SHE WAS SHOCKED when her gynaecologist told her she had to have a hysterectomy. Sandra*, 48, a proofreader from Cape Town, had been suffering from heavy, painful periods for many months and was diagnosed with a uterine fibroid (a noncancerous growth in the uterus) in 2012 – but she couldn’t believe that major surgery was the solution.
“I searched online for a more viable alternative and found Gary Sudwarts, MD, an interventional radiologist, who specialises in a procedure called uterine fibroid embolization (UFE). I’d never heard of it, but it seemed safer and far less drastic than losing my womb. After consulting with him, I decided to book an appointment a week later at the University of Cape Town’s Private Academic Hospital (UCTPAH). After the non-surgical procedure, I had pain for about 12 hours, but it subsided gradually over the next day. I stayed in hospital for two nights, and two weeks later, I was back to normal. After many months of bleeding, pain and anaemia, I felt like a new person. The work Dr. Sudwarts and his colleagues are doing is so important.”
Uterine fibroids affect 20 to 40 percent of women aged 35 and older, but only 10 to 20 percent of women require treatment due to heavy bleeding, period pain and infertility, among other adverse symptoms, says Dr. Sudwarts as he shows me around UCTPAH’s state-of-the-art theatre, where he conducts UFEs. “Fibroids are a major public health issue. However, far too many hysterectomies are being performed in South Africa to deal with them.
Unfortunately local women – and many doctors, too – just don’t know about the efficacy of UFE; the default treatments recommended are a hysterectomy or myomectomy (cutting fibroids out of the uterus). But both of these are major, highly complicated surgeries, whereas a UFE is minimally invasive, safe and effective. “Recovery time is faster, too: Most women are able to return to normal activity within one to two weeks after having the procedure, unlike with hysterectomies and myomectomies, where patients often take about four to six weeks to recover.”
MINIMAL INVASION, MAXIMUM RESULTS
UFE involves making a small incision in the groin and inserting a catheter into the femoral artery. “Using real time imaging, I guide the catheter into the artery and then release tiny particles into the arteries that supply blood to the fibroid,” he explains. “This blocks the blood flow to it, causing it to shrink and die. This can be performed while the patient is conscious and sedated. About 85 or 90 percent of women who’ve had it done experience significant or total relief of symptoms, and the recurrence of treated fibroids is rare.”
There are risks involved; however, complication rates are lower than those of hysterectomy and myomectomy, says Dr. Sudwarts. “The role of UFE in infertility is not yet fully understood, so for now, we stick to inoperable fibroids and high-risk patients,” he says. “This treatment is endorsed both by the UK and American Colleges of Obstetricians and Gynaecologists and the UK’s National Health Service. It costs the same as a hysterectomy and is covered by most medical aids.” If you suffer from symptomatic fibroids, consult with your gynaecologist and an interventional radiologist to discuss UFE’s benefits and risks.
CARLA CALITZ – THE OPRAH MAGAZINE SOUTH AFRICA – DECEMBER 2013