BabsieGirl

Health Awareness for Women with Endometriosis:

I'm sharing my story (and hope many of you will also) with all the women or joining memebers here at IM (as a mother and figure athlete) to all of the women going through what I'm am. I wish this brings hope to all women in doubt of following their dream to be a pro figure athlete, model or what ever your personal goal may be.

Please feel free to ask me any question and I'll do my best to answer based off my personal experience, research and shared advice given to me. This is all new so please bare with me.

Feb 9th, I was diagnosed with stage IV Endometriosis which has spilled over into, on or around my colon. On this date I had a D&C and a Laparascopy. A Laparascopy is (from what I've been reading) the only way to diagnose Endometriosis. If when your doctor goes in and he/she sees the endometriosis, majority of it can be burned off by lasering.

**I'll post some research.

Feb. 24th, I meet with my gyno to discuss the results from my previous surgery and to go over my options. So far, I know my options are to either go on Hormone Therapy for a while or have a Hysterectomy. At the moment, I'm currently doing a lot of research to help weigh my options and to help me think of questions I need to ask my doctor on this date.

IF there is anyone out there who would like to share their story and how they've over come such a disease that affects over 70% of women today. I urge you to step forward and share your experience, how long it took before you returned to weight training, etc.... so that one day when this thread is opened by a lady who is now is our shoes, she'll know what to do, what to expect and she'll have gained some knowledge.

On Feb 25th, I'll share with you my decision and keep progress and status reports here for Figure/Fitness athletes, Models, Mommies, etc........

My goal is to become a Pro Figure athlete regardless of the scars I have developed during my battle of fighting Endometriosis. I'll share how soon I return to weight training,my sadness & how I've over come it. I am proud of my progress and the person I've become and I wish to spread hope to all women/figure/fitness competitors who have given up or are thinking about it. Scars or no Scars, I'm still getting on stage because I'm proud of who I am and the work I've put in to be the person I am today. On stage and off.

Be proud of who you are and stand up for who you want to be.

Thanks for following along. Please do not joke around in this thread. Endometriosis is a serious matter to a lot of women and I would like to give them a wonderful learning experience.

Thank you
Babsie

Don't hate the player, hate the game!http://pages.prodigy.net/rogerlori1/...the%20wave.GIF
Before you talk about what you want - appreciate what you have.

http://home.earthlink.net/~gwcaton/s...ctures/tmf.jpg
A good marriage would be between a blind wife and a deaf husband. -Honore de Balzac
Desire+Consistency='s RESULTS

DFINEST

GOD Bless You sweetness
and may your message inform & motivate

GODSPEED as you overcome, achieve, and succeed

Drama is the result of an attempt
to find wholeness & success
in the midst of forces that have been
birthed in chaos and nurtured in confusion.
-- No More Drama

BabsieGirl

Thank you D for your words of support. I really do appreciate it.

Don't hate the player, hate the game!http://pages.prodigy.net/rogerlori1/...the%20wave.GIF
Before you talk about what you want - appreciate what you have.

http://home.earthlink.net/~gwcaton/s...ctures/tmf.jpg
A good marriage would be between a blind wife and a deaf husband. -Honore de Balzac
Desire+Consistency='s RESULTS

BabsieGirl

Endometriosis


Definition

Endometriosis is a condition in which bits of the tissue similar to the lining of the uterus (endometrium) grow in other parts of the body. Like the uterine lining, this tissue builds up and sheds in response to monthly hormonal cycles. However, there is no natural outlet for the blood discarded from these implants. Instead, it falls onto surrounding organs, causing swelling and inflammation. This repeated irritation leads to the development of scar tissue and adhesions in the area of the endometrial implants.

Description

Endometriosis is estimated to affect 7% of women of childbearing age in the United States. It most commonly strikes between the ages of 25 and 40. Endometriosis can also appear in the teen years, but never before the start of menstruation. It is seldom seen in postmenopausal women.

Endometriosis was once called the "career woman's disease" because it was thought to be a product of delayed childbearing. The statistics defy such a narrow generalization; however, pregnancy may slow the progress of the condition. A more important predictor of a woman's risk is if her female relatives have endometriosis. Another influencing factor is the length of a woman's menstrual cycle. Women whose periods last longer than a week with an interval of less than 27 days between them seem to be more prone to the condition.

Endometrial implants are most often found on the pelvic organs-the ovaries, uterus, fallopian tubes, and in the cavity behind the uterus. Occasionally, this tissue grows in such distant parts of the body as the lungs, arms, and kidneys. Newly formed implants appear as small bumps on the surfaces of the organs and supporting ligaments and are sometimes said to look like "powder burns." Ovarian cysts may form around endometrial tissue (endometriomas) and may range from pea to grapefruit size. Endometriosis is a progressive condition that usually advances slowly, over the course of many years. Doctors rank cases from minimal to severe based on factors such as the number and size of the endometrial implants, their appearance and location, and the extent of the scar tissue and adhesions in the vicinity of the growths.

Causes and symptoms

Although the exact cause of endometriosis is unknown, a number of theories have been put forward. Some of the more popular ones are:


**Implantation theory. Originally proposed in the 1920s, this theory states that a reversal in the direction of menstrual flow sends discarded endometrial cells into the body cavity where they attach to internal organs and seed endometrial implants. There is considerable evidence to support this explanation. Reversed menstrual flow occurs in 70-90% of women and is thought to be more common in women with endometriosis. However, many women with reversed menstrual flow do not develop endometriosis.


**Vascular-lymphatic theory. This theory suggests that the lymph system or blood vessels (vascular system) is the vehicle for the distribution of endometrial cells out of the uterus.


**Coelomic metaplasia theory. According to this hypothesis, remnants of tissue left over from prenatal development of the woman's reproductive tract transforms into endometrial cells throughout the body.


**Induction theory. This explanation postulates that an unidentified substance found in the body forces cells from the lining of the body cavity to change into endometrial cells.

In addition to these theories, the following factors are thought to influence the development of endometriosis:


**Heredity. A woman's chance of developing endometriosis is seven times greater if her mother or sisters have the disease.


**Immune system function. Women with endometriosis may have lower functioning immune systems that have trouble eliminating stray endometrial cells. This would explain why a high percentage of women experience reversed menstrual flow while relatively few develop endometriosis.


**Dioxin exposure. Some research suggests a link between the exposure to dioxin (TCCD), a toxic chemical found in weed killers, and the development of endometriosis.

While many women with endometriosis suffer debilitating symptoms, others have the disease without knowing it. Paradoxically, there does not seem to be any relation between the severity of the symptoms and the extent of the disease. The most common symptoms are:


**Menstrual pain. Pain in the lower abdomen that begins a day or two before the menstrual period starts and continues through to the end is typical of endometriosis. Some women also report lower back aches and pain during urination and bowel movement, especially during their periods.


**Painful sexual intercourse. Pressure on the vagina and cervix causes severe pain for some women.


**Abnormal bleeding. Heavy menstrual periods, irregular bleeding, and spotting are common features of endometriosis.


**Infertility. There is a strong association between endometriosis and infertility, although the reasons for this have not been fully explained. It is thought that the build up of scar tissue and adhesions blocks the fallopian tubes and prevents the ovaries from releasing eggs. Endometriosis may also affect fertility by causing hormonal irregularities and a higher rate of early miscarriage.

Diagnosis

If a doctor suspects endometriosis, the first step will be to perform a pelvic exam to try to feel if implants are present. Very often there is no strong evidence of endometriosis from a physical exam. The only way to make a definitive diagnosis is through minor surgery called a laparoscopy. A laparoscope, a slender scope with a light on the end, is inserted into the woman's abdomen through a small incision near her belly button. This allows the doctor to examine the internal organs for endometriotic growths. Often, a sample of tissue is taken for later examination in the laboratory. Endometriosis is sometimes discovered when a woman has abdominal surgery for another reason such as tubal ligation or hysterectomy.

Various imaging techniques such as ultrasound, computed tomography scan (CT scan), or magnetic resonance imaging (MRI) can offer additional information but aren't useful in making the initial diagnosis. A blood test may also be ordered because women with endometriosis have higher levels of the blood protein CA125. Testing for this substance before and after treatment can predict a recurrence of the disease, but the test is not reliable as a diagnostic tool.

Treatment

How endometriosis is treated depends on the woman's symptoms, her age, the extent of the disease, and her personal preferences. The condition cannot be fully eradicated without surgery. Conservative treatment focuses on managing the pain, preserving fertility, and delaying the progress of the condition.

Pain relief

Over-the-counter pain relievers such as aspirin and acetaminophen (Tylenol) are useful for mild cramping and menstrual pain. Prescription-strength and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn), are also effective. If pain is severe, a doctor may prescribe narcotic medications, although these can be addicting and are rarely used.

Hormonal treatments

Hormonal therapies effectively tame endometriosis but also act as contraceptives. A woman who is hoping to become pregnant would take these medications for a period of time, then try to conceive within several months of discontinuing treatment.


**Oral contraceptives. Continuously taking estrogen-progestin pills tricks the body into thinking it is pregnant. This state of pseudopregnancy means reduced pelvic pain and a temporary withering of endometrial implants.


**Danazol (Danocrine) and gestrinone are synthetic male hormones that lower estrogen levels, prevent menstruation, and shrink endometrial tissues. On the downside, they lead to weight gain and menopause-like symptoms, and cause some women to develop masculine characteristics.


**Progestins. Medroxyprogesterone (Depo-Provera) and related drugs may also be used in treating endometriosis. They have been proven effective in minimizing pain and halting the progress of the condition, but are rarely used because of the high rate of side effects.


**Gonadotropin-releasing hormone (GnHR) agonists. These estrogen-inhibiting drugs successfully limit pain and prevent the growth of endometrial implants. They can cause menopause symptoms, however, and doses have to be regulated to prevent bone loss associated with low estrogen levels.

Surgery

Removing the uterus, ovaries, and fallopian tubes is the only permanent method of eliminating endometriosis. This is an extreme measure that deprives a woman of her ability to bear children and forces her body into menopause. Endometrial implants and ovarian cysts can be removed with laser surgery performed through a laparoscope. For women with minimal endometriosis, this technique is usually successful in reducing pain and slowing the condition's progress. It may also help infertile women increase their chances of becoming pregnant.

Alternative treatment

Although severe endometriosis should not be self-treated, many women find they can help their condition through alternative therapies. Taking vitamin B complex combined with vitamins C, E, and the minerals calcium, magnesium, and selenium can help the depression and lack of energy that may accompany endometriosis. B vitamins also counteract the side effects of hormonal drugs. Other women have found relief when they turned to a macrobiotic diet. Less extreme diets that cut out sugar, salt, and processed foods are sometimes helpful, as well. Mind-body therapies such as relaxation and visualization help women cope with pain. Other avenues to combat pain include acupuncture and biofeedback techniques. Still other women report positive results after being treated by chiropractors or homeopathic doctors.

Prognosis

Most women who have endometriosis have minimal symptoms and do well. Overall, endometriosis symptoms come back in an average of 40% of women over the five years following treatment. With hormonal therapy, pain returned after five years in 37% of patients with minimal symptoms and 74% of those with severe cases. The highest success rate from conservative treatment followed complete removal of implants using laser surgery. Eighty percent of these women were still pain-free five years later. In cases that don't respond to these treatments, a woman and her doctor may consider surgery to remove her reproductive organs.

Prevention

There is no proven way to prevent endometriosis. One study, however, indicated that girls who begin participating in aerobic exercise at a young age are less likely to develop the condition.


Adhesions
Web-like scar tissue that may develop as a result of endometriosis and bind organs to one another.


Dioxin
A toxic chemical found in weed killers that has been linked to the development of endometriosis.


Endometrial implants
Growths of endometrial tissue that attach to organs, primarily in the pelvic cavity.


Endometrium
The tissue lining the uterus that grows and sheds each month during a woman's menstrual cycle.


Estrogen
A female hormone that promotes the growth of endometrial tissue.


Hormonal therapy
Use of hormone medications to inhibit menstruation and relieve the symptoms of endometriosis.


Laparoscopy
A diagnostic procedure for endometriosis performed by inserting a slender, wand-like instrument through a small incision in the woman's abdomen.


Menopause
The end of a woman's menstrual periods when the body stops making estrogen.


Retrograde menstruation
Menstrual flow that travels into the body cavity rather than being expelled through the uterus.


For Your Information

Books
Breitkopf, Lyle J. Coping With Endometriosis. Prentice Hall, 1988.


D'Hooghe, Thomas M., and Joseph A. Hill. "Endometriosis." In Novak's Gynecology. 12th ed. Ed. Jonathan S. Berek, et al. Baltimore: Lippincott, 1996.


Overcoming Endometriosis. Ed. Mary Lou Ballweg, et al.Chicago: Congdon & Weed, 1987.


The Endometriosis Sourcebook. Ed. Mary Lou Ballweg, et al.Chicago: Congdon & Weed, 1995.


Organizations
Endometriosis Association International Headquarters. 8585 North 76th Place, Milwaukee, WI 53223. (800) 992-3636. http://EndometriosisAssn.org

Source: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group

The Essay Author is Stephanie Slon.

Don't hate the player, hate the game!http://pages.prodigy.net/rogerlori1/...the%20wave.GIF
Before you talk about what you want - appreciate what you have.

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A good marriage would be between a blind wife and a deaf husband. -Honore de Balzac
Desire+Consistency='s RESULTS

Stacey

Awesome Post Babsie!!!!!! I (I know you know) Have Endometriosis also--and I know it's a Mean Mean disease. OF course we are not going to die from it, so many people do not take us seriously when we say we have Endometriosis--they think oh no big deal-- just cramps. But the pain does HURT, Imagine not being able to have Sex with your hubby or the man you love because of pain. OR Sitting at work sitting in pain due to cramps, wanting to cry. Having horrible back aches due to endo.

The list of symptoms goes on and on. None of them are fun. I can't wait to overcome this disease. Hopefully, having a baby will do so. I know its very very possible. It did help my cousin, and other women I know.

Babsie-- You are remarkable and you are a success!!

Stacey

POSTED BY BABS--Infertility. There is a strong association between endometriosis and infertility, although the reasons for this have not been fully explained. It is thought that the build up of scar tissue and adhesions blocks the fallopian tubes and prevents the ovaries from releasing eggs. Endometriosis may also affect fertility by causing hormonal irregularities and a higher rate of early miscarriage. "

MY Doctor thinks I will have this problem

BabsieGirl

Same here. I also have adhesions


Getting ready to post some more INTERESTING material

Don't hate the player, hate the game!http://pages.prodigy.net/rogerlori1/...the%20wave.GIF
Before you talk about what you want - appreciate what you have.

http://home.earthlink.net/~gwcaton/s...ctures/tmf.jpg
A good marriage would be between a blind wife and a deaf husband. -Honore de Balzac
Desire+Consistency='s RESULTS

BabsieGirl

Hysterectomy


Definition

Hysterectomy is the surgical removal of the uterus. In a total hysterectomy, the uterus and cervix are removed. In some cases, the fallopian tubes and ovaries are removed along with the uterus (called hysterectomy with bilateral salpingo-oophorectomy). In a subtotal hysterectomy, only the uterus is removed. In a radical hysterectomy, the uterus, cervix, ovaries, oviducts, lymph nodes, and lymph channels are removed. The type of hysterectomy performed depends on the reason for the procedure. In all cases, menstruation stops and a woman loses the ability to bear children.

Purpose

Hysterectomy is the second most common operation performed in the United States. About 556,000 of these surgeries are done annually. By age 60, approximately one out of every three American women will have had a hysterectomy. Yet it's estimated that 30 percent of hysterectomies are unnecessary.

About 10% of hysterectomies are performed to treat cancer of the cervix, ovaries, or uterus. Women with cancer in one or more of these organs almost always have the organ(s) removed as one part of their cancer treatment.

The most frequent reason for hysterectomy in the United States is to remove fibroid tumors, accounting for 30% of these surgeries. Fibroid tumors are non-cancerous (benign) growths in the uterus, which can cause pelvic and low back pain and heavy or lengthy menstrual periods. They occur in 30-40% of women over age 40, and are three times more likely to be present in African-American women than in Caucasian women. Fibroids do not need to be removed unless they are causing symptoms that interfere with a woman's normal activities.

Treatment of endometriosis is the reason for 20% of hysterectomies. The endometrium is the lining of the uterus. Endometriosis is a condition that occurs when the cells from the endometrium begin growing outside the uterus. The outlying endometrial cells respond to the hormones that control the menstrual cycle, bleeding each month the way the lining of the uterus does. This causes irritation of the surrounding tissue, leading to pain and scarring.

Another 20% percent of hysterectomies are done because of heavy or abnormal vaginal bleeding that can not be linked to any specific cause and cannot be controlled by other means. The remaining 20% of hysterectomies are performed to treat prolapsed uterus, pelvic inflammatory disease, and endometrial hyperplasia, a potentially precancerous condition.

Alternatives

There are several alternatives to hysterectomy today. They include:

Embolization

Uterine artery embolization is not a surgical procedure. Instead, interventional radiologists put a catherter into the artery that leads to the uterus and inject polyvinyl alcohol particles right where the artery leads to the blood vessels that nourish the fibroids. By killing off those blood vessels, the fibroids have no more blood supply, and they die off. Severe cramping and pain after the procedure is common, but serious complications are less than 5 percent and it may protect fertility.

Myomectomy

A myomectomy is a surgery used to remove fibroids, thus avoiding a hysterectomy. Hysteroscopic myomectomy, in which a surgical "telescope," or laparascope, is inserted into the uterus through the vagina can be done on an outpatient basis. If there are large fibroids, however, an abdominal incision is required. Then women typically are hospitalized for two to three days, and require up to six weeks recovery. However, laparascopic myomectomies are also being done more often. They only require three small incisions in the abdomen, and have a much shorter hospitalization and recovery time.

Once the fibroids have been removed, the surgeon must repair the wall of the uterus to eliminate future bleeding or infection.

Endometrial ablation

In this surgical procedure, recommended for women with small fibroids, the entire lining of the uterus is removed. Women are no longer fertile, however. The uterine cavity is filled with fluid and a hysteroscopy, or telescope, inserted to provide a clear view of the uterus. Then the uterus is destroyed using a laser beam or electric voltage. The procedure is typically done under anesthesia, although women can go home the same day as the surgery. Another, newer procedure involves using a balloon, which is filled with superheated liquid and inflated until it fills the uterus. The liquid kills the lining, and after 8 minutes the balloon is removed.

Endometrial resection

Like endometrial ablation, the uterine lining is also destroyed during this procedure, only instead of a laser, an electrosurgical wire loop is used.

Total hysterectomy

A total hysterectomy, sometimes called a simple hysterectomy, removes the entire uterus and the cervix. The ovaries are not removed and continue to secrete hormones. Total hysterectomies are always performed in the case of uterine and cervical cancer. This is the most common kind of hysterectomy.

Sometimes, in addition to a total hysterectomy a procedure called a bilateral salpingo-oophorectomy is performed. This surgery removes the ovaries and the fallopian tubes. Removal of the ovaries eliminates the main source of the hormone estrogen, so menopause occurs immediately. Removal of the ovaries and fallopian tubes is performed in about one-third of hysterectomy operations, often to reduce the risk of ovarian cancer.

Subtotal hysterectomy

If the reason for the hysterectomy is to remove uterine fibroids, treat abnormal bleeding, or relieve pelvic pain, it may be possible to remove only the uterus and leave the cervix. This procedure, called a subtotal hysterectomy (or partial hysterectomy), removes the least amount of tissue. The opening to the cervix is left in place. Some women feel that leaving the cervix intact aids in their achieving sexual satisfaction. This procedure, which used to be rare, is now performed more frequently when requested.

Subtotal hysterectomy is easier to perform than a total hysterectomy, but leaves a woman at risk for cervical cancer. She will still need to get yearly pap smears.

Radical hysterectomy

Radical hysterectomies are performed on women with cervical cancer or endometrial cancer that has spread to the cervix. A radical hysterectomy removes the uterus, cervix, top part of the vagina, ovaries, fallopian tubes, lymph nodes, lymph channels, and tissue in the pelvic cavity that surrounds the cervix. This type of hysterectomy removes the most tissue and requires the longest hospital stay and longer recovery period.

Precautions

The frequency with which hysterectomies are performed in the United States has been questioned in recent years. It has been suggested that a large number of hysterectomies are performed unnecessarily. The United States has the highest rate of hysterectomies (number of hysterectomies per thousand women) of any country in the world. Also, the frequency of this surgery varies across different regions of the United States. Rates are highest in the South and Midwest, and are higher for African American women. In recent years, although the number of hysterectomies performed has declined, the number of hysterectomies performed on younger women in their 30s and 40s is increasing, and 55 percent of all hysterectomies are performed on women 35 to 49.

Women for whom a hysterectomy is recommended should discuss possible alternatives with their doctor and consider getting a second opinion, since this is major surgery with life-changing implications. Alternative treatments exist for many conditions. Whether these alternatives are appropriate for any individual woman is a decision she and her doctor should make together.

As in all major surgery, the health of the patient affects the risk of the operation. Women who have chronic heart or lung diseases, diabetes, or iron-deficiency anemia may not be good candidates for this operation. Heavy smoking, obesity, use of steroid drugs, and use of illicit drugs add to the surgical risk.

Description

There are two ways that hysterectomies can be performed. The choice of method depends on the type of hysterectomy, the doctor's experience, and the reason for the hysterectomy.

Abdominal hysterectomy

About 75% of hysterectomies performed in the United States are abdominal hysterectomies. The surgeon makes a four to six inch incision either horizontally across the pubic hair line from hip bone to hip bone or vertically from navel to pubic bone. Horizontal incisions leave a less noticeable scar, but vertical incisions give the surgeon a better view of the abdominal cavity. The blood vessels, fallopian tubes, and ligaments are cut away from the uterus, which is lifted out.

Abdominal hysterectomies take from one to three hours. The hospital stay is three to five days, and it takes four to eight weeks to return to normal activities.

The advantages of an abdominal hysterectomy are that the uterus can be removed even if a woman has internal scarring (adhesions) from previous surgery or her fibroids are large. The surgeon has a good view of the abdominal cavity and more room to work. Also, surgeons have the most experience with this type of hysterectomy. The abdominal incision is more painful than with vaginal hysterectomy and the recovery period is longer.

Vaginal hysterectomy

With a vaginal hysterectomy, the surgeon makes an incision near the top of the vagina. The surgeon then reaches through this incision to cut and tie off the ligaments, blood vessels, and fallopian tubes. Once the uterus is cut free, it is removed through the vagina. The operation takes one to two hours. The hospital stay is usually one to three days, and return to normal activities takes about four weeks.

The advantages of this procedure are that it leaves no visible scar and is less painful. The disadvantage is that it is more difficult for the surgeon to see the uterus and surrounding tissue. This makes complications more common. Large fibroids cannot be removed using this technique. It is very difficult to remove the ovaries during a vaginal hysterectomy, so this approach may not be possible if the ovaries are involved.

Vaginal hysterectomy can also be performed using a laparoscopic technique. With this surgery, a tube containing a tiny camera is inserted through an incision in the navel. This allows the surgeon to see the uterus on a video monitor. The surgeon then inserts two slender instruments through small incisions in the abdomen and uses them to cut and tie off the blood vessels, fallopian tubes, and ligaments. When the uterus is detached, it is removed though a small incision at the top of the vagina.

This technique, called laparoscopic-assisted vaginal hysterectomy, allows surgeons to perform a vaginal hysterectomy that might be too difficult otherwise. The hospital stay is usually only one day. Recovery time is about two weeks. The disadvantage is that this operation is relatively new and requires great skill by the surgeon.

Any vaginal hysterectomy may have to be converted to an abdominal hysterectomy during surgery if complications develop.

Preparation

Before surgery the doctor will order blood and urine tests. The woman may also meet with the anesthesiologist to evaluate any special conditions that might affect the administration of anesthesia. On the evening before the operation, the woman should eat a light dinner and then avoid eating or drinking anything.

Aftercare

After surgery a woman will feel pain. The degree of discomfort varies, and is generally greatest in abdominal hysterectomies because of the incision. Hospital stays vary from about two days (laparoscopic-assisted vaginal hysterectomy) to five or six days (abdominal hysterectomy with bilateral salpingo-oophorectomy). During the hospital stay, the doctor will probably order more blood tests.

Return to normal activities such as driving and working takes anywhere from two to eight weeks, again depending on the type of surgery. Some women have emotional changes following a hysterectomy. Women who have had their ovaries removed will probably start taking hormone replacement therapy.

Risks

Hysterectomy is a relatively safe operation, although like all major surgery it carries risks. These include unanticipated reaction to anesthesia, internal bleeding, blood clots, damage to other organs such as the bladder, and post-surgery infection. The risk of death is about one in every 1,000 (1/1,000) women having the operation.

Other complications sometimes reported after a hysterectomy include changes in sex drive, weight gain, constipation, and pelvic pain. Hot flashes and other symptoms of menopause can occur if the ovaries are removed. Women who have both ovaries removed and who do not take estrogen replacement therapy run an increased risk for heart disease and osteoporosis (a condition that causes bones to be brittle). Women with a history of psychological and emotional problems before the hysterectomy are more likely to experience psychological difficulties after the operation.

Normal results

Although there is some concern that hysterectomies may be performed unnecessarily, there are many conditions for which the operation improves a woman's quality of life. In the Maine Woman's Health Study, 71% of women who had hysterectomies to correct moderate or severe painful symptoms reported feeling better mentally, physically, and sexually after the operation.


Cervix
The lower part of the uterus extending into the vagina.


Fallopian tubes
Slender tubes that carry eggs (ova) from the ovaries to the uterus.


Lymph nodes
Small, compact structures lying along the channels that carry lymph, a yellowish fluid. Lymph nodes produce white blood cells (lymphocytes), which are important in forming antibodies that fight disease.


Prolapsed uterus
A uterus that has slipped out of place, sometimes protruding down through the vagina.


For Your Information

Books

Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. "Hysterectomy." In The Harvard Guide to Women's Health, Cambridge, MA: Harvard University Press, 1996, pp. 308-313.

Griffith, H. Winter. "Hysterectomy." In The Complete Guide to Symptoms, Illness and Surgery, 3rd ed. New York: Berkeley Publishing, 1995, pp. 818-825.


Organizations

American Cancer Society. (800) 227-2345. http://www.cancer.org.

National Cancer Institute. (800) 4-CANCER. http://www.nci.nih.gov.

Other

Parker, William H. "A Gynecologist's Second Opinion." http://www.gynsecondopinion.com.

Source: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group

The Essay Author is Debra Gordon.

Don't hate the player, hate the game!http://pages.prodigy.net/rogerlori1/...the%20wave.GIF
Before you talk about what you want - appreciate what you have.

http://home.earthlink.net/~gwcaton/s...ctures/tmf.jpg
A good marriage would be between a blind wife and a deaf husband. -Honore de Balzac
Desire+Consistency='s RESULTS

BabsieGirl

Hormone replacement therapy

Definition

Hormone replacement therapy (HRT) is the use of synthetic or natural female hormones to make up for the decline or lack of natural hormones produced in a woman's body. HRT is sometimes referred to as estrogen replacement therapy (ERT), because the first medications that were used in the 1960s for female hormone replacement were estrogen compounds.

Estrogens

**In order to understand how HRT works and the controversies surrounding it, women should know that there are different types of estrogen medications commonly prescribed in the United States and Europe. These drugs are given in a variety of prescription strengths and methods of administration. There are at present three estrogen compounds used in Western countries. Only the first two are readily available in the United States.


**Estrone. Estrone is the form of estrogen present in women after menopause. It is available as tablets under the brand name Ogen. The most commonly prescribed estrogen in the United States, Premarin, is a so-called conjugated estrogen that is a mixture of estrone and other estrogens.


**Estradiol. This is the form of estrogen naturally present in premenopausal women. It is available as tablets (Estrace), skin patches (Estraderm), or vaginal creams (Estrace).


**Estriol. Estriol is a weaker form of estrogen produced by the breakdown of other forms of estrogen in the body. This is the form of estrogen most commonly given in Europe, under the brand name Estriol. It is the only form that is thought not to cause cancer.

In addition to pills taken by mouth, skin patches, and vaginal creams, estrogen preparations can be given by injection or by pellets implanted under the skin. Estrogen implants, however, are used less and less frequently.

Progestins

Most HRT programs include progestin treatment with estrogen compounds. Progestins-sometimes called progestogens-are synthetic forms of progesterone that are given to reduce the possibility that estrogen by itself will cause cancer of the uterus. Progestins are commonly prescribed under the brand names Provera and Depo-Provera. Other common brand names are Norlutate, Norlutin, and Aygestin.

Estrogen/testosterone combinations

Women's ovaries secrete small amounts of a male sex hormone (testosterone) throughout their lives. Women who have had both ovaries removed by surgery are sometimes given testosterone along with estrogen as part of HRT. Combinations of these hormones are available as tablets under the brand name Estratest or as vaginal creams. Women who cannot take estrogens can use 1% testosterone cream by itself for problems with vaginal soreness.

Estrogen/tranquilizer combinations

There are several medications that combine estrogen with a tranquilizer like chlordiazepoxide (sold under the trade name Menrium) or meprobamate (sold under the trade name PMB). Many doctors warn against these combination drugs because the tranquilizers can be habit-forming.

Purpose

HRT has two primary purposes: preventive treatment against [b]osteoporosis[/]b and heart disease; and relief of physical symptoms associated with menopause.

Menopausal symptoms

Women in midlife enter a stage of development called menopause, when their menstrual periods become irregular and finally stop. The early phase of this transition is called the perimenopause. In the United States, the average age at menopause is presently 50 or 51, but some women begin menopause as early as 40 and others as late as 55. It can take as long as 10 years for a woman to complete the process. Women who have had their ovaries removed surgically are said to have undergone surgical menopause.

Doctors have not always agreed on definitions of the menopause. Some use age as the baseline. Others define menopause as the point when a woman has had no menstrual periods for a full calendar year. Still others define menopause as the end of ovulation. It is not always clear, however, when a woman has had her last period or when she has stopped ovulating. In addition, women who take oral contraceptives can have breakthrough bleeding long after they have stopped ovulating. As a result, some doctors now measure the level of follicle-stimulating hormone (FSH) in a woman's blood to estimate whether the woman has entered menopause. During perimenopause, the FSH levels in a woman's blood rise as her body attempts to stimulate the release of ripe ova. An FSH level over 40 is considered an indicator of menopause.

During the menopausal transition, the levels of estrogen in the woman's body drop. The lowered estrogen level is responsible for a group of symptoms that include hot flashes (or flushes), weight gain, changes in skin texture, mood swings, heart palpitations, sleep disturbances, a need to urinate more frequently, and loss of sexual desire. The estrogen that is given in HRT can eliminate hot flashes, night sweats, lack of vaginal lubrication, and urinary tract problems. HRT will not prevent weight gain or wrinkles. It also does not cure depression in most women.

Preventive care

HRT is recommended by many doctors on the grounds that estrogen replacement helps to protect women against two serious midlife health problems.

OSTEOPOROSIS

Osteoporosis is a disorder in which the bones become more brittle and more easily fractured. It is a particular problem for postmenopausal women because the lower levels of estrogen in the blood lead to weakening of the bone. About 25% of Caucasian women will develop severe osteoporosis; Asian women have a slightly lower risk level; Latino and African American women are least at risk.

In addition to race, there are other factors that put some women at higher risk of developing osteoporosis. Women in any of the following groups should take bone loss into account when considering HRT:


**family history of osteoporosis


**menopause before age 40


**kidney disease and dialysis


**thin body build or being underweight


**history of colitis, Crohn's disease, or chronic diarrhea


**thyroid medications


**childlessness


**chronic use of antacids


**lack of exercise


**poor food choices, including high salt intake, lack of vitamin D, high caffeine consumption, and low calcium intake


**smoking and alcohol abuse


**cortisone therapy

HEART DISEASE

Heart disease is a major health concern of women in midlife. It is the leading cause of death in women over 60. The primary disorders of the circulatory system in postmenopausal women are stroke, hypertension, and coronary artery disease. Current studies of women on HRT do not yield a completely clear picture. In particular, although estrogen given without progestins has been shown to offer some protection against heart disease, the effect of progestins in offsetting the benefits of estrogen complicates the research findings. It seems likely that estrogen levels are only part of the picture in evaluating a woman's risk of heart disease.

The major factors that are known to increase the risk of heart disease include:


**history of smoking


**being overweight


**high-fat diets


**alcohol abuse


**family history of heart disease


**high blood pressure


**high blood cholesterol levels


**diabetes.

Less important risk factors include being African American, having a sedentary lifestyle, undergoing menopause before age 45, and having high levels of family- or job-related stress.

[b]Precautions[b]

Medical conditions

Certain groups of women should not use HRT. They include women with:


**breast cancer


**cancer of the uterus


**abnormal vaginal bleeding that has not been diagnosed


**high blood pressure that rises when HRT is used


**liver disease


**gallstones or diseases of the gallbladder

Drug interactions

HRT can interact with other prescription medications that a woman may be taking. Women who are taking corticosteroids, drugs to slow the clotting of blood (anticoagulants), and rifampin should ask their doctor about possible interactions.

Combining estrogens with certain other medicines can cause liver damage. Among the drugs that may cause liver damage when taken with estrogens are:


**acetaminophen (Tylenol), when used in high doses over long periods


**anabolic steroids such as nandrolone (Anabolin) or oxymetholone (Anadrol)


**medicine for infections


**antiseizure medicines such as divalproex (Depakote), valproic acid (Depakene), or phenytoin (Dilantin)


**antianxiety drugs, including chlorpromazine (Thorazine), prochlorperazine (Compazine), and thioridazine (Mellaril).

In addition, estrogens may interfere with the effects of bromocriptine (Parlodel), used to treat Parkinson's disease and other conditions; they may also increase the chance of toxic side effects when taken with cyclosporine (Sandimmune), a drug that helps prevent organ transplant rejection.

Description

HRT medications come in several different forms, including tablets, stick-on patches, injections, and creams that are worn inside the vagina. The form prescribed depends on the purpose of the hormone replacement therapy. Women who want relief from vaginal dryness, for example, would be given a cream or vaginal ring. Women using HRT to relieve hot flashes or to prevent osteoporosis and heart disease often prefer oral medications or patches. All HRT medications used in the United States are available only with a doctor's prescription.

HRT treatment regimens

One of the complications of HRT is the number of treatment options, including combinations of types of estrogen; dosage levels; forms of administration; and whether or not progestins are used with the estrogen to offset the risk of uterine cancer. This variety, however, means that a woman who wants to use HRT while minimizing side effects can try different forms of medication or dosage schedules when she consults her doctor. It is vital, however, for women to follow their doctor's directions exactly and not change dosages themselves.

At present, women who are taking a combination of estrogens and progestins are placed on one of three dosage schedules:


**Estrogen pills taken daily from the first through the 25th day of each month, with a progestin pill taken daily during the last 10-14 days of the cycle. Both drugs are then stopped for the next five to six days to allow the uterus to shed its lining.


**Estrogen pills taken on a daily basis with low-dose progestin pills, also on a daily basis. Both medications are taken continuously with no days off.


**Estrogen pills and low-dose progestins taken on a daily basis for five days each week, with both medications stopped on the last two days of each week.

Controversies over HRT

It is important to know that there is still considerable disagreement over the advantages and disadvantages of HRT. Further research is ongoing and intensive concerning the benefits and/or risks.

INCREASED RISK OF BREAST CANCER

The most important controversy over HRT is whether it increases a woman's risk of developing breast cancer. Some studies not only indicate a connection, but suggest that the risk of breast cancer rises with the length of time that a woman has been taking HRT. According to an American study published in June 1998, the risk of breast cancer increases by 2.3% for each year that a woman takes HRT. A Swedish study found that the risk of breast cancer doubled after six years of HRT, which agrees with American findings that risk is connected to length of treatment.

TIMING AND LENGTH OF TREATMENT

One of the disagreements about HRT concerns the best time to begin using it. Some doctors think that women should begin using HRT while they are still in perimenopause. Others think that there is no harm in a woman's waiting to decide. Either way, the question of timing means that a woman should keep track of changes in her periods and other signs of perimenopause so that her doctor can evaluate her readiness for HRT.

The other question of timing concerns length of treatment. Some women use HRT only as long as they need it to relieve the symptoms of menopause. Others regard it as a lifetime commitment because of concerns about osteoporosis. One study found that the average length of time that women stay on HRT is 23 months.

UNWANTED SIDE EFFECTS

Much of the disagreement about unwanted side effects from HRT concerns the role of progestins in the estrogen/progestin combinations that are commonly prescribed. Many women who find that estrogen relieves hot flashes and other symptoms of menopause have the opposite experience with progestin. Progestin frequently causes moodiness, depression, sore breasts, weight gain, and severe headaches.

Other treatment approaches

Women who are uncertain about HRT, or who should not take estrogens, should know about other treatment options, such as natural progesterone. Progestins, which are synthetic hormones, were developed because natural progesterone cannot be absorbed in the body when taken in pill form. A new technique called micronization has made it possible for women to take natural progesterone by mouth. Many women prefer this form of hormone because it lacks the side effects of the synthetic progestins even though it is somewhat more expensive. The most common form of natural progesterone is called Prometrium and it is available by prescription only. Another form of natural progesterone consists of the hormone suspended in vitamin E oil. It is absorbed through the skin and is available without a prescription.

Alternative therapies are also available. Many mainstream as well as alternative practitioners recommend changes in diet and nutrition as helpful during menopause. Women who limit their intake of fats and salts, increase their use of fresh fruits and vegetables, cut out smoking, and drink only in moderation often find that these dietary changes help them feel better. Naturopaths typically recommend vitamin and mineral supplements for general well-being as well as for relief from hot flashes and leg cramps. In addition, herbal teas and tonics are helpful to some women in treating water retention, insomnia, constipation, or moodiness.

Women who find menopause emotionally stressful because of negative social attitudes toward older women are often helped by meditation, biofeedback, therapeutic massage, and other relaxation techniques. Yoga and tai chi provide physical exercise as well as stress reduction. Exercise is an important safeguard against osteoporosis.

Preparation

Women who are considering HRT should visit their doctor for a series of tests to make sure that they do not have any serious health disorders. They should have a Pap smear and breast examination to rule out cancer. They should also have a urinalysis, a bone density test, and blood tests to measure their red blood cell level, blood sugar level, cholesterol level, and liver and thyroid function.

In addition to these tests, most doctors will also give a progesterone challenge test. It consists of doses of progesterone given over a 10-day period to see if the woman is still producing her own estrogen. If she bleeds at the end of the test, she is still producing estrogen.

Aftercare

Aftercare is a very important part of HRT. Women who are taking HRT will need to see their doctor more frequently. At a minimum, they should be checked twice a year with a blood pressure test and breast examination. They should have a complete physical on a yearly basis. Any abnormal bleeding must be reported to the doctor as soon as it occurs. The doctor will need to order a tissue biopsy or dilation and curettage (D & C) in order to rule out cancer of the uterus.

Women who are taking HRT and decide to stop should taper their dosage over a period of several months rather than discontinuing abruptly. A gradual reduction minimizes the possibility of hot flashes and other side effects.

Risks

The short-term risks associated with HRT include a range of physical side effects. Common side effects include fluid retention, bloating, weight gain, sore breasts, leg cramps, vaginal discharges, migraine headaches, hair loss, nausea and vomiting, acne, depression, shortness of breath, and dizziness. Potentially serious side effects include tissue growths in the uterus (fibroids), gallstones, thrombophlebitis, hypoglycemia, abnormal growth (hyperplasia) of uterine tissue, thyroid disorders, high blood pressure, and cancer.

Normal results

Normal results of HRT include relief of hot flashes, night sweats, vaginal dryness, and urinary symptoms associated with menopause.


Dilation and curettage (D & C)
A surgical procedure in which the patient's cervix is widened (dilated) and the endometrium is scraped with a scoop-shaped instrument (curette).


Estrogen
The primary sex hormone that controls normal sexual development in females. During the menstrual cycle, estrogen helps prepare the body for possible pregnancy.


Follicle-stimulating hormone (FSH)
A hormone produced by the pituitary gland that stimulates the follicles in the ovaries to swell and release ripe ova. Doctors sometimes use its levels in a woman's blood to evaluate whether she is in menopause.


Hormone
A substance secreted by an endocrine gland that is carried by blood or other body fluids to its target tissues or organs.


Hot flash
A warm or hot sensation on the face, neck and upper body, sometimes accompanied by flushing and sweating. Some women refer to hot flashes as hot flushes.


Osteoporosis
A bone disorder in which the bones become brittle, porous, and easily broken. It is a major health concern for postmenopausal women.


Ovary
The female sex gland that produces eggs and female reproductive hormones.


Ovulation
The cyclical process of egg maturation and release from the ovary.


Progesterone
A female hormone produced by the ovary. It functions to prepare the lining of the uterus to receive a fertilized ovum.


Progesterone challenge test
A test that is given to see if a woman is still secreting estrogen. It consists of doses of progesterone given over a 10-day period.


Progestin
Synthetic progesterone available as an oral medication.


Testosterone
A male sex hormone that is sometimes given as part of HRT to women whose ovaries have been removed. Testosterone helps with problems of sexual desire.


Uterus
The hollow organ in women in which fertilized eggs develop during pregnancy. The uterus is sometimes called the womb.


For Your Information

Books

**Compton, Madonna Sophia, MA. Women at the Change: The Intelligent Woman's Guide to Menopause. St. Paul: Llewellyn Publications, 1998.


**Goldman, Lee, et al, eds. Cecil Textbook of Medicine. 21st ed. W. B. Saunders, 2000.


**Goroll, Alan H. Primary Care Medicine. 4th ed. Lippincott Williams & Wilkins, 2000.


**Greer, Germaine. The Change: Women, Aging, and the Menopause. New York: Fawcett Columbine, 1991.


**Greenwood, Sadja. Menopause, Naturally: Preparing for the Second Half of Life. Volcano, CA: Volcano Press, 1992.


**Nurses Drug Guide 1995. Ed. Billie Ann Wilson, et al. Norwalk, CT: Appleton & Lange, 1995.


**Sander, Pela. "Natural Healing Therapies." In Women of the 14th Moon: Writings on Menopause. Ed. Dena Taylor and Amber Coverdale Sumrall. Freedom, CA: The Crossing Press, 1991.


Organization

**American Heart Association. 7320 Greenville Avenue, Dallas, TX 75321. (214)373-6300.


**National Women's Health Network. 514 10th Street, NW, Washington, DC 20004. (202) 347-1140.


**North American Menopause Society (NAMS). 11100 Euclid Avenue, 7th Avenue, McDonald Hospital, Cleveland, OH 44105.


**Women's International Pharmacy. 5708 Monona Drive, Madison, WI 53716. (800) 279-5708.


Other

Menopausal Hormone Replacement Therapy. Fact sheet. National Cancer Institute. http://rex.nci.nih.gov

Source: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group

The Essay Author is Laith Farid Gulli M.D..

Don't hate the player, hate the game!http://pages.prodigy.net/rogerlori1/...the%20wave.GIF
Before you talk about what you want - appreciate what you have.

http://home.earthlink.net/~gwcaton/s...ctures/tmf.jpg
A good marriage would be between a blind wife and a deaf husband. -Honore de Balzac
Desire+Consistency='s RESULTS

Stacey

BABS-- I don't need hormone therapy treatment right?? Thats only if I have a hysterectomy! Correct???

Stacey

Prevention

There is no proven way to prevent endometriosis. One study, however, indicated that girls who begin participating in aerobic exercise at a young age are less likely to develop the condition.


I don't think this is true, I started jogging when I was 13 years old--and started aerobics at age 14--sooooo I doubt that one is true...lol

BabsieGirl

It depends on which stage women are in with their Endo. If you're on BCP, that's a form of therapy. BCPs are given to those who want to prevent pregnancy and to those with painful periods. BCPs are hormones.

From what I've been reading, seems like once a person has been diagnosed with Endometriosis and has a Hysterectomy, dif. strength hormones are prescribed to replace the hormones your body once created naturally.

Don't hate the player, hate the game!http://pages.prodigy.net/rogerlori1/...the%20wave.GIF
Before you talk about what you want - appreciate what you have.

http://home.earthlink.net/~gwcaton/s...ctures/tmf.jpg
A good marriage would be between a blind wife and a deaf husband. -Honore de Balzac
Desire+Consistency='s RESULTS

BabsieGirl

I believe the key words in prevention are: Less Likely to develope the condition.

Like you, I was very active at a very young age. Didn't help me.

I wonder if this also goes in hand with when a person says: "Exercise helps me feel better during my mensus"

A friend of mine says she feels better during her mensus when she exercises.

The only thing I can say is: Everyone is dif. and react/respond in many dif. ways. I consider the people who can escape the pain by exercising to be very lucky. I'm guess these people do their research by conducting surveys

Don't hate the player, hate the game!http://pages.prodigy.net/rogerlori1/...the%20wave.GIF
Before you talk about what you want - appreciate what you have.

http://home.earthlink.net/~gwcaton/s...ctures/tmf.jpg
A good marriage would be between a blind wife and a deaf husband. -Honore de Balzac
Desire+Consistency='s RESULTS

Stacey

YES-you are right.

I am on BCP--well 2 more days of it!
I am in between stage 4 and 5