Sonographic Diagnosis of Uterine Fibroids and the Associated Patient Experience: The Psychosocial and Cultural Challenges Encountered

Data Collection

Data was collected between February and July 2025 using semi-structured interviews. Participants were recruited from sonography waiting areas and invited to participate voluntarily. Interviews were conducted by the lead researcher, who had prior training in qualitative interviewing using a consistent semi-structured interview guide. This ensured that similar topics were explored across interviews. The interview was conducted face to face in a private setting within the ultrasound facility to ensure confidentiality and participant comfort. Rapport was established through informal conversation prior to the interview and by assuring participants that their responses would remain confidential and would not influence their medical care. Core domains included experiences of diagnosis and symptoms; emotional responses; cultural and social stigma; impact on family, relationships, and reproductive health outlook; lifestyle adjustments; barriers to care; coping mechanisms; and interactions with the healthcare system.

Interviews were conducted in English (with clarifications in local languages as needed), lasted between 30 and 55 minutes, and were audio-recorded with participants’ permission. Interviews were transcribed verbatim, anonymized, and cross-checked against recordings for accuracy.

Data Analysis

Data were analyzed using reflexive thematic analysis and a six-phase process as described by Braun and Clarke. ¹⁵ This method was chosen because it allowed the researcher to clearly identify patterns of meaning within the qualitative data while acknowledging the interpretative role of the researcher in the analytic process, consistent with established qualitative research frameworks. ¹⁶ The six phases of the process were carried out as follows.

First, the researchers engaged in data familiarization by repeatedly reading the interview transcripts and listening to the audio recordings to ensure accuracy and deepen understanding of participants’ narratives. The researchers were practicing sonographers with over 10 years of experience managing patients presenting with fibroids, which facilitated familiarity with the clinical context of participants’ experiences. Second, initial codes were inductively generated from the transcripts by identifying segments of the text that reflected participants’ emotional responses, coping behaviors, and experiences with healthcare encounters during fibroid diagnosis. The researchers then engaged in reflective discussions about emerging interpretations to enrich the analytical process. Third, related codes were grouped into candidate themes representing a broader pattern across participants’ responses. These themes were reviewed iteratively and refined by referring to the transcripts to ensure that they captured meaningful aspects of participants’ experiences and addressed the study’s research questions. Fourth, themes were reviewed and further developed to ensure internal coherence within each theme and clear distinction between themes. This resulted in three overarching themes that captured key facets of women’s psychological experiences, coping responses, and healthcare interactions. Fifth, the themes were then defined and named by articulating the central organizing concept of each theme and its relevance to the research questions. Lastly, the analytic narrative was developed by integrating the themes with illustrative participant quotations and by interpreting the findings in relation to the Lazarus Stress and Coping Theory and the Engel Biopsychosocial Model.

NVivo (v. 12.0, Lumivero, 2024) software was used for data management. Reflexivity was maintained through reflective note-taking and periodic discussions among the research team to consider how researchers’ perspectives might shape interpretation of the data. An audit trail documenting coding decisions and theme development was maintained, and member checking with selected participants was conducted to confirm that the findings reflected their experiences.

Theme 1: Psychological Distress and Threat Appraisal

Most participants reported that receiving a fibroid diagnosis was emotionally difficult. Many described the fear and anxiety that came with not knowing what the symptoms really meant or how the disease would affect their future. Women who were newly diagnosed seemed to be the most anxious.

When I first heard fibroid, I could not sleep . . . I thought it was a death sentence. (Participant 7, newly diagnosed)

Body image changes were another source of stress. Abdominal swelling and weight gain made some women feel less attractive, and a few said they were ashamed to appear in public.

People keep asking me if I am pregnant, but I am not . . . it makes me feel very bad. (Participant 12, follow-up)

A strong concern was the impact on fertility and childbearing, which many participants linked directly with their sense of womanhood and stability in marriage.

I just fear that I may never give birth, and in our culture, that is a big problem. (Participant 2, newly diagnosed)

Overall, distress appeared highest immediately after diagnosis, when women had the least information and were dealing with uncertainty.

Theme 2: Adjustment and Coping

The women also talked about diverse ways they tried to adjust to the condition. One of the most common strategies was faith and spirituality. Prayer, attending church, and relying on God were often mentioned as sources of strength.

I leave everything to God. Only God can heal. (Participant 14, follow-up)

Family and partner support were also important. Women whose partners or relatives encouraged them reported feeling less alone.

My husband always tells me not to worry, that he will stand by me. It gives me courage. (Participant 5, follow-up)

Some participants tried lifestyle changes, such as diet restrictions, avoiding certain foods, or reducing stress. While some felt these helped, others said it only made them worry more about what they could or could not do. In addition, many used herbal preparations and other complementary remedies, either before or alongside medical care. This was often tied to fear of surgery and the desire to preserve fertility.

People say surgery will make you barren, so I am trying herbs first. (Participant 10, newly diagnosed)

Although these strategies helped women cope, they also reflected the mixed feelings and uncertainty many had about conventional treatment.

Theme 3: Healthcare Encounters and Information Gaps

Because sonography often represented the first diagnostic encounter for women with fibroids, interactions with sonographers formed an important part of participants’ experiences. Some participants said that physicians, nurses, and especially sonographers who broke the news to them first were supportive and gave good explanations, which reassured them and encouraged them to continue treatment.

The ultrasound man [sic] (sonographer) took his time to explain to me what he was seeing during scan, and I felt some relaxation in me. It really helped me calm down. (Participant 19, newly diagnosed)

In summary, fibroid diagnosis was associated with significant emotional burden, particularly related to fear, fertility concerns, and self-image. Participants reported coping through faith, family support, lifestyle changes, and herbal remedies but remained uncertain about surgical treatment due to concerns about potential effect on fertility. Healthcare encounters, especially with sonographers, were central to their experiences, with poor communication reinforcing distress, and proper communication helping them cope.

Psychological Distress and Threat Appraisal

Women in this study described fibroid diagnosis as emotionally overwhelming, particularly during the early stages when uncertainty about symptoms and prognosis was greatest. This experience of distress has also been reported in previous research, where women construct meaning around their diagnosis by navigating uncertainty and oscillating between feelings of defeat and optimism. ¹⁷ Studies have shown that women with symptomatic uterine fibroids often experience significant emotional and psychological consequences, including fear, anxiety, anger, depression, helplessness, and negative self-image. Newly diagnosed women also report disruptions in daily life, including reduced participation in work and social activities, accompanied by fatigue, depression, fear, and anxiety.^5,18 In addition, research focusing on black women has highlighted how fibroids may be interpreted as a particularly heavy burden shaped by race-gendered histories and social stressors, influencing both self-perception and lifestyle. ¹⁹ Consistent with these findings, uterine fibroids have been shown to significantly impair psychosocial functioning, with reduced quality-of-life scores observed in many women prior to treatment. Many participants in this study described the fibroid diagnosis as frightening, particularly in the early stage when information was limited. The sense of anxiety and fear aligns with previous studies showing that uncertainty about gynecological conditions contributes to poor mental health outcomes.^20,21 In this study, fear was made worse by fertility concerns, which have deep cultural implications in Nigeria and other African settings. Infertility is often equated with failure in womanhood and can threaten marital stability. ²² These findings were also reported in an Egyptian study, where fibroids affected women’s self-image and marital relationships. ²³

Body image concerns were also prominent. Women expressed shame over abdominal swelling and weight changes, which lowered self-esteem and restricted social participation. This is similar to studies in the United States and Europe that link fibroids to poor body image and depressive symptoms. ⁵ Using the Engel Biopsychosocial Model, ¹⁴ it becomes clear that biological symptoms (swelling, bleeding) interact with cultural values and psychological responses, creating a cycle of distress, as has been earlier established theoretically ²⁴ and practically ²⁵ in previous studies; however, this interpretation is not universally supported in literature. ²⁶

Adjustment and Coping Strategies

Despite the distress, women showed a wide range of coping strategies. Many turned to faith and spirituality, which offered meaning and hope in the face of uncertainty. This form of coping has also been observed in other African studies, ⁹ where prayer and church support were central. Family and partner support was also critical in this study. Women who felt supported by their husbands or close relatives were more likely to report encouragement and strength. This is in line with an earlier study that pointed out social networks buffer stress during chronic illness. ²⁷

Lifestyle adjustments and the use of herbal remedies were also reported. While some changes helped women feel a sense of control, others increased worry. Fear of surgery was especially strong, with many women delaying biomedical treatment due to concerns about fertility loss or complications. These findings suggest that coping is shaped not just by individual choice but by cultural narratives about womanhood and reproduction. The Lazarus Stress and Coping Theory ¹³ provides a useful way to understand this situation. Women engaged in both problem-focused coping (seeking care, modifying lifestyle) and emotion-focused coping (prayer, avoidance, reframing).

Evidence of coping strategies specifically following uterine fibroid diagnosis remains limited. However, Ghant et al, ⁵ in a qualitative study of women with symptomatic fibroids, identified avoidance-based coping and psychological dissociation from the condition as common responses. These strategies were often associated with delayed treatment-seeking, suggesting that some women cope by minimizing or distancing themselves from the diagnosis. Within the framework of the Lazarus Stress and Coping Theory, such responses can be interpreted as emotion-focused coping strategies aimed at reducing immediate psychological distress. Similarly, participants in the present study adopted coping mechanisms including reliance on faith, family support, lifestyle adjustments, and complementary remedies, reflecting efforts to manage uncertainty and emotional strain associated with the diagnosis. These strategies, although helpful in managing emotional burden, were not always effective, showing how coping responses can be both adaptive and maladaptive.

Healthcare Encounters and Information Gaps

Because sonography is often the first imaging technique used to confirm or further evaluate suspected uterine fibroids, interactions with sonographers and other healthcare providers can play an important role in shaping women’s understanding of the condition and their emotional responses to the diagnosis. A consistent theme was the variable nature of interactions with sonographers and other healthcare workers. Several participants reported feeling reassured when sonographers clearly explained their condition and showed empathy, while others reported feeling dismissed or not given enough time when their initial curiosity was not satisfied. This behavior was seen mostly among newly diagnosed participants. Similar concerns about patient-provider communication have been reported in studies examining fibroid care in Nigeria.^10,22

Direct evidence examining how sonographer-patient encounters influence women’s understanding and adjustment to uterine fibroid diagnosis remains limited. Most available studies focus more broadly on women’s emotional burden, treatment decisions, and general healthcare experiences rather than on sonographer interactions specifically. In a related context, Lalor et al ²⁸ reported that women undergoing ultrasound for fetal abnormalities valued clear information, prompt referral, written guidance, continuity of care, and empathetic communication—factors that may also be relevant in fibroid diagnosis. Supporting evidence from adjacent literature further suggests that counseling can improve patient knowledge and reduce anxiety among women with leiomyomata, ²⁹ while low disease knowledge and avoidance-based coping may delay treatment-seeking. ⁵ Research conducted in sonography practices, more broadly, indicated that communication style and information provision during imaging encounters can significantly influence patient anxiety and understanding.^30-32 Taken together, these findings suggest that although direct evidence in fibroid diagnosis is scarce, effective communication during sonographic encounters may play an important role in shaping patient adjustment and informational outcomes.

When communication was inadequate, women turned to family, peers, or the internet. While this helped them gather information, it often led to confusion and reinforced myths such as fibroids being spiritually caused. This finding emphasizes how information gaps during diagnosis worsen anxiety and encourage reliance on less-reliable sources. The Engel Biopsychosocial Model highlights this as a point where healthcare systems can intervene during sonography diagnosis by improving communication and providing structured counseling, which may include clear explanations of the condition, discussion of treatment options, guidance on fertility implications, and referral to appropriate specialists. This may go a long way to reduce distress and encourage adaptive coping.

The findings of this study can be very influential for clinical practice by strengthening patient-provider communication via training in culturally sensitive counseling and empathetic dialogue. Fertility counseling should also be integrated into fibroid diagnosis and management given the central role reproductive concerns play in many patients. In addition, psychosocial support programs, which may include peer groups and faith-based services, should be adopted to normalize experiences and reduce stigma. Lastly, community education campaigns should be promoted to address myths, improve awareness, and encourage earlier healthcare seeking. Because ultrasound is often the first imaging modality used in fibroid diagnosis, sonographers occupy an important position in shaping patients’ initial understanding of the condition. Clear explanations during ultrasound examinations and appropriate referral guidance may help reduce anxiety and improve patient engagement with care.

Limitations

This study has several limitations based on the research design with threats to internal and external validity. In addition, member checking was not conducted; however, credibility was supported through the use of verbatim transcripts, an audit trail, and reflexive discussions among the research team. The sample size was relatively small and limited to women attending sonographic medical imaging facilities in Nigeria. It was felt that this was consistent with the reflexive thematic analysis, as the findings reflected participants’ experiences within a specific cultural and healthcare context. A strength of this study was that it contributed to the limited qualitative literature on fibroids in African contexts by focusing specifically on women’s diagnostic experiences. Importantly, it has provided information on the key role sonographers play in the psychological state of patients diagnosed with fibroids in the clinical setting. While the results may be particularly relevant to similar urban African settings, they may also offer insights for other contexts where women experience comparable cultural expectations surrounding fertility and reproductive health.