INTRODUCTION:

Uterine fibroids or Leiomyoma are most common pelvic tumours present in women and incidence mostly depends on age and race and one of the most commonly diagnosed gynaecologic conditions among women.⁽¹⁾

Prevalence Rate for Uterine fibroid is approximately 1 in 20 or 5.00% or 13.6 million people globally. It appears that African-American women are much more likely to develop uterine fibroids. If a prevalence of 50% by 50 years of age is accepted, a large number of women have asymptomatic fibroids.⁽²⁾

Fibroids asymptomatic in at least 50% of cases and at least an important cause of morbidity and a common reason for surgery⁽³⁾.

The Symptoms occurs in 1 in 3 women with fibroids were many women are unaware of them. In some cases they are detected during a routine examination or during scan done for other reason.⁽⁴⁾

Leiomyoma symptoms may include heavy or prolonged menstrual bleeding, menstrual pain or cramping, bladder dysfunction, and fatigue.⁽⁵⁾

Aetiology of uterine fibroids are unknown were genetic changes and hormonal changes plays main role⁽⁶⁾. The treatment options for uterine leiomyoma include medication, surgery, myolysis, and uterine artery embolization.⁽⁷⁾

The hormonal treatment such as Oral contraceptives helps in reducing the heavy menstrual bleeding associated with fibroids but they do not reduce the fibroid growth.

Gonadotropin-releasing hormone (GnRH) antagonist blocks the release of reproductive hormones LH (luteinizing hormone) and FSH (follicle-stimulating hormone) that leads in reduction of uterine fibroid volume.

Non hormonal treatment such as antifibrinolytics and NSAIDs are also used as treatment.^.(8)

Hysterectomy is considered as one of the best option for women especially who have children because of its benefits⁽⁹⁾.

Uterine Artery Embolization (UAE) deprives fibroids of their blood supply, causing them to shrink (ischemic fibroid necrosis) where the therapy is not for individual leiomyomas but treating the whole uterus were UAE will be a better alternative to hysterectomy.^(10,11)

Myomectomy is most commonly used option for women who desire to have fertility ⁽¹²⁾ the disadvantage of the Myomectomy is that 50 to 60% of women will present with new fibroids within 5 years after the procedure⁽¹³⁾

Knowledge, perception, and attitude is studied in order to understand the patients Knowledge, perception, and attitude towards the disease were uterine fibroids is one of the major gynaecological problem and hence monitoring the patient regarding disease would enable us to improve patient knowledge.

M. A Adegbeasan-Omilabu et al conducted a study on “knowledge, perception and attitude towards uterus fibroid” and concluded in present study that patient has very poor knowledge on uterine fibroids and most of women are taking an over the counter drugs in order to reduce the growth of fibroids.⁽¹⁴⁾

Atombosoba. A. Ekine et al conducted a study on the common “clinical presentation of uterine fibroid and assess the effect of therapeutic intervention on fertility” were the study shows 29% was uterine fibroids affected in reproductive age group (31-40 years) and also fertility and viable pregnancy could be improved with therapeutic interventions in selected women had an unexplained infertility⁽¹⁵⁾

The main aim of the study was to assess the impact on knowledge, attitude and perception in patient with uterine fibroid. The main objective of study was to assess level of knowledge, attitude and perception in patient with uterine fibroid by evolving a questionnaire and to evaluate the impact on knowledge, attitude and perception in patient with uterine fibroid.

MATERIALS AND METHODS:

The Study was carried out for a period of 9 months in tertiary care hospital

Study Instrument: KAP Questionnaire.

Inclusion Criteria:

i) Women between age group of 30-50years.

ii) Patients diagnosed to have fibroid uterus.

Exclusion Criteria:

Patients with other structural abnormalities of uterus.

Method:

This method involves prospective study analysis of knowledge, attitude and perception in women with uterine fibroids. The study is carried out by the collection and documentation of general information of the patient including personal history, family background, clinical findings, investigations and medical illness associated with uterine fibroids. All enrolled patients will be assessed for knowledge, attitude and perception towards fibroid uterus using suitable KAP questionnaire.

KAP questionnaire:

The questionnaire form contains questions regarding patient knowledge of, attitude of, and perception about the diseases and treatment.

Finally the documented questionnaire is evaluated for the final outcome.

The study was conducted after obtaining informed consent from the patient. This study was approved by the Ethics committee IEC/DOPV/2015/01

RESULTS AND DISCUSSION:

The following results were obtained when the data were collected from patient. Age wise distributions of patients included for the study is shown in table 1 were it shows that the age group of 35-40 years is more affected when compared to other groups. Table 2 shows the patient Reason for hospital visit were 36% heavy bleeding, 23% abdominal pain, 8% Miscarriages and 31% both heaving bleeding and abdominal pain. Figure1 shows comorbidities in patient 53% were anaemic. Patients aware of disease before counselling is shown in figure 2 were it shows 68% of patient is unaware of uterine fibroids. Patients aware of disease after counselling are shown in Figure 3 were it shows 84% of patient is aware of disease. The knowledge Questions are shown in table 3. The knowledge scores before and after counselling is shown in table 3 the study showed most of the respondents (52.2%) had Low knowledge score (≤6) of uterine fibroids and respondents (47%) had high knowledge score (>6) of uterine fibroids before counselling. The study showed most of the respondents (24.4%) had low knowledge score (≤6) of uterine fibroids and respondents (75.5%) had high knowledge score (>6) of uterine fibroids after counselling. The table 4 shows the patients attitude towards treatment and increase in percentage after counselling. The patient perception on uterine fibroids and increase in patient’s knowledge is shown in table 4. The KAP score before and after counselling is shown in table 5 and figure 4 were patients knowledge before counselling is 6.81 (±1.30) and after counselling is 9.9 (±0.73), Attitude before counselling is 1.54 (±0.65) and after counselling is 2.81 (±0.39) and Perception before counselling is 2.24 (±1.01) and after counselling is 3.51(±0.58).

Age Distribution:

Table 1 shows that there are more uterine fibroid patients are above 35 years of age

Age	No. of patients (n=90)	Percentage
30-35	33	36%
36-40	36	40%
41-45	15	16%
45-49	06	6%

Reason for Admission:

Table 2 shows that 36% of patient had heavy bleeding

Reason for admission	No. of Patient	Percentage
Heavy bleeding	33	36%
Abdominal pain	21	23%
Miscarriages	8	8%
Heavy bleeding and abdominal pain	28	31%

Co morbidity:

Figure 1 Shows that anaemia is the most common co-morbidites

Aware of Patients Knowledge on Disease before Counselling:

Figure 2 shows that 68% of patients are unaware of uterine fibroid

Aware of Patients Knowledge on Disease after Counselling:

Figure 3 shows that 84% of patients are aware of uterine fibroid

Table 3 Questionnaire

Knowledge of uterine fibroids Score=11
1	Heavy bleeding may occur in FIBROIDS	YES	1
2	FIBROIDS are seen mostly in infertile women.	No	1
3	FIBROIDS lead to cancer.	No	1
4	FIBROIDS may increase the risk of pregnancy.	Yes	1
5	Medical treatment is helpful in FIBROIDS.	Yes	1
6	Hysterectomy is the only treatment of FIBROIDS.	No	1
7	Obesity is a risk factor of FIBROIDS.	Yes	1
8	High blood pressures may have changes of causing FIBROIDS.	Yes	1
9	Having multiple sexual partners may be a risk factor for FIBROIDS.	No	1
10	Positive family history may be a risk factor for FIBROIDS.	Yes	1
11	Stress may be a risk factor for FIBROIDS.	No	1

Table 4 knowledge score

Knowledge score of Uterine Fibroids Before Counselling
≤6	47	52.2%
>6	43	47.7%
Knowledge score of Uterine Fibroids After Counselling
≤6	22	24.4%
>6	68	75.5%

Table 5 Attitude of patient towards treatment after counselling of fibroids

1	No drug is required for treatment, FIBROIDS will cure by itself	86	95.55%
2	Herbal drugs and life style modification is the best treatment for FIBROIDS	79	87.7%
3	Patients willing for medical treatment of FIBROIDS	87	96.6%

Table 6 Patient Perception towards Uterine Fibroids after counselling

1	Co-morbidity occurs along with fibroids	82	91.11%
2	Fibroid will cure after menopause	87	96.66%
3	Fibroid affects childbearing	85	94.44%
4	Fibroids is a life-threatening disease	86	95.55%

KAP Score Before and After Counselling:

Table 7 KAP scoring before and after counselling

Study parameters	Before counselling	After counselling	P value
Knowledge	6.81(±1.30)	9.9(±0.73)	<0.05*
Attitude	1.54(±0.65)	2.81(±0.39)	>0.05
Perception	2.24(±1.01)	3.51(±0.58)	<0.05*

*P value is significant

Figure 4 KAP scoring before and after counselling

DISCUSSION:

Care should be given to the individual. Whereas patient’s age, coexisting medical disease, family history and desire for fertility such factors should be considered while selecting an appropriate treatment for the patients whereas medication cost and adverse effect must also be considered where they play a direct role in patient compliance.⁽¹⁶⁾

This study shows that most of patient presented with the complaints were within the age group of 34-40, this result did approve with the study done by M. A. Adegbesan-Omilabu, et al-2014⁽¹⁴⁾

This study shows that most of patient presented with the complaints of heavy bleeding and abdominal pain this results did not approve with the study done by Elizabeth A. Stewart, et al-2013.⁽¹⁷⁾

This study shows that most of patient presented with late complaints due to lack of time results did not approve with the study done by Atombosoba. A. Ekine, et al- 2015.⁽¹⁵⁾

This study shows that most of the patients were unaware of disease before counselling this study result did not approve with the study done by M. A. Adegbesan-Omilabu, et al-2014.⁽¹⁴⁾

CONCLUSION:

The study has shown that there is poor knowledge about uterine fibroids. Patient counselling plays an important role in order to improve patient knowledge regarding diseases, management and healthy diet. The patients were encouraged for early reporting and hence prevent complications that accompany surgical operation of huge fibroids. Qualified health care professionals should also be involved in the public enlightenment and campaign.

ACKNOWLEDGEMENTS:

The authors are thankful to VELS University (VISTAS) and its management for providing research facilities and encouragement.

REFERENCES

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2. Bruce and Debra 1998 "Fibroids." In The Unofficial Guide to Alternative Medicine. New York, NY: McMillan General Reference, 1998, pp. 278-281.

3. Divakar 2008 Asymptomatic uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2008;22:643–54.

4. Hirst et al., 2008 Dutton S ,Wu O “A multi-centre retrospective cohort study comparing the efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids.” The Hopeful study. Health Technol Assess. 2008 Mar;12(5):1-248, iii. [abstract]

5. Laughlin and Stewart, 2011. Uterine leiomyomas: individualizing the approach to a heterogeneous condition. Obstetrics and gynecology. 2011;117:396–403. [PMC free article] [PubMed]

6. E. A. Wilson et al.,1980, F. Yang, and E. D. Rees, “Estradiol and progesterone binding in uterine leiomyomata and in normal uterine tissues,” Obstetrics and Gynecology, vol. 55,no. 1, pp.20–24, 1980.

7. Banu and Manyonda2004.Myometrial tumours. Current Obstetrics and Gynaecology. 2004;14(5):327–336.

8. Parker W,2007. Uterine myomas: management. Fertility and Sterility. 2007;88:255–71. doi: 10.1016/j.fertnstert.2007.06.044. [PubMed] [Cross Ref]

9. Elizabeth A and Stewart M 2010. Overview of treatment of uterine leiomyomas (fibroids). In: Robert L, Barbieri M, ed., editors. Uptodate Online 182, 2010

10. Ravina JH et al.,1995, Herbreteau D, Ciraru-Vigneron N, Bouret JM, Houdart E, Aymard A, et al. Arterial embolisation to treat uterine myomata. Lancet. 1995;346:671–2. [PubMed]

11. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol. 2008;112:387–400. [PubMed]

12. Myers ER BM et al., 2001, Couchman GM, Datta S, et al. Management of uterine fibroids (Evidence Report/Technology Assessment No. 34, contract 290-97-0014 to the Duke Evidence-based Practice Center). In: Matchar DB, ed., editor. AHRQ Evidence Reports. Rockville, MD: 20852: Agency for Health care research and Quality; 2001

13. Hanafi M 2005. Predictors of leiomyoma recurrence after myomectomy. Obstet Gynecol. 2005;105(4):877–881 [PubMed]

14. Adegbesan-Omilabu et al., 2014 K. S. Okunade, and A. Gbadegesin “Knowledge of, Perception of, and Attitude towards Uterine Fibroids among Women with Fibroids in Lagos, Nigeria” Volume 2014;2014:809536. doi: 10.1155/2014/809536. Epub 2014 Mar 13.

15. Atombosoba. A. Ekine1, Lucky O. Lawani2, Chukwuemeka “A Review of the Clinical Presentation of Uterine Fibroid and the Effect of Therapeutic Intervention on Fertility” American Journal of Clinical Medicine Research, 2015, Vol. 3, No. 1, 9-13.

16. Donnette Simms-Stewart and Horace Fletcher 2012 “Counselling Patients with Uterine Fibroids” A Review of the Management and Complications Obstetrics and Gynaecology International Volume 2012 (2012)

17. Elizabeth A. Stewart, MD et al “The Burden of Uterine Fibroids for African-American Women Results of a National Survey” journal of women’s health Volume 22, Number 10, 2013 DOI: 10.1089/jwh.2013.4334

Received on 15.07.2017 Modified on 18.08.2017

Research J. Pharm. and Tech 2017; 10(11): 3748-3752.

DOI: 10.5958/0974-360X.2017.00680.1

This study shows that most of patient presented with the complaints were within the age group of 34-40, this result did approve with the study done by M. A. Adegbesan-Omilabu, et al-2014(14)

This study shows that most of patient presented with the complaints were within the age group of 34-40, this result did approve with the study done by M. A. Adegbesan-Omilabu, et al-2014⁽¹⁴⁾