Prolonged and heavy menstrual bleeding, pelvic pain, back and leg pains, pain during sex, feelings of exhaustion and even a strange urge to eat clay; these are just some of the troubling, even debilitating, symptoms that affect many of the hundreds of thousands of South African women who suffer from uterine fibroids.
Dr Gary Sudwarts, an interventional radiologist who performs uterine fibroid embolisation (UFE) procedures at Netcare Park Lane and Netcare Linksfield hospitals in Johannesburg, as well as at UCT Private Academic Hospital in Cape Town, describes uterine fibroids as a major women’s health issue in South Africa.
“This is a medical condition that warrants much greater attention and awareness than it currently receives, particularly as more and more effective treatment options are becoming available. Many South African women are silently suffering devastating symptoms as a result of untreated uterine fibroids. In addition, every year many thousands of women in South Africa have a hysterectomy, a major surgical procedure to remove the entire uterus, due to severe uterine fibroids.”
Uterine fibroids are muscular, non-cancerous tumours that develop in the walls of the uterus. They most commonly, although not exclusively, develop in women in their 30s and 40s. Internationally, 20% of women have fibroids although this number is likely to be much higher in South Africa.
“I began to experience long, irregular periods with heavy bleeding that could last as long as 12 days,” relates Bernadette Chiponda, a 39-year-old woman from Johannesburg, who says she also inexplicably suddenly started putting on weight and suffering migraines a year ago.
“I would do one single chore around the house and feel completely drained. Fibroids were draining the energy and joy from my life. I often suffered migraines and my work as an IT administrator and pastor suffered. I became so bloated that, embarrassingly, some friends even asked if I was pregnant,” she adds.
Jenny Hamman, a 42-year-old businesswoman from Fourways, Johannesburg, who recently underwent a highly successful uterine fibroid embolisation procedure for the condition, says that she suffered similar symptoms. “I started feeling more and more exhausted and had difficulty getting up in the mornings, and getting through the day. I also developed restless leg syndrome, which was very uncomfortable.”
“The condition developed gradually over some time and I had no idea the cause was uterine fibroids. I just thought I was getting older and that these symptoms were age-related and completely normal.”
Hamman says she suffered a further unusual symptom before she had her uterine fibroid embolisation procedure, which has since completely resolved with all of her symptoms. “I sometimes had a strong desire to eat clay,” she admits. “I would buy blocks of white clay, sometimes from street-side sellers, cut it into neat blocks like cheese, and consume it. My husband thought my behaviour very odd,” she laughs.
Dr Sudwarts says that while a desire to eat clay may sound strange, it is actually quite commonly reported among women who suffer severe anaemia as a result of fibroids. Many women with uterine fibroids suffer such heavy menstrual bleeding that they become anaemic, because the iron levels in the blood become dangerously low. These women therefore tend to feel exhausted and develop a pressing need to consume earth or clay, which despite it not being very nutritious, is actually an attempt to replenish their iron levels.”
According to Dr Sudwarts, the location, size, type and number of fibroids that are present all influence the signs and symptoms of the condition. Fortunately, in most cases they cause few symptoms, and therefore the fibroids may go unnoticed. They often do not require any treatment whatsoever.
However, those women who experience complications as a result of fibroids may suffer severely and in some cases even be rendered infertile. Fibroids can grow as a single tumour, or large numbers of them can develop in the uterus. Should fibroids get sizable, they may cause the abdomen to enlarge, making a woman look pregnant, as in Bernadette Chiponda’s experience.
What should women do if they suspect they may have a problem? Dr Sudwarts advises they visit their doctor or gynaecologist. If a patient is diagnosed with uterine fibroids, she would be well advised to inform herself as much as possible about the condition. “Be sure to ask your doctor about all of the possible treatment options that are available for your particular situation,” he adds.
Dr Sudwarts says that if other medical therapies fail, there are three main treatment options available and the choice of which to use may depend on the type, number, location and size of the fibroids present. In some cases an open myomectomy, which is a procedure in which the fibroids are removed during open surgery, is indicated. Alternatively, a hysterectomy may be recommended.
UFE is the latest alternative and it is becoming an increasingly popular choice among those women who qualify for the procedure. This is not surprising, as UFE does not involve major invasive surgery and consequently has a much lower rate of complications, is less painful with a considerably shorter recovery time, compared with either myomectomy or hysterectomy.
The procedure is done using catheters and with the aid of imaging tools such as X-rays, ultrasound and magnetic resonance imaging (MRI). Catheters and wires are inserted into minor puncture wounds in the groin are used to inject microscopic particles into the arteries supplying the fibroids with nutrients, causing them to shrink dramatically. The patient usually only stays in hospital overnight.
“Understandably, many women today prefer UFE over the radical surgical options of open myomectomy and hysterectomy, both of which are major surgeries,” explains Dr Sudwarts. “In addition, myomectomy may not always be possible where large numbers of tumours are present. Some women, particularly younger ones, also do not wish to go the hysterectomy route, which they feel robs them of them femininity, and makes it impossible for them to bear children.”
According to Dr Sudwarts, in some cases UFE and myomectomy may be used together in a complementary way, UFE being used to reduce blood flow to the tumours so that they can then be successfully surgically removed.
Chiponda says that when she was first diagnosed with uterine fibroids, which were rendering her infertile, she was totally distraught.
“I got married the year before and wanted to do everything possible to retain the option of having children. When I was diagnosed I therefore decided to research all of the alternatives available to me and get further medical opinion. Due to the large number of tumours that were found in my womb, as well their great size, it was recommended that I have combined UFE and myomectomy procedures, which were done early in August.”
After the UFE procedure, Chiponda had 15 uterine fibroids surgically removed, five of which were large and one no less than 18cm in size. She says she is feeling the benefits of the procedures and is delighted by the outcome.
Jenny Hamman suggests that her UFE procedure, which was performed by Dr Sudwarts in April, has transformed her life. “All of my symptoms and feelings of tiredness have been resolved and my periods are now again regular. I am truly thankful that my gynaecologist was able to offer me the UFE option. For me the procedure was a no-brainer; why go through a hysterectomy when an alternative such as UFE is now available?”
Dr Sudwarts says the clinical outcomes of UFE compare most favourably with the other treatment options, and it is a recommended treatment in countries such as the United Kingdom where the National Health Service (NHS) offers it for appropriate cases.
“The overwhelming majority of women who have undergone UFE experience significant or total relief from heavy bleeding, pain and bloating. Other problems it can help resolve include heaviness and discomfort; constipation, urinary frequency or incontinence; and leg or back pain.”
UFE is offered at Netcare Park Lane, Netcare Sunward Park and Netcare Linksfield hospitals in Johannesburg, Netcare Unitas Hospital in Pretoria, UCT Private Academic Hospital in Cape Town, Universitas Hospital in Bloemfontein and Netcare St Augustine’s Hospital in Durban.