Friday, November 19, 2010

Encouraging News About UAE, An Alternative to Hysterectomy

Recently published research on Uterine Artery Embolization has shown that it is a good alternative to hysterectomy for women suffering heavy menstrual bleeding or pain from uterine fibroid--benign--tumors.

A 5-year follow-up study of women who agreed to be randomly picked for either a hysterectomy or Uterine Artery Embolization (UAE) showed that 7 of 10 women who underwent the organ-sparing procedure had relief of their symptoms that was good enough to have been able to avoid further surgery after five years.

This is important news because 40% of all hysterectomies--275,000 of them--are done each year because of symptoms caused by fibroids. According to best estimates, another 250,000 women a year undergo myomectomies, in which the fibroids are cut out of the uterus but the uterus is spared. Both surgeries usually involve a stay in the hospital and, depending on the technique used for the hysterectomy, recovery periods of up to six weeks. With UAE, women report returning to normal activity, including sex, within two weeks.

In addition, a UAE poses much less risk to a woman's ovaries if she is under 45. Dr. Bruce McLucas, a Los Angeles gynecologist who performed the first UAE in the United States in the early 90s, said in an interview that the incidence of ovarian failure "in my hands is 3%" in women in that age group and about 5% when done by other surgeons. McLucas recently performed his thousandth UAE. However, ovarian failure occurs in about half of all women older than 45 who undergo UAE.

About half of all women who undergo hysterectomies end up without their ovaries--often healthy ovaries-- because gynecologists continue to scare them into consenting to their removal (or yank them out even with no consent) with talk of ovarian cancer. They minimize the adverse impact on women's health that will result from the loss of their ovaries. Most gynecologists still view the low risk of developing ovarian cancer as outweighing the much greater risks of developing heart disease, osteoporosis, loss of sexual pleasure, etc. from castration (the proper word for amputation of women's sex/reproductive organs.)

 McLucas, who practices at the Ronald Reagan UCLA Medical Center and is Clinical Professor in the medical school there, is now engaged in a campaign to publicize the benefits of the procedure. He will be appearing December 1 on the TV show, The Doctors.

I've long wondered why so many women in their early 40s experience such heavy bleeding. McLucas explained that, "In the years running up to the menopause, we have a domination of estrogen in the menstrual cycle," and estrogen fuels the growth of fibroids, which are present in 40% of women over 40. Many women, however, do not experience heavy bleeding or pain from them; only 10 to 20% of women who have fibroids need treatment.

But those who do must deal with monthly hemorrhaging that can last two weeks and require frequent changing of even the most absorbent tampons. Many become anemic.

"The first major myth about fibroids is that waiting for menopause is necessarily a good option," said McLucas. He explained that because fatty tissue produces a substance that mimics estrogen, fibroids in some women will not shrink after menopause. And, if a woman is taking replacement hormones, the fibroids also tend to grow. Waiting for menopause therefore, may or may not be a good idea depending on the individual woman.

So what is UAE? It's an outpatient procedure done under local anesthetic in which a small cut is made in the upper thigh and then in the femoral artery. From there, guided by X-rays, the surgeon plugs the uterine artery with inert particles.

Starved of blood, the fibroids usually--but not always--shrivel to about half their size, calcify and cause no further problems.

But doesn't the uterus then die as well?

Fortunately, the uterus is fed blood by the ovarian artery as well, and will "resupply the uterus within an hour of surgery," according to Dr. McLucas.

He has also published research showing that among women who still wanted to have children after the procedure, about 1/3 had successful pregnancies.

I had a hysterectomy in my early 40s because of heavy menstrual bleeding, and after viewing this new research, I would have tried a UAE if it had been available to me. Maybe it would not have worked, as is the case with a friend of mine, but given the information I now have, it would have been worth a try to keep my uterus.

Even now, many years later, women who want to try this alternative will very likely need to look beyond their usual gynecologist. McLucas thinks he is the only gynecologist doing UAE in the United States. But interventional radiologists--the same doctors who insert cardiac stents--do them, and so do, oddly enough, some cardiologists.

Ideally, women should find a gynecologist who can refer them to a radiologist who will perform the procedure. After that,  the gynecologist will oversee their recovery.

Dr. McLucas predicts that within 10 years there will be at least one gynecologist in each major city who performs UAEs. Until then, women are still on their own in their efforts to keep their precious organs. A good starting place for information is the Fibroid Treatment Collective website, which features Dr. McLucas.

Tuesday, November 2, 2010

An "Essential" Guide to Hysterectomy That Isn't

The title, Women's Hysterectomy Stories:  The Essential Guide," gave me great expectations. Here, available on line for $17, was an e-book that I thought might help to enlighten women about the perils to their long-term health and sexuality from hysterectomies.

So, I sprung for the $17. And was sorry that I did.

This book, written by Ruth Steeves and promoted on her website,, is only for you if you've already made up your mind that you really need a hysterectomy. It will advise you about making arrangements in advance of your surgery for child care, and meals, and what to expect in the hospital, and once you get home.

But just like HysterSisters, which is promoting the daVinci robotic system for the surgery, this book and Steeves' website see the epidemic of hysterectomies through rose-colored glasses. The goal is to eliminate your anxiety about having a hysterectomy.  The furthest they go in bucking the medical establishment is to encourage women to get a second opinion.

HysterSisters has actually launched a "Give Me a Second" campaign whose purpose is "to strengthen the doctor-patient relationship, to improve women's quality of care through awareness of minimally invasive surgical procedures (italics mine) and to increase confidence in their healthcare decisions."

Once again, it's all about finding a doctor who will use laparoscopy or robots for a less traumatic hysterectomy. Not to avoid one altogether and survive with your organs intact.

The problem with the generic advice to get a second opinion is that too many gynecologists disregard all the evidence about the serious after-effects of hysterectomy and removal of the ovaries and won't volunteer any information about them. These are not side-effects--like an infection due to the surgery--but long-term adverse impacts on health and sexual pleasure.

Without a uterus, a woman can not experience what some refer to as a full-body orgasm in which the uterus pulses rthymically. That is not an opinion. It's an incontrovertible fact, but the gynecologist who will warn you about that is a rare individual. You also won't hear about your increased risk of future bladder and back problems, or about your much higher risk of heart attack if your ovaries are removed. There's no controversy at all about these after-effects of hysterectomy. The evidence has been reported in medical journal articles repeatedly over the last several decades.

Yet, to justify the supposed joy of hysterectomy, The Essential Guide  tells one anonymous woman's tale of painful periods ever since she had her first, and her gloriously wonderful life after hysterectomy.

Other than that one, there are only three other stories included as MP3 downloads or PDFs. One of the women had uterine cancer (an absolutely valid and unavoidable reason for a hysterectomy); another had to be on blood thinners for another condition and this had serious effects on her periods (how common is that one? and who knows what alternatives she had?); and the third said she had "passed out" every time she got her period. Again, thankfully, not a common experience. All end up as testimonials for Steeves' book.

That said, yes indeed, women should get second opinions. And third and fourth, if need be, until they find a doctor whose practice is focused on avoiding hysterectomies, not doing them. Some medical centers now have specific hysterectomy alternatives centers. Search for them. But first, arm yourself for these discussions by learning about the anatomy of our reproductive organs and the essential role they play in our health and pleasure for as long as we are alive.

To get that information, I once again recommend the HERS Foundation website where you can watch a plain vanilla explanation, with diagrams but not any sort of bloody video, of the functions of your uterus and organs. You'll be grateful for investing 10 minutes of your time to save your future health and pleasure.