Hysterectomy – is it necessary?

Hysterectomy

In a normal adult female, the uterus is roughly the size of her fist and is located in the lower abdomen ( belly ). Hysterectomy is the surgical removal of the uterus or womb. It is done for many reasons, such as uterine prolapse, multiple large fibroids, and diseases such as cancer. Unless the ovaries are diseased, they can and should not be removed with the uterus as they produce hormones even after menopause.

When is the surgical removal necessary – when both you and your gynecologist decide it is necessary.

This is my story. I started having problems with super heavy bleeding during periods about 7-8 years ago. I  didn’t think much of it – lots of people have heavy periods. I considered myself lucky that I had had very light and very regular periods for my whole life since periods began. Then, they just got really heavy – like bleed all over the bed type heavy. How embarrassing! Still, that wasn’t too bad, or so I thought. Just get on with it. Then, about 4  years ago now, I started having trouble going for a pee in the toilet. The flow seemed blocked somehow. I couldn’t explain it. It wasn’t right. At around the same time, or soon after, I found I didn’t have any energy. Found it hard to get out of bed, which is not like me at all. So, long story short, I went to the doctor, he did an examination, found what he called a bulky uterus ( just means bigger than normal ) and he sent me for an ultrasound scan. He also sent me for a blood test. The scan showed lots of fibroids inside the uterus, some of them really big, bigger than golf balls, which made the uterus bigger than normal and also caused my heavy bleeding. More surface area of the lining of the uterus = more bleeding. So then, my doctor referred me to a gynecologist. His first suggestion was to have a hysterectomy – which didn’t go down too well. He did perform a procedure which checked the lining of the uterus, which turned out to be normal.  So, then I thought I would try some other things to get rid of the fibroids. I tried Chinese herbs for a couple of years and fasting ( both water fasting and juice fasting ) and while both of these did make me feel a lot better, they didn’t get rid of the problem – the fibroids.

Back to the blood test, which showed a very low ferritin count ( iron in the blood ). Really low. So low, the doctor almost freaked. Caused by the heavy bleeding. I tried iron tablets, they do have side effects for some people – such as cramping and feeling nauseous and that was me, so I didn’t take them for long. I had 2 iron infusions instead, about 8 months apart. They did make me feel a lot better, certainly able to get out of bed but I really didn’t want to keep having them. To me they were just a bandaid, a temporary fix that didn’t get to the cause of low ferritin count, which was those pesky fibroids. I did keep taking an oral iron supplement, called Maltofer , it was easier on the stomach than the others but felt the time was coming to make a big decision.

Picture of the ovaries, falopian tubes and uterus

So then in January 2020, I did it, I made the decision, the time had come to get rid of those unwanted passengers in my uterus. In some cases, just the fibroids can be removed – and this is an option worth exploring if you can. I had too many fibroids, so my only option was removal of the uterus. Having said that – even I had the option to keep my cervix and so I did. This is called a subtotal hysterectomy. I also had the option of keeping my ovaries and I did. Depending on the reason for the operation, a hysterectomy can be removed through the vagina and thereby leave no abdominal scarring. This has been done, very successfully for more than 30 years. My mother had it done this way. However, she had it done for a different reason – uterine prolapse. I did not have this option, nor did I have the option of keyhole surgery. The sheer size of my uterus meant I had to have the same cut as a normal cesarean section, low down on the belly.

Near the end of March, 2020, I had the subtotal hysterectomy and salpingectomy done. Salpingectomy is the correct word for surgical removal of the fallopian tubes. As they are attached to the uterus, it would be pointless to leave them behind. The ovaries were left, that was always the plan – lots of hormonal issues if they are removed and I already have enough of those! I had the good old fashioned cesarean section, with a big cut nice and low on the bikini line. I literally gave birth to a uterus full of about 40 fibroids – or as the surgeon put it ”a Christmas tree full of baubles”.

The operation was a success and healing has been steady, although not as rapid as I would like. Time in hospital was 2  1/2 days, it was a private hospital and the care given by all staff was incredible. One of the risks of a surgical procedure is the chance of DVT, ( deep vein thrombosis ) a very painful and possibly life threatening condition, so several measures are given to avoid it. Several injections of an anti-coagulating agent are given and also compression stockings for the lower legs are worn, both day and night for several days.

So far, even though the healing is quite painful, it has proven to be a good decision and the right decision for me and my personal circumstances. There is life after a hysterectomy! As I still have a cervix, I still have to have pap smears. Cervical cancer is still a possibility. Why did I keep my cervix, then? My choice. One of the reasons I did not want to have a hysterectomy in the first place is because I felt the uterus would have connective tissue that would support and hold other organs in place, rather like the cross beams in a house or building – there for structural integrity.  To a certain extent, this is true – and the connective tissue that supports and holds other things in place is on the cervix. So as far as I was concerned, that had to stay.

 

 

 

 

Hormone Replacement Therapy

Hormone Replacement Therapy

Questions are always asked about hormone replacement therapy ( HRT), or really it’s just hormone therapy ( HT ), so I thought it best to cover it briefly.

Now is the time to point out I am not a doctor or medical professional of any modality. So all I can give is my personal opinion and my experience as a woman. I will also state right here, I do not take any kind of hormone therapy myself. I have done some research and a small amount of study on the endocrine system ( hormone system of the body ) and what I discovered is the whole system is so finely tuned that I would not attempt to control it artificially with either manufactured hormones or bio-identical hormones. I find the risk of adverse effects is not worth the possible upside. That is my choice. I use Chinese herbs, acupuncture and homeopathy and I find that works for me. No side effects. However, I do not live in your body, so if you wish to take hormone therapy that is your choice and your decision. Please just research it first, so you know what you are getting into, both good and bad. Know what side effects you could experience. How much relief you can expect. How long it will take to get relief. Ask women who are taking it already to see how they find it.

What is it?

Picture of the ovaries, fallopian tubes and uterus

Time for a quick biology lesson – the hormones that drive the female monthly cycle are estrogen and progesterone, produced by the ovaries. Progesterone and estrogen are necessary to prepare the uterus for menstruation, and their release is triggered by the hypothalamus.

Once you reach puberty, the ovaries release a single egg each month (the ovaries typically alternate releasing an egg)—this is called ovulation. The hypothalamus sends a signal to the pituitary gland to release gonadotrophic substances (follicle stimulating hormone and luteinizing hormone). These hormones are essential to normal reproductive function—including regulation of the menstrual cycle.
As the egg migrates down the fallopian tube, progesterone is released. It is secreted by a temporary gland formed within the ovary after ovulation called the corpus luteum. Progesterone prepares the body for pregnancy by causing the uterine lining to thicken. If a woman is not pregnant, the corpus luteum disappears.

Menopause is a normal part of aging. It refers to the time when ovarian reproductive function ends—when a woman’s ovaries stop producing eggs and making the hormones estrogen and progesterone. Menopause is retrospectively diagnosed 1 year after your last period.

Menopause tends to occur in a woman’s late 40s to early 50s, but varies by country, with an average age of 51 years in the United States. Occasionally, women may have premature ovarian failure or early menopause. In addition, menopause may occur abruptly in a woman who has her ovaries removed or who undergoes chemotherapy or radiation.

What is Perimenopause?
Perimenopause refers to the time period leading up to menopause (premenopause) and the time following it (postmenopause). During the years preceding menopause, hormone levels fluctuate and average estrogen levels may even be higher. After menopause, hormone levels gradually decline.

You can still become pregnant during premenopause, even with erratic periods, making contraception important for women who don’t wish to become pregnant.

What are the Symptoms of  Perimenopause?
Hot flush with fanDuring the years leading up to menopause, periods are often irregular, and vasomotor symptoms such as hot flashes and night sweats often occur. Vasomotor symptoms refer to a difficulty regulating body temperature. These vasomotor symptoms may persist for years but do usually dissipate over time.

During the postmenopausal period, estrogen levels gradually decline, which may cause symptoms of vaginal dryness and increase the risk of cardiovascular and bone problems (discussed below). Sleep disturbances also are common throughout the entire perimenopausal period.

A host of other symptoms have been reported in association with perimenopause, but it is unclear whether they are directly related to menopause or are a result of aging. These other symptoms include fatigue, depression, irritability, anxiety, memory difficulties, weight gain, and urinary incontinence (trouble holding your bladder).

Signs and symptoms of perimenopause vary not only during a woman’s perimenopausal period, but also from person to person.

Health Changes with Menopause
The hormone changes that occur after menopause increase the risk for bone thinning (osteopenia and osteoporosis) and fracture, and heart disease. Thus, it is important to see your doctor during this time to monitor for these conditions and get treatment if necessary.

Management of Menopause Symptoms
Many women have difficulty with perimenopausal symptoms and may benefit from lifestyle changes and/or medications to manage symptoms and other health risks that occur with menopause. It is important to talk to your doctor about these issues.

Reference – this came direct from Endocrineweb

So hormone therapy is commonly prescribed for the hot flashes, night sweats and vaginal dryness of the peri-menopausal, menopausal and post- menopasal time of life. It is  considered, by many medical professionals, to be the most effective treatment.

Hormone therapy commonly refers to two different options:

–  combination estrogen plus progestin therapy (EPT), which is generally prescribed for women who still have a uterus ( womb).  The progestin is added to protect the uterus from cancer that can occur when estrogen is used alone                 – and one hormone, estrogen (ET) which is prescribed for women who have had their uterus removed.

There are many hormone therapy options available by prescription from your healthcare provider:

 a pill taken by mouth

 a patch, cream, gel, or spray that can be applied to your skin

 a cream, suppository, tablet, or ring that can be used within the vagina.

Many doses are available to meet your needs. Each of these options has different pros and cons that you can discuss with your healthcare provider.

In 2002, a large study called the Women’s Health Initiative (WHI) reported an increased risk of breast cancer, heart disease, stroke, and blood clots with the use of EPT. In the years since the reporting of those results, we have learned that the type of HT (ET versus EPT), how it is taken, and the timing of starting this treatment (early versus late after menopause) produce different benefits and side effects. The risk of side effects (such as heart attack, stroke, blood clot, or breast cancer) with HT in healthy women ages 50 to 59 is low. In contrast, using HT for a long time or starting HT when you are a number of years beyond menopause is associated with a higher risk of these side effects.Evaluating the benefits and risks of HT for you personally is an important discussion for you to have with your healthcare provider. Because you are unique, treatment options should be tailored to your needs and your concerns.

 If you have had blood clots, heart disease, stroke, or breast cancer, it may not be in your best interest to take HT. Be sure to discuss your health conditions with your healthcare provider. How long you should take HT is different for EPT and ET. For EPT, the time is limited by the increased risk of breast cancer that is seen with more than 3 to 5 years of use. For ET, no sign of an increased risk of breast cancer was seen during an average of 7 years of treatment, a finding that allows more choice in how long you choose to use ET.  Most healthy women below age 60 will have no increase in the risk of heart disease with the risks of stroke and blood clots in the lungs are increased but, in these younger age groups, the risks are less than 1 in every 1000 women per year taking HT.

 ET delivered through the skin (by patch, cream, gel, or spray) and low‐dose oral estrogen may have lower risks of blood clots and stroke than standard doses of oral estrogen, but all the evidence is not yet available. Research will continue to bring valuable information to help women with their decision about HT.

Reference –      NAMS website: www.menopause.org

NAMS is North America’s leading nonprofit organization dedicated to promoting the health and quality of life of all women during midlife and beyond through an understanding of menopause and healthy aging.

There are plenty of other websites with information also but bear in mind some of them will be promoting hormone therapy or supplements.

Insomnia

InsomniaInsomnia, or sleeplessness is very common for women experiencing the changes that come with menopause. It can take several forms – it can be difficulty falling alseep, or waking up early and not being able to get back to sleep or waking up several times a night. I have experienced, and continue to experience,  all these personally and they are not much fun. Whatever form it takes, it can lead to tiredness, fatigue, lack of concentration, lack of motivation and brain fog. If it becomes a long term issue, it can also lead to anxiety and depression. And it just takes the joy out of this wonderful thing called life.

Tips for Better Sleep

There are are a number of things you can do to improve your sleep;

Keep the room dark – light can play havoc with your sleep cycle and either hinder getting to sleep or wake you up too early. I can vouch for this,  I find it very hard to get to sleep and stay asleep if there is  light in the room. Try blockout curtains or blinds, they work a treat. I’ve even used blankets or doonas ( quilt, duvet ) to cover non blockout curtains when sleeping away from home.

Don’t use devices just before going to bed – don’t have TV’s or computers in the bedroom and stop using the phone or tablet around about an hour before bed. Even though you can get blue light filter apps that change the blue light to yellow and that helps, it’s not just the light that’s the problem it’s the stimulation to your brain. If you like to read to relax, use books. Personally I find reading books to be too stimulating at night, but this seems to be uncommon. No one else I know or have asked has this problem.

Avoid caffeine for several hours before bedtime. Caffeine is a well-known sleep inhibitor, so avoid tea, coffee, chocolate, red bull and any other energy drinks before bed. Even decaffeinated tea and coffee still has a small amount of caffeine, which could upset your sleep if you are sensitive to it. Stick to herbal teas which are naturally caffeine free.

Some herbal teas are designed specifically to help the body relax and get to sleep. One such tea is Casimiroa, which is the dried leaves of the Casimiroa tree and has a mild sedative effect. Another, more well known is Chamomile tea. There are lots of other teas available now, too – all of them best taken around an hour before going to bed.

Exercise – is great for the body and has multiple benefits one of which is promoting better sleep.  Vigorous exercise, however, such as running, cycling, swimming etc is best done before evening. Do it too close to bedtime and it will probably keep you awake. Keep to gentle, stress relieving exercise such as yoga and tai chi  or walking  gently in the evening  – although these are good anytime. Everyone is different and myself I found dancing to be the exception to this rule – I could dance all night, go straight to bed and sleep really well.

Good sleepTry to avoid eating a large meal just before bed. Allow at least a couple of hours for ‘dinner to go down’. Heavy digestion interferes with sleeping – although it does depend on what you eat, as well. A light meal in evening, like soup, or salad would be better than something heavy. I find I can get away with eating the evening meal late every now and then, without it interfering with my sleep.

Avoid alcoholic drinks in the evening – yes, they may put you to sleep at first, but they will also wake you up later! Alcohol also affects the quality of your sleep, you tend not to get to the deeper stages of sleep which are when your body restores itself. And, I find I wake up feeling tired even if I don’t have a hangover or headache. Actually avoid drinking too much of anything in the evening – even water. Otherwise you will have to get up in the night to use the bathroom.

Try keeping the bedroom cool – cooler is better for sleeping. I find a temperature of 20-22*C (68 -72*F ) works best for me and I use a ceiling fan with the air conditioner or just the ceiling fan. If you don’t have a ceiling fan, an ordinary desktop fan or pedestal fan will suffice.

Keep the bedroom quiet – a bit of a challenge if you live in a noisy area or near a main road. There are devices called white noise generators and they are amazing at blocking out external noise. A fan, with a constant, gentle whirr can also block out other noise – if the whirr of the fan itself doesn’t disturb you. It took a while but I have gotten used to the sound of a fan – and now I don’t hear it anymore.

Take a bath, with some magnesium chloride flakes in it. Try 1/2 a cup to start and up it to one cup or one and a 1/2 cups of magnesium flakes in warm – not hot – water and try and soak for 30 minutes or more. Magnesium is incredibly important for the body yet it’s better to absorb it through the skin rather than take it orally. You can get a magnesium oil to put on your skin, but a bath is fun and it worked a treat for me! Had the best sleep in months after a magnesium bath.

Try deep, slow, belly breathing – works best for me if I wake up in the night and find it hard to go back to sleep.

Use wicking pyjamas – ones that absorb sweat and wick it away from the body so that you are not so drenched when having night sweats. Fibres like bamboo do this, bamboo in particular is really soft and comfortable as well. Personally I like no pyjamas is summer – but you run the risk of drenching the sheets. It’s easier to wash pyjamas or a nightie.

Essential oilEssential Oils – either one or a blend of essential oils can help you get off to sleep. Lavender is well known for helping to relax and support sleep and ylang ylang, also well known for winding down ( and a favorite oil for romance ) are two oils that can be used on their own. Use 6 drops in a diffuser ( don’t use a candle or tea light diffuser in the bedroom, bit of a fire risk ) about 30 minutes before youwant to go to bed. Don’t have a diffuser? Put 10-12  drops into a clean, 60ml ( 2 oz) glass spray bottle and fill up with distilled water. Shake and use the spray on your pillow or just spray around the room.

Essential oil singleIf you love essential oils and prefer to have a blend, a combination of lavender, ylang ylang, clary sage, grapefruit and frankincense works well as a sleep enhancer.  Blend 20 drops each of lavender, grapefruit and frankincense in a clean essential oil bottle, then add 12 drops of ylang ylang and 6 drops of clary sage. Allow to blend together for at least 30 minutes before using.  Use 6 drops of the blend in a diffuser, and put on 30 minutes before bed. No more than that, a little goes a long way. Or use it in a spray bottle, same thing as single oil, 10 to 12 drops in  60ml glass spray bottle and fill with water. Spray around room or on pillow.  Or 8 to 10 drops in a relaxing bath, with some epsom salts in too.  A word of warning – essential oils are a concentrated product of plant origin, they are powerful and need to be treated with care and respect. Just because they are natural doesn’t mean they cannot harm. Always use with care and discontinue if you have any bad reaction. And there are a few places they should NEVER EVER go. Never, ever, ever put any essential oil in your eyes or inside  your ears. Don’t even put it too close. EVER! Eyes and ear drums and canals are delicate and easily damaged. It will hurt. A lot. Don’t do it.

Also, don’t store oils in plastic bottles or cups. They react with the plastic and will eat through it.  Store essential oils in glass, always.

Next word of warning, not all essential oils are the same. Some are carefully made from organic plants with rigorous testing and these will naturally be more expensive than those made from conventional ingredients. Or in a lab, or with lesser quality oils. For best results, use best quality oils, like Young Living or doTerra. There are other good brands out there, just these are the only 2 I use on myself and I can recommend them personally.

Homeopathic remedies – can also be useful. The beauty of homeopathic remedies is that they are completely safe and have absolutely no contraindications. So you can use them no matter what medication, supplements or whatever you are already taking. Homeopathic remedies are also more available than ever before, even some pharmacies stock them. You can buy remedies and take them yourself or you can also visit a homeopath.  Homeopathic remedies are made in pillule or liquid form, both are equally effective, it comes down to personal preference. The pillule form is usually very inexpensive.

If none of these  help – it would be a good idea to see a health professional. There might be something else going on.

Getting Enough Sun

Sun is vital to good health.

sunEverybody knows that the body produces vitamin D from sunlight on the skin but did you know that vitamin D is unique compared to other vitamins? When  your body gets enough vitamin D, through a complicated process, it turns vitamin D into a steroid  hormone. This hormone is sometimes called “activated vitamin D” or “calcitriol.” Vitamin D is very important for strong bones because it is essential for absorbing the calcium and phosphorus from foods we eat. You can also get a small amount of vitamin D from foods but the main source of vitamin D is sunlight.

Sunlight is a natural cure that helps the body maintain a high state of physical and mental health.  In fact, it holds the cure to the vast majority of diseases that are now considered epidemic in the western world. Vitamin D is vital for general good health, and researchers now are discovering that vitamin D is used by the body for so much more than maintaining bone health. Some of the functions of the body that vitamin D helps with include:

  • Immune system, which helps you to fight infection
  • Muscle function
  • Cardiovascular function, for a healthy heart and circulation
  • Respiratory system –for healthy lungs and airways
  • Brain development
  • Anti-cancer effects

It doesn’t end there –  Vitamn D lifts your mood – when you expose your eyes to sunlight (without sun glasses), the bio photons of light entering your brain via the visual cortex, stimulate emotional molecules of happiness and joy. So you feel good. And, when you don’t get enough, depression can kick in and take the joy out of life.

Be careful with sunscreens

Most sunscreen are made with chemicals, many of them now found to be toxic.

Because your skin is cytophylactic (like a sponge), it virtually ‘eats’ whatever you put on it – and so if there are toxic chemicals in the sunscreen you are using – they’ll be absorbed into your bloodstream and can cause problems ( like cancer) at a later date. If any of these chemicals are listed as ingredients on the sunscreen you are using, you may want to do some more research before putting it on your skin:

  • Para amino benzoic acid
  • Octyl salicyclate
  • Oxybenzone
  • Cinoxate
  • Dioxybenzone
  • Phenylbenzimidazole
  • Homosalate
  • Menthyl anthranilate
  • Octocrylene
  • Methoxycinnamate
  • Parabens

 

How to protect your skin?

Fresh fruitGet your sun in the early hours, or later in the afternoon if possible. Eat fresh fruits and vegetables, grown locally or at least in the same climate zone where you live and in season. A diet rich in fresh fruits and vegetables, after a few months will improve your skin’s tolerance to the sun.

Also, not wearing sunglasses protects our skin –  when we are outside the light that comes into our eyes sends signals to the pituitary gland which triggers hormones to be released for skin protection. Humankind has not had sunglasses for the last couple of million years, so what if by wearing them you are also signalling to your brain that you are indoors – when actually you are in direct sunlight. Then your body is not sending the proper protection to your skin. Food for thought. Made me think, I can tell you! I live in a sunny part of the world, Western Australia and I’ve been wearing sunglasses, religiously, for years. So I tried not wearing them, started slowly at first to see how it went. I did not burn, even with extended periods of time spent in the sun, usually from early to mid morning. So now I don’t wear them at all – and keep out of the sun during the middle of the day, where possible. Or I wear a hat but not sunglasses.