prone to youth restiveness, the essence of bringing the wash programme to the Niger Delta region was to address one of the agitations of the region, reduce conflicts and agitation and promote good hygiene.

While reporting that about 206,954 additional people have been reached with the WASH programme as against the targeted 543,000, she used the occasion to applaud some Niger Delta states which have lived upto their counterpart fundings arrangement, but however appealed to states yet to do so to step up to enable UNICEF do more.

Addressing the meeting, Nse Edem,  the Permanent Secretary, Akwa Ibom State  Ministry of Political, Legislative Affairs and Water Resources, said that  the State is committed to the provision of safe water for the people of the state and is ready  to partner UNICEF.

Register Early For Antenatal To Prevent Malaria In Pregnancy - Researchers Tell Mothers

Chioma Umeha

Malaria is highly endemic in Nigeria and poses a major challenge to human development.

Pregnant women, especially ‘primigravidas’ that is a woman who is pregnant for the first time are particularly at risk.

The disease may not only account for up to 15 per cent of anemia in pregnancy, it cause

s miscarriages, premature births and low birthweights in newborn babies.

In view of this, researchers and stakeholders have restated the need for early commencement of antenatal care by pregnant women.

According to them, this aids early diagnosis and prompt treatment of malaria in pregnant women as well as uptake of Intermittent Preventive Treatment in Pregnancy (IPTp).

Making the recommendations during a recent media chat on “Malaria In Pregnancy,” they stressed that regular and appropriate use of Long Lasting Insecticidal Nets (LLINs) help to prevent malaria in pregnant women.

The event was jointly organised by the National Media Elimination Programme (NMEP) and the Health Writers Association of Nigeria (HEWAN) at the National Institute of Medical Research (NIMR) in Lagos.

The health experts drawn from World Health Organisation (WHO), NMEP and NIMR gave detailed presentations on management and effective control of malaria during pregnancy.

Speaking at the media parley, Dr Tolu Arowolo of the WHO emphasised the importance of early Antenatal Care (ANC), and insisted that booking and administering of IPTp are critical in preventing malaria during pregnancy.

“IPTp is based on the assumption that every pregnant woman living in an area of high malaria transmission has malaria in her blood stream or placenta, whether or not she has symptoms of malaria.

“A pregnant woman is supposed to receive a minimum of three doses of SP before delivery.

“They should also sleep under LLINs because it is also an intervention against malaria,” she said.

Arowolo said that good nutrition was also critical during pregnancy as it helped to nourish the mother and foetus, as well as boost the immune system.

Also, Itohowo Uko, the Head of Advocacy, Communication and Social Mobilisation in NMEP, also enjoined women to report for ANC immediately they realised they are pregnant.

Uko also said that following uptake of IPTp, 37 per cent of pregnant women took two doses of Sulphadoxine Pyrimethamine (SP) according to 2015 Nigeria Malaria Indicator Survey (NMIS).

Sulphadoxine Pyrimethamine is a recommended medicine for malaria prevention for pregnant women in Nigeria.

This should be taken at least once during an ANC visit. 

Noting that the uptake of SP is significantly low based on NMIS 2015, she charged women to exercise their right of demanding for at least for three doses of SP during pregnancy based on recommendation.

She further clarified that each dose should be taken one month apart.

Dr. Bartholomew Odio, a gynaecologist, urged people, especially pregnant women to always request for testing before the treatment of malaria fever.

Odio, who is the Malaria Technical Advisor with Jhpiego Nigeria, an affiliate organisation to John Hopkins University, U.S, advised them to always demand to know the drugs that were given to them.

Participants at the training were worried that despite the effectiveness of LLINs in preventing malaria and widespread accessibility to it, there are many cases of low and incorrect usage of LLINs in Nigeria, thereby reducing its ability to protect pregnant women against malaria.

They advised all pregnant women to sleep inside LLIN every night.

Earlier, the Dr Audu Mohammed, National Coordinator of NMEP, urged the media to collaborate with it on malaria control, care and prevention in Nigeria.

According to the organisation, collaboration with HEWAN would help to achieve the programme’s strategic plan of ensuring total elimination of malaria in Nigeria by 2020.

Mohammed, represented by Dr Joel Akilah, Head of Integrated Vector Management in NMEP, said that the importance of the meeting could not be over emphasised because malaria was a major public health concern in Nigeria

“This is especially when considered against the backdrop of the negative effects of malaria attacks on our social and economic development as a result of absenteeism from schools, offices and farms.

“Over 90 per cent of Nigerians are at risk of malaria while children under-five and pregnant women are seen to be more vulnerable to this disease, hence the focus of this discussion,” he stressed.

Mr. Timothy Obot, representing the Head, Monitoring and Evaluation in NMEP, urged the media to take the lead in providing investigated and researched evidence of the efficacy of recommended malaria prevention strategies.

Responding, Mrs. Chioma Obinna, President, HEWAN, commended the NMEP for its strategic policies and activities toward the elimination of malaria in the country.

“It is important that NMEP is collaborating with the media in the fight to eliminate malaria because the media had the power to reach out to the masses,” she said.

Also, Mr. Sola Ogundipe, a seasoned health journalist applauded NMEP for the initiative.

He said that eliminating malaria in Nigeria, especially in pregnancy was achievable through commitment and collaboration with all stakeholders, as well as Nigerians themselves.

“Deaths from malaria as well as deaths as a result of Malaria in Pregnancy can be reduced to the barest minimum and HEWAN will join in this cause,’’ Ogundipe said.

Men Who Take Alcohol Risk Infertility – Expert

Lagos – Men that take up to 60 per cent alcohol in 48 hours may be at risk of developing abnormal quality of sperm-teratozospermia.

Stating this was Dr. Sharon Osaide, a fertility physician and gynecologist with Rose Du Rouge International Initiative while delivering a lecture recently on health, at the National Youth Service Corps (NYSC) Orientation Camp, Ipaja-Lagos.

Not only did Osaide warn against too much consumption of alcohol, she also warned against unhealthy lifestyle as well as conditions such as smoking and obesity, which she linked to infertility in men and women.

“Men that take up to 60 per cent alcohol in 48 hours would develop teratozospermia otherwise described as abnormal sperm cell. Though they have normal sperm counts, but they would have abnormal quality of sperm.

“Obesity in male and female could lead to infertility, when a woman is obese, they would not ovulate regularly. When a man is obese, he will produce the estrogen hormone rather than the testosterone hormone and the estrogen hormone is the female hormone and after some time the estrogen will inhibit their production and a lot of them would not produce sperm cell anymore.

“Smoking is another cause of infertility, unfortunately a lot of women smoke and women that smoke has 70 per cent more chance of going into early menopause than women that does not smoke, especially women that smoked at early puberty,” she stated.

Osaide continued that the longer a woman smoke the earlier she goes into menopause.

“It is unfortunate today that some women go into menopause at age 42, while our mothers were still menstruating at the age of 52. This is the more reason why we need to make our society better,” Osaide added.

Pharmacists Seeks FG's Respond To Demands Of Health Workers

Ahmed Yakasai, President, Pharmaceutical Society of Nigeria (PSN) is a veteran practitioner with over three decades of experience. Yakasai who is a former Chairman of PSN Kano State Branch, first National Deputy President of PSN and a two-time past Commissioner in Kano State, in this interview with CHIOMA UMEHA, shares perspectives on pharmacy and health management issues. Excerpts:

Nigeria has celebrated 57th years anniversary of independence. What are the challenges of the health sector? What is the way forward?

Nigeria continues to contend with a plethora of challenges not necessarily caused by this incumbent administration. Among numerous challenges, the following stand out: poor funding, delayed and unlawful appointments in regulatory agencies, poor composition structures in the health sector including, lopsided appointments in Federal Health Institutions (FHIs) as well as poor attitude to research and development.

If we restrict ourselves to the highlighted, you will agree that the inherent tendency of health tourism is predicated on poor funding.

Currently, over 95 per cent of the health workforce is on an avoidable strike as a result of challenges in funding. Low wages and obsolete equipment combine to make our health system largely unproductive.

Universal Health Coverage (UHC) is impossible because of deficiently administered social health insurance agenda.

Delays in appointments that are also sometimes unlawful in sensitive regulatory agencies like NAFDAC, PCN and others ultimately take a toll on the quality of care consumers of health receive from caregivers.

An agency like NAFDAC, which normally should enhance a high safety margin in the range of available regulated products, cannot dwell on ad-hoc structures in perpetuity. It can be even more tragic when government conducts unlawful appointments like those we have witnessed in previous dispensations at NAFDAC, PCN, Nursing and Midwifery Council and Medical Laboratory Science Council of Nigeria (MLSCN).

You are familiar with the position of stakeholders in health with reference to the composition of the board of management of FHIs that is unduly skewed against majority of stakeholders. The way forward is to redress the highlighted challenges.

The pharmaceutical sector is an often neglected goldmine, because we have the requisite expertise to share. We can meet over 90 per cent  of local needs and export to other African countries  –  become African hub for pharmaceuticals. It will be my joy to see this actualised in my lifetime for the good of Nigeria.

Pharmacists recently celebrated World Pharmacists Day. What is it all about?

Every September 25 marks the annual World Pharmacists Day(WPD). Many years ago, the FIP Congress in Istanbul encouraged the world’s pharmacists to celebrate the day and use it to organise activities that promote the role of the pharmacists in improving health globally.

The theme of this year’s celebration was, “ From Research To Health Care: Your Pharmacist is at Your Service.” The theme was chosen to reflect the numerous contributions which the pharmacist makes to health, from research and development of medicines to educating future practitioners as well as pharmaceutical scientists, and providing direct care. Our goal is to serve patients and the community. However, providing care does not begin in community or hospital pharmacies. Patients’ care starts with recognising the health issues of populations and developing medicines, policies and education to tackle them.

WPD highlights the pivotal role of pharmacists in healthcare delivery from research to care giving.

Where does the PSN stand in the quest to improve the welfare of health workers in Nigeria, especially against the backdrop of incessant strikes in federal health institutions (FHIs)?

We wish to appeal to the President Muhammadu Buhari-led Federal Government to give immediate attention to the clamours of health workers, including pharmacists to redress some pressing welfare demands. The demands include immediate release of the circular on adjustment of the CONHESS scale by the Salaries and Wages Commission. Second is the full payment of balance of arrears of the skipping of CONHESS 10 which remains outstanding in some FHIs since 2010.

Next is proper implementation of the circular which prescribes sanctions on defaulting Federal Health Institution Managements which frustrate the promotion of health workers from CONHESS 14 to 15 as directors

The fourth is issuance of enabling circular authorising consultancy cadre for health professionals who have adhered to due process by scaling the hurdles of approval of the National Council on Establishment.

Fifth is sponsoring an amendment bill to finally correct the litany of contentious provisions in the enabling statute that establishes teaching hospitals in Nigeria (cap 415 463 LFN 2004).

PSN is appealing to the Federal Government to sustain the lofty ideals of the intervention championed by the late Minister of State for Labour and Productivity, Barrister James Ocholi, who calmed frayed nerves within the ranks of the various Health Sector Unions and Health Professional Associations that had threatened to go on strike in February, last year.

PSN strongly urges JOHESU/AHPA to continue using dialogue as a tool of engaging government in public interest to resolve the ongoing strike.

The PSN believes that now is the time to give all care-providers unlimited latitudes to showcase their potentials, skills and enhance their performance in various areas of specialisation. We must continue to align with the global objectives and targets of health care which places huge premium on all health workers in the value chain.

We call on the Office of the Secretary to Government of the Federation, Head of Service of the Federation, Budget Office, Federal Ministry of Health, Federal Ministry of Labour and Productivity and all others involved in negotiations with JOHESU/AHPA to do everything possible to facilitate urgent end to the ongoing strike of health workers which paralyses the economy and causes untold sufferings on the masses.

What plans are in place to ensure commencement of the amended National Drug Distribution Guidelines (NDDG)?

Stakeholders are collaborating to ensure that the proposed Coordinated Wholesale Centres (CWCs) takes off effectively.

Among the collaborators are Pharmacists Council of Nigeria (PCN), National Agency for Food and Drug Administration and Control (NAFDAC), Federal Ministry of Health and pharmacy stakeholders. These include Pharmaceutical Manufacturers Group of Manufacturers Association of Nigeria (PMG-MAN), Nigerian Representatives of Overseas Pharmaceutical Manufacturers (NIROPHARM), AIDS Prevention Initiative in Nigeria (APIN), Association Of Community Pharmacists Of Nigeria(ACPN) and representative of non-pharmacist wholesalers. The CWCs are already constructed in some parts of the country. You will agree with me this is very strategic to our overall success.

It is my belief that when PCN and NAFDAC structure are fully established, we shall mobilise to consolidate our present level of commitment and gains. The PSN remains committed to effective drug distribution channels and I assure the consuming public we shall not fail in this regard.

The Federal Government has now given the CWCs a new deadline of December 2018 and I must say all stakeholders must ensure a no-going back posture on the deadline.

We have had appointments in most parastatals including some in the health sector, when and what do you expect with notable appointments in the pharmaceutical sector?

It is the prerogative of the Federal Government to carry out these appointments whether at PCN, NAFDAC or National Institute for Pharmaceutical Research and Development (NIPRD) which I believe you are referring to. I however presume that your interest is predicated in public interest, especially in the value such appointments can bring to bear on public health endeavours.

Our first priority is to ensure lawful appointments on all pharmaceutical platforms because we certainly do not envisage or pray for the disruption in equilibrium we experienced at PCN when representatives of PSN was compromised due to a distasteful manipulation by an interested party.

We once had the same scenario at NAFDAC which degenerated to a court action in another dispensation.

To avoid an unpalatable discourse, the PSN has since recommended its representatives to the Minister of Health as provided for in Section 3 (1) F of the PCN Act. The Federal Government is also familiar with the required criteria for the appointments of substantive DG/CEO for NAFDAC.

We shall continue to believe that an administration that abhors corruption as the incumbent government has demonstrated would be seriously mindful of not appointing elements who have antecedents that are tainted with corruption. The protracted delay in the appointment of the DG NAFDAC in particular has encouraged rumour mongering which generates entropy in the pharmaceutical space.

Our profession is at a critical junction because the delayed appointments in the regulatory agencies make us unduly vulnerable to the whims and caprices of merchants of death and other violators of the law.

It is instructive to put on record too that to appoint regulators especially, in our sector should be premised or built around persons who are conversant with the terrain to be regulated. I therefore appeal to the Federal Government to give us lawful and befitting appointments in the pharmaceutical sector in the days and months ahead.

The 90th annual national conference of the Pharmaceutical Society of Nigeria holds in  November  this year at  Umuahia. What do we expect?

This conference has as its theme, “Medicines Availability and National Security.” The Speaker, House of Representatives, Hon. Yakubu Dogara, is expected to declare it open as a special guest of honour, while the Governor of Abia State is chief host. The Minister of Health will be the guest of honour and the occasion would be chaired by Mr. Peter Obi, former Governor of Anambra State.

Our nation needs to develop an efficient manpower base in the quest for self-sufficiency and economic growth. We shall strategise on improving local drug manufacturing, while ensuring all other drugs that will assist in wellness and eradicating life-threatening situations would be available in our health system.

This unique conference will therefore exploit avenues for this much sought after maxims as it concerns the pharmaceutical sector of the economy. It is a peculiar gathering of pharmacists and other scientists nationwide as well as the Diaspora, so you can only expect new positive force to emerge, pharmaceutically speaking after November 11, 2017.