The fibroid truth
A look at two books that examine core issues that affect women's health.
UTERINE fibroids are benign tumours developing from the smooth muscles of the uterine wall which can grow at times to as large as 15 cm or more. The reasons behind the transformation of the uterine wall to fibroids is not known even though there is evidence that progesterone and oestrogen play a role in this change. Though benign, these tumours can cause enough symptoms like menorrhagia, anaemia, fatigue, chronic pelvic or back pain, constipation and urinary incontinence to the women concerned. In about 25 per cent of cases, fibroids can become a serious, full blown illness. It is seen that most doctors when approached assume that hysterectomy is the most logical solution to "treating" fibroids. As a matter of fact between 3.5 and 7.3 million women in the U.S have had a hysterectomy over the past 20 years for fibroids. That is over 60 per cent of women who undergo hysterectomies in the U.S have had them for this relatively benign disease.
Both the books under review here address not just the question of fibroids and hysterectomies but also the wider context in which doctors practice medicine and offer "treatment choices" to patients, the sexism of the medical community and end with a clarion call for women to take charge of their bodies and organise to get a better deal from the medical community.
Carla Dionne, herself a sufferer from uterine fibroids takes us through her personal journey from diagnosis to final recovery in her book, Sex, Lies and the Truth about Uterine Fibroids. Starting with the detection of her fibroids in the late 1980s to her uterine arterial embolisation in the late 1990s, it is a story of a decade or more of visits to various doctors, her own courage, perseverance and determination to research all possible options before settling on a treatment course for herself. Her meticulous research has paid off . I would urge the uninformed reader to read this book for its information on fibroids, their methods of detection and various types of treatments which include apart from hysterectomy, myomectomy, uterine artery embolisation, myolysis/cryomyolysis and hormonal treatments.
With such a range of choices available to most women, why then is it that hysterectomy is the most common method of "treating" fibroids? Most women go to gynaecologists and then follow their "advice" for treatment. Women need to be more cautious before doing so.
"A recent study ¹ published in Obstetrics and Gynaecology titled, `The Appropriateness of Recommendation for Hysterectomy', determined that as many as 70 per cent of hysterectomies performed were recommended inappropriately and that roughly 76 per cent did not even meet the hysterectomy guidelines set by the ACOG (American College of Obstetrics and Gynaecologists)."
Hysterectomy is the most performed surgical procedure for women today in the U.S.. Contrast that to men with an enlarged prostrate gland. Even though roughly 10 per cent of these glands do contain cancerous tissue, surgery is not done or even suggested to men as a preventive measure. On the other hand, nearly 3,60,000 women in the U.S. have their ovaries removed for prevention of ovarian cancer annually, even though the lifetime risk of cancer was only 1.8 per cent. Why are women's bodies more disposable especially the uteri and ovaries? Are these only limited to reproduction or do they play a bigger role ?
Lise Cloutier-Steele in her book Misinformed Consent 13 Women Share their Stories About Unnecessary Hysterectomy paints a rather grim picture. Based on interviews with women from the U.S and Canada who have undergone a hysterectomy and sometimes an oopherctomy, Cloutier-Steele takes us through 13 lives transformed for the worse by decisions made for women by doctors without their consent. Cloutier-Steele includes her own story in which she was hysterectomised in 1991 for possible endometriosis. She was presented with no choice and soon after her hysterectomy she has suffered many ailments linked to that. What is striking is how vulnerable all these women living in "advanced" Western countries were at the hands of the medical profession and how little say they had in their treatment protocols. Even when doctors were given clear instructions, very often these were ignored. Most women are afraid to speak out and many are silenced as they are embroiled in long drawn out court cases against the doctors concerned. Dr. Stanley T. West, M.D writes in the foreword to Misinformed Consent, that most procedures are "in vogue" till they are challenged by women themselves. He believes that nine out of 10 hysterectomies performed on women are absolutely unnecessary. These transformations happen because "doctors suddenly found out that, if they wished to remain in practice they needed to listen to their patients", I am convinced that women will prevail and force the medical profession to listen. Cloutier-Steele's book adds yet another nail in the coffin to the myth that "women don't need their uterus".
I recommend these two books to all women and members of the medical community who are interested in taking a fresh look at women's bodies and women's health.
¹Broder, MS et al, ? The appropriateness of recommendations for hysterectomy? Obstet Gynec 2000;95(2): 199-205)
Sex, Lies and the Truth about Uterine Fibroids A journey from diagnosis to treatment to renewed good health, Carla Dionne, Avery, 2001, p.316, $14.95.
Misinformed Consent 13 Women Share their Stories About Unnecessary Hysterectomy, Lise Cloutier-Steele, Stoddard, 2002, p.222, $15.95.
G. Asha is a neuroscientist currently based in Thiruvanathapuram. She has been a Pembroke Scholar at Brown University, U.S..
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