The Chemical Pathology of Leiomyoma

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Uterine leiomyomas or fibroids are a major public health problem among women, occurring more frequently in women of reproductive age and are associated with diverse symptoms. In spite of the frequency with which fibroids occur, their biology is poorly understood. Studies indicate that oestrogen and progesterone play a role in the regulation of tumour growth, and there is increasing evidence that this response may be mediated via a number of growth factors. The literature regarding predisposing risk factors for development of myomas in Ghanaian women is very limited by the paucity of studies available. This is against the background that Ghana is thought to have a high prevalence of fibroids due to its indigenous black population, since uterine fibroids are more prevalent in black women. Almost all the studies done so far have been on women in the U.S.A or some other developed country where the environmental factors that are thought to influence the development of fibroids are very different from what pertains in the under developed world, particularly, Africa. Against this background, there is the need to investigate the risk factors that are believed to influence the development of fibroids in Ghanaian women. Therefore, the chemical pathology of fibroids was studied to bridge the gap in information on fibroids between the developed and the under developed world. The specific objectives of this study were to: 1) establish the demographic characteristics of women with fibroids in Ghana. 2) assess the association between fibroid development and growth, and the gynaecologic history of patients. 3) assess the relationship between the life styles of patients and the risk of developing fibroids among Ghanaian women. 4) determine the haematological profile of Ghanaian women with fibroids in relation to the tumour growth and development. 5) assess the impact of fibroids on the renal and liver functions of Ghanaian women with fibroids. 6) assess the association of oxidative stress with the development and growth of fibroids among Ghanaian women. A consecutive study of 200 women with fibroids between the ages of 20 to 40 was done in which questionnaires were designed to elicit information on their socioeconomic background and gynaecologic history. Anthropometric features were also taken and their blood samples analyzed for oxidative stress markers, biochemical, and haematological profiles. Women with obvious hormonal imbalances and chronic or malignant diseases were excluded. Control subjects recruited had similar age distribution as the patients and had been examined to exclude fibroids. Significant difference exist between the patients and the controls in terms of socio-economic characteristics most especially education and income earnings. Abortion, nulliparity, early onset of menarche and history of sexually transmitted diseases were observed to be strongly associated positively with the risk of fibroid development. BMI and waist-to-hip ratios of the patients were significantly higher than those of the controls. The results of the liver and renal function tests of patients were not significantly different from those of the controls and generally showed that both patients and controls had normal liver and renal functions. The patients had higher serum malondialdehyde and lower vitamin C levels compared to the controls. It was observed that most red blood cell indices were higher in the patients compared to the controls. However all other haematological parameters of the patients were not significantly different from those of the controls. Though generally, this study’s findings were similar to what has been observed by previous studies, the observation that higher incidence of abortions, PIDs, and STIs in patients may interplay through mediating hormonal and probably growth factors leading to the development of fibroids is quite novel.
A thesis submitted in fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY In the Department of Molecular Medicine, School of Medical Sciences.