Management of Fibroids in Resource-Limited Settings

  • Bassam Nusair
  • Maher Maaita
  • Omar Taso
  • Anas Almasaleha
  • Ibrahim A. Abdelazim
  • Mohannad Abu Faza
Uterine Fibroids (N Narvekar, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Uterine Fibroids


Purpose of Review

Uterine fibroids (leiomyomas) are the commonest pelvic tumors in women worldwide. The presenting symptoms are variable and can have a devastating impact on the life of women. Most fibroids are asymptomatic. If symptomatic, the symptoms depend on the location and size of the fibroid. Accurate diagnosis is possible when proper diagnostic modalities and experts are available and accessible. Management of fibroids depends on the availability of health care options.

Recent Findings

The purpose of this review is to address the treatment options and extent of the problem in settings where there is scarcity of health resources. This article reveals that limited data are available regarding the prevalence, treatment, and extent of the management of uterine fibroids in such settings. Myomectomy is the most common procedure used for fibroids’ treatment and it can be done during cesarean sections under certain circumstances. Medical treatment and new technologies of fibroids treatment are rarely available for use.


Management and treatment of fibroids needs continuous efforts in research and innovation into finding cost-effective solutions. Media should play a major rule in increasing the awareness of the problem among women. On the other hand, training programs for health care providers, midwifes, and gynecologists will help in reducing morbidity and mortality in women with fibroids in resource-limited settings.


Uterine fibroid Leiomyoma Myomectomy Hysterectomy Resource-limited settings 


Compliance with Ethical Standards

Conflict of Interest

Bassam Nusair, Maher Maaita, Omar Taso, Anas Almasaleha, Ibrahim A. Abdelazim, and Mohannad Abu Faza declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Unkels R (2012). A textbook of gynecology for less-resourced locations. Retrieved from
  2. 2.
    Nusair B, Al-Gudah M, Chodankar R, Abdelazim IA, Abu Faza M. Uterine fibroid mapping. Curr Obstet Gynecol Reports, 5:2. 2016:73–80.Google Scholar
  3. 3.
    Awoleke JO. Myomectomy during caesarean birth in fibroid-endemic, low-resource settings. Obstet Gynecol Int. 2013;2013:1–6.CrossRefGoogle Scholar
  4. 4.
    Bouwsma EVA, Hesley GK, Woodrum DA, Weaver AL, Leppert PC, Peterson LG, et al. Comparing focused ultrasound and uterine artery embolization for uterine fibroids—rationale and design of the fibroid interventions: reducing symptoms today and tomorrow (FIRSTT) trial. Fertil Steril. 2011 Sep;96(3):704–10.Google Scholar
  5. 5.
    Mutai JK, Vinayak S, Stones W, Hacking N, Mariara C. Uterine fibroid embolization for symptomatic fibroids: study at a teaching hospital in Kenya. J Clin Imaging Sci. 2015 Mar 31;5:18.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Women’s Health. 2014;(6):95–114.Google Scholar
  7. 7.
    Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017 Sep;124(10):1501–12.CrossRefPubMedGoogle Scholar
  8. 8.
    Stewart EA, Nicholson WK, Bradley L, Borah BJ. The burden of uterine fibroids for African-American women: results of a National Survey. J Women's Health (Larchmt). 2013 Oct;22(10):807–16.CrossRefGoogle Scholar
  9. 9.
    Butt JL, Jeffery ST, Van der Spuy ZM. An audit of indications and complications associated with elective hysterectomy at a public service hospital in South Africa. Int J Gynaecol Obstet. 2012 Feb;116(2):112–6.Google Scholar
  10. 10.
    Yao Kwawukume E. Caesarean myomectomy. Afr J Reprod Health. December, 2002;6(3):38–43.CrossRefPubMedGoogle Scholar
  11. 11.
    Wallach EE. Myomectomy. In: JD Thompson and JA rock (Eds.). Te Linde's operative Gynaecology. New York: JB Lippincott company, 1992, 647–662.Google Scholar
  12. 12.
    Agboola A., “Tumours of the corpus uteri,” in Textbook of Obstetrics and Gynaecology for Medical Students, A. Agboola, Ed.,pp.235–247,UniversityServicesEducational,Lagos,Nigeria,1stedition,1988.Google Scholar
  13. 13.
    •• George AV, Allaire C, Laberge P-Y, Leyland N. The management of uterine leiomyomas. J ObstetGynaecol Can. 2015;37(2):157–78. It provides a very good review of the pathophysiology, prevalence, and clinical significance of fibroids and the latest available treatment modalities. Google Scholar
  14. 14.
    Patricia Sealy. FIBROIDS: A silent health problem affecting women in Trinidad and Tobago. Journal of the Department of Behavioural Sciences. Vol. 2, (1), December 2012.Google Scholar
  15. 15.
    Parker WH. Uterine myomas: management. Fertil Steril. August 2007;88(2):255–71.CrossRefPubMedGoogle Scholar
  16. 16.
    Aymara Mas, Marta Tarazona, Joana Dasí Carrasco, Gloria Estaca, Ignacio Cristóbal, Javier Monleón. Updated approaches for management of uterine fibroids. Int J Womens Health 2017; 9: 607–617.
  17. 17.
    • Ndububa VI. Uterine fibroids: experience with 100 myomectomies in Orlu, South East Nigeria. Port Harcourt Medical Journal Sep-Dec 2016,Vol.10, Issue 3, 124–129. It provides the real facts about fibroids treatment in resource-limited settings. Google Scholar
  18. 18.
    Boosz AS, Reimer P, Matzko M, Römer T, Müller A. The conservative and interventional treatment of fibroids. DtschArztebl Int. 2014;111(51–52):877–183.Google Scholar
  19. 19.
    Ezeama CO, Ikechebelu JI, Obiechina NJ, Ezeama NN. Clinical presentation of uterine fibroids in Nnewi, Nigeria: a 5-year review. Ann Med Health Sci Res. 2012;2(2):114–8.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Moroni RM, Vieira CS, Ferriani RA, Candido-dos-Reis FJ, Brito LGO. Pharmacological treatment of uterine fibroids. Ann Med Health Sci Res. 2014 Sep-Oct;4(Suppl 3):S185–92.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Moroni RM, Vieira CS, Ferriani RA, Candido-dos-Reis FJ, Brito LGO Pharmacological treatment of uterine fibroids. Annals of medical and health sciences research. Sep-Oct 2014, Vol 4, Special Issue 3: 185–192.Google Scholar
  22. 22.
    Fernandez H, Schmidt T, Powell M, Costa AP, Arriagada P, Thaler C. Real world data of 1473 patients treated with ulipristal acetate for uterine fibroids: Premya study results. Eur J ObstetGynecolReprod Biol. 2017;208:91–6.CrossRefGoogle Scholar
  23. 23.
    Okezie O, Ezegwui HU. Management of uterine fibroids in Enugu, Nigeria. J ObstetGynaecol. 2006;26(4):363–5.Google Scholar
  24. 24.
    Laughlin SK, Stewart EA. Uterine Leiomyomas: individualizing the approach to a heterogeneous condition. Obstet Gynecol. 2011;117(2 Pt 1):396–403.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Adegbesan-Omilabu MA, Okunade KS, Gbadegesin A. Knowledge of, perception of, and attitude towards uterine fibroids among women with fibroids in Lagos, Nigeria. Scientifica Volume 2014, Article ID 809536, 5 pages.Google Scholar
  26. 26.
    Walker CL, Stewart EA. Uterine fibroids: the elephant in the room. Science. 2005;308:1589–92.CrossRefPubMedGoogle Scholar
  27. 27.
    Steven Nonde. Uterine fibroids, an African problem. African health news, May, 2016.
  28. 28.
    Ifijeh, M. AllAfricanews: Nigeria, US, GE Launch US$20 Million women’s health initiative. Available from:
  29. 29.
    •• South Africa government news agency. New technology to speed up fibroid surgery. Available from: A proof that introducing a new technology for fibroids treatment is positively effective in resource-limited settings.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Bassam Nusair
    • 1
  • Maher Maaita
    • 1
  • Omar Taso
    • 1
  • Anas Almasaleha
    • 1
  • Ibrahim A. Abdelazim
    • 2
    • 3
  • Mohannad Abu Faza
    • 4
  1. 1.Department of Obstetrics and GynecologyRoyal Medical ServicesAmmanJordan
  2. 2.Department of Obstetrics and GynecologyAin Shams UniversityCairoEgypt
  3. 3.Ahmadi Hospital, Kuwait Oil Company (KOC)Al AhmadiKuwait
  4. 4.Department of Obstetrics and GynecologyAhmadi Hospital, Kuwait Oil Company (KOC)Al AhmadiKuwait

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