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One woman's choice: fibroids and hysterectomy.



Seven months after my surgery, I still dream that I am bleeding: I look down, and there is blood all over the place, soaking my underwear, running down my thighs. A lapful of blood. Damn, I think, and then Oh well, there it is again. Resignation sets in.

Then I wake up, and joy! No blood. No periods, no clots, no breakthrough bleeding breakthrough bleeding Gynecology A term applied to various gynecologic “bleeds,” usually refers to mid-cycle bleeding in OC users, and is attributed to insufficient estrogens; the term is not applied to abnormal bleeding in OC users , no cramps, no birth control pills birth control pill
n.
See oral contraceptive.


birth control pill Oral contraceptive, see there
, no aching lower belly. No tampons and pads in every purse, overnight bag, bathroom cabinet, glove compartment glove compartment
n.
A small storage container in the dashboard of an automobile. Also called glove box.


glove compartment
Noun

a small storage area in the dashboard of a car

Noun
 and desk drawer, just in case. No planning vacations around the periods (only to have them interrupted anyway by kamikaze kamikaze (kä'məkä`zē) [Jap.,=divine wind], the typhoon that destroyed Kublai Khan's fleet, foiling his invasion of Japan in 1281.  between-period assaults).

This is the story of my hysterectomy hysterectomy (hĭstərĕk`təmē), surgical removal of the uterus. A hysterectomy may involve removal of the uterus only or additional removal of the cervix (base of the uterus), fallopian tubes (salpingectomy), and ovaries  at age thirty-six: what my experience was like, why I made the decision I did. I know that hysterectomy is not the right choice for every woman, but here is why it was definitely the right choice for me.

In the Beginning ...

The day after my nineteenth birthday, I underwent emergency surgery to remove a ruptured ovarian cyst ovarian cyst
n.
A cystic tumor of the ovary, which is usually benign.


Ovarian cyst
A benign or malignant growth on an ovary.
. I had been in the university hospital all week as they tried to determine what was causing the incredible abdominal pain Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem.  that had come over me suddenly on a Saturday night out with friends. Two pelvic sonograms (or ultrasounds) later, the university doctors decided it was probably cysts. They weren't entirely sure, but they needed to do something. So they sent me downtown to the "real" hospital for surgery.

I went under at six o'clock on a Friday night, not knowing if I was undergoing merely exploratory surgery Exploratory surgery is a diagnostic method used by doctors when trying to find a diagnosis for an ailment. It can be performed in both humans and animals, but it is far more common in animals.  or would wake up with only one ovary ovary, ductless gland of the female in which the ova (female reproductive cells) are produced. In vertebrate animals the ovary also secretes the sex hormones estrogen and progesterone, which control the development of the sexual organs and the secondary sexual . (I had been told that if both ovaries Ovaries
The female sex organs that make eggs and female hormones.

Mentioned in: Choriocarcinoma

ovaries (ō´v
 needed to be removed, they would schedule a second surgery.) The surgeon put a scope in my belly button belly button Medtalk Umbilicus, navel  and verified the presence of the cysts: one on each ovary. The left cyst cyst, abnormal sac in the body, filled with a fluid or semisolid and enclosed in a membrane. Cysts can be congenital but are usually acquired, the most common locations being the skin and the ovaries.  had burst; the right one seemed likely to.

I was lucky. The surgeon was able to cleanly remove the cysts, leaving both ovaries in place. However, as I lay in the hospital recovering from the six-inch incision in my lower abdomen (below the "bikini line The "Bikini line" refers to the exposed skin of female humans at the boundary of bikini style undergarments, both along the lower abdomen and between the legs. Women commonly shave or depilate their bikini line to remove pubic hair from this area. ," as they call it), he advised me that I should now start taking birth control pills. Nineteen was a very young age to develop ovarian cysts Ovarian Cysts Definition

Ovarian cysts are sacs containing fluid or semisolid material that develop in or on the surface of an ovary.
Description

Ovarian cysts are common and the vast majority are harmless.
, so it was likely they would grow back. Because the cysts form on the nodes that the ovaries create when they produce an egg each month, taking oral contraceptives Oral Contraceptives Definition

Oral contraceptives are medicines taken by mouth to help prevent pregnancy. They are also known as the Pill, OCs, or birth control pills.
 to suppress ovulation ovulation /ovu·la·tion/ (ov?u-la´shun) the discharge of a secondary oocyte from a graafian follicle.ov´ulatory

o·vu·la·tion
n.
The discharge of an ovum from the ovary.
 was the only way to be (relatively) sure the cysts would not grow back. He also advised that I should stay on the pill until I wanted to get pregnant. If I never wanted to become pregnant, I should stay on the pill until menopause.

I was only nineteen. I didn't much question the fact that I was given no choice in the matter. I felt grateful to the doctor for saving me and in awe of the medical system. So I went on the pill. After I got over the horrors of the possible side effects Side effects

Effects of a proposed project on other parts of the firm.
 detailed in the package insert package insert Pharmacology A synopsis of key physicochemical, pharmacologic, clinical efficacy, and clinical safety properties of a prescription drug, bundled therewith, intended to be highly readable and helpful to clinicians looking for specific  (blood clots Blood Clots Definition

A blood clot is a thickened mass in the blood formed by tiny substances called platelets. Clots form to stop bleeding, such as at the site of cut.
, stroke, heart disease, death death death), I loved the pill. I enjoyed the extremely regular cycles--my menstruation menstruation, periodic flow of blood and cells from the lining of the uterus in humans and most other primates, occurring about every 28 days in women. Menstruation commences at puberty (usually between age 10 and 17).  now started precisely every fourth Tuesday at three o'clock in the afternoon and were finished by the weekend. I appreciated not having to worry about pregnancy, which I had obsessed ob·sess  
v. ob·sessed, ob·sess·ing, ob·sess·es

v.tr.
To preoccupy the mind of excessively.

v.intr.
 about even before I ever had intercourse. And I very much enjoyed my now-tiny periods and complete absence of cramps. I had always had fairly onerous menstrual cycles throughout high school with very painful cramping cramping

see cramp.
. Now my periods were not even heavy enough to fill a junior-sized tampon tampon /tam·pon/ (tam´pon) [Fr.] a pack, pad, or plug made of cotton, sponge, or other material, variously used in surgery to plug the nose, vagina, etc., for the control of hemorrhage or the absorption of secretions.  in eight hours. It was grand.

Fibroids Fibroids
Benign tumors of muscle and connective tissue that develop within or are attached to the uterine wall.

Mentioned in: Menstrual Disorders
 

Several years later when I was twenty-five, my periods changed. Suddenly, they were double or triple what I was accustomed to. My menstrual cycle still started on time, but I flooded the little "thin maxi" pads. I had to go out and buy tampons and try to remember how to insert them. The bleeding didn't stop by the weekend either; it dragged on. Certain that I was hemorrhaging to death, I went to see my new gynecologist gynecologist /gy·ne·col·o·gist/ (-kol´ah-jist) a person skilled in gynecology.

gy·ne·col·o·gist
n.
A physician specializing in gynecology.
.

"Well," he explained to me after I told him my symptoms, "it could be fibroids, but you're awfully young for that."

"My mother has fibroids," I remembered. I didn't know what they were, but I knew she had had several procedures to try to alleviate heavy bleeding, with limited success.

"They do run in families."

He examined me and quickly concluded, "Yes, fibroids. Your uterus is the size of a small lemon, or a six-week fetus." He wrote me a prescription for a different formulation of birth control pills to attempt to reduce the bleeding and sent me on my way.

I stood in the subway station waiting for the train home, my hand tentatively down on my abdomen, trying to feel what the doctor had so easily detected. Something's in there! I marveled. Growing! It was sort of creepy and sort of fun in the perverse way that having undergone major surgery in college had been fun: yes, it was scary and painful, but it also made me special in a way. It made a great story. Now the story had another chapter.

I did a little research on fibroids at that point--mostly looked through my dog-eared copy of Our Bodies, Ourselves, and of course talked to my mother. I learned that fibroids are extremely common (even in twenty-five-year-olds), affecting perhaps three-quarters of all women; that they are benign tumors, which do not become cancerous; and that most women don't even know they have them because they often cause no symptoms and therefore can be left alone. When they do cause trouble, it can come in the form of heavy bleeding or bleeding between periods, a feeling of abdominal fullness or bloating bloating Vox populi A lay term for post-prandial abdominal fullness or swelling , or the need to urinate urinate /uri·nate/ (u´ri-nat) to discharge urine.

u·ri·nate
v.
To excrete urine.



urinate

to void urine.
 often. If they become large enough, they can cause reproductive problems as they take over the uterus and crowd out a growing baby. Or they can prevent conception altogether.

I also learned that fibroids are easy to remove without a hysterectomy (removing the uterus). Most common is procedure called myomectomy: the fibroids are excised and removed vaginally or through a small abdominal incision. Everything I read and heard pointed towards a wait-and-see approach and away from hysterectomy: "the last resort." I learned I should ask a lot of questions, become informed, take charge of my own medical decision-making, not let the doctor tell me what to do. (Ironically, my doctor didn't tell me to do anything, except for suggesting a change of pills.)

But the new pills did work, and my nice, light periods returned.

Growing Pains grow·ing pains
pl.n.
Pains in the limbs and joints of children or adolescents, frequently occurring at night and often attributed to rapid growth but arising from various unrelated causes.
 

For about a year and a half, that is. Then I lost a little weight, got married, and during our honeymoon driving trip to visit my husband's family in the southern United States The Southern United States—commonly referred to as the American South, Dixie, or simply the South—constitutes a large distinctive region in the southeastern and south-central United States. , the demon periods returned. The loss of blood made me dizzy and nauseated nau·se·at·ed
adj.
Affected with nausea.
, and the cramps sent me to bed several afternoons in a row, the fainting "delicate" bride. I passed clots the size of my pinkie finger (and was told, in a gorgeous Southern drawl drawl  
v. drawled, drawl·ing, drawls

v.intr.
To speak with lengthened or drawn-out vowels.

v.tr.
, "Oh, that's nothing, honey, I've passed clots the size of my foot!")

Again terrified ter·ri·fy  
tr.v. ter·ri·fied, ter·ri·fy·ing, ter·ri·fies
1. To fill with terror; make deeply afraid. See Synonyms at frighten.

2. To menace or threaten; intimidate.
, I went back to the doctor after we returned home and again changed birth control prescriptions. I mentioned the factor of weight loss to the doctor, but he didn't see any connection. However, the fact is that whenever I have lost five or ten pounds, my periods have stepped up in severity. Perhaps a coincidence, but I thought it was worth noting. When I brought up the idea of hysterectomy, the doctor also brushed it away. I got the message that women in their twenties do not receive hysterectomies, certainly not newlywed women.

I have never wanted to have children. When I was a little girl, I did not play with dolls; instead, I read books, wrote stories and played with tiny ceramic animals who drove around in Matchbox cars on complicated roadways I constructed out of mud and sticks. When I was in high school, I wrote myself a note to read years later explaining the many reasons not to have children (the world is too crowded, I wanted to have a career, and--vainly--I worried about stretch marks stretch marks nplestrías fpl

stretch marks npl (on skin) → vergetures fpl

stretch marks stretch npl
), in case I should forget and need a reminder. When I got married, I was lucky enough to fall in love with a man who also did not want to have children. I spent several years arguing with my Jungian analyst who tried to convince me that the reason for this bizarre aversion was some sort of misguided rebellion against my mother, or a failure to mature, but it is less of an aversion and more of a lack of interest. It is the absence of something, not the presence: the absence of the desire to be a mother. I have a cat whom I love very much. I am looking forward to being an aunt some day. But I do not want to have children.

So again, the new prescription of oral contraceptives eventually worked, a little. I had to go through several different formulations before I found one that didn't make me bitchy bitch·y  
adj. bitch·i·er, bitch·i·est Slang
1. Malicious, spiteful, or overbearing.

2. In a bad mood; irritable or cranky.
 or starving or pimply or queasy QUEASY - An early system on the IBM 701.

[Listed in CACM 2(5):16 (May 1959)].
. I didn't have crazy-heavy periods; but they weren't the little light ones I was used to, and they didn't always stop by the weekend. I now always used tampons during my period, with a pad backup in case of unpredictability. But the bleeding seemed to stabilize, and I lived with it.

When I was about thirty, I had my first post-fibroid-diagnosis ultrasound test to get a baseline image of the size of my uterus. The test revealed that it had reached (on the fruit scale they seem to favor) "larger than an orange," or about a twelve-week fetus. That seemed like alarming growth to me, but my nurse practitioner nurse practitioner
n. Abbr. NP
A registered nurse with special training for providing primary health care, including many tasks customarily performed by a physician.
 didn't seem concerned.

However, the significant thing about this first ultrasound is that it revealed that my fibroids were "intramural intramural /in·tra·mu·ral/ (-mu´r'l) within the wall of an organ.

in·tra·mu·ral
adj.
Occurring or situated within the walls of a cavity or organ.
," that is, embedded within the uterine uterine /uter·ine/ (u´ter-in) pertaining to the uterus.

u·ter·ine
adj.
Of, relating to, or in the region of the uterus.
 wall (the myometrium myometrium /myo·me·tri·um/ (-me´tre-um) the tunica muscularis of the uterus.myome´trial

my·o·me·tri·um
n.
The muscular wall of the uterus.
) as opposed to forming entirely inside the uterus. Therefore, they could not be removed by myomectomy without destroying the uterine wall. I was told at this time that a hysterectomy would be the only option for removing them but that they were certainly not recommending such a drastic procedure.

Two years later when I was bleeding even more heavily, I had a hysteroscopy. This is a slightly more invasive procedure--it is technically surgery, not a test. A doctor inserts a scope up through the cervix cervix /cer·vix/ (ser´viks) pl. cer´vices   [L.]
1. neck.

2. the front portion of the neck.

3. cervix uteri.
 in order to look directly at the uterine walls from the inside. It is a little painful, and I was nervous about having it done. But I thought certainly it would show that some fibroids had now grown inside the uterus and caused the dramatic bleeding and that now a myomectomy would be possible, at least for the new fibroids. But no: the walls were smooth, clean, lovely.

"I should just have a hysterectomy," I said to my nurse practitioner. She laughed. Of course not. I didn't push it. Hysterectomy seemed like a drastic and imperfect solution to my potpourri of problems. If I had a complete hysterectomy complete hysterectomy Total hysterectomy Gynecology Complete surgical removal of the uterus and cervix, but not the adnexae–ovaries and fallopian tubes. See TAH-BSO.  to also remove the troublesome, cyst-prone ovaries I'd go into instant menopause and be faced with the decision whether to take potentially harmful hormone replacement therapy 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.
. If my ovaries were saved, I'd still have to take hormones so the cysts wouldn't redevelop. So I waited. Maybe something better would come along.

In March 2000, I read an article about the invention of the birth control pill by Dr. John Rock in the late 1950s and the religious and social, as opposed to medical, reasons why oral contraceptives were designed with a four-week cycle. In an ultimately futile attempt to gain the approval of the Catholic Church, Dr. Rock Dr. Rock began his career as one of the original DJs in Lonzo's Wreckin' Cru during the early 80's. When the crew made the transition from being a mobile DJ group to recording and performing music, Rock left and relocated in Dallas, Texas. Once in Dallas, Dr.  proposed that the regimen should mimic a woman's natural twenty-eight day cycle, including seven days of placebo. Apparently, it is perfectly natural and healthy for women to increase the length of their cycles by skipping the placebo pills and going straight to the next active pills. In fact, the author cited recent research showing that monthly menstrual cycles are less healthy for women since historically women have had far fewer periods during their fertile lifetimes, instead, most women would be pregnant or nursing and therefore not undergoing the monthly wash of hormonal changes that a menstrual period subjects us to. This hormonal superabundance su·per·a·bun·dant  
adj.
Abundant to excess.



super·a·bundance n.
 has been linked to many serious diseases, including breast and ovarian cancer ovarian cancer

Malignant tumour of the ovaries. Risk factors include early age of first menstruation (before age 12), late onset of menopause (after age 52), absence of pregnancy, presence of specific genetic mutations, use of fertility drugs, and personal history of breast
.

But the exciting news that I took away from the article was, Wow, I could have a period once every three months! I immediately asked my nurse practitioner about it; she had not heard of the new research. I sent her a copy of the article. She worried; she had been taught that longer cycles were unhealthy, that increased pill usage would cause cancer. She researched further and talked with other practitioners who were trying the new regime with their patients. Eventually, she agreed to let me switch from my tri-phasic pills to a low-overall dose. Unfortunately, it also involved a lengthy and frustrating educational process with my insurance company's pharmacists who kept trying to explain to me that I could not have a refill, since my ninety days were not yet up.

The three-month cycles were lovely. No bleeding for twelve straight weeks! Heavenly! Best of all, when the periods came, they weren't any heavier than they had been when I bled every four weeks. I had been concerned that all that saved-up menstruation would come back to haunt me, but it doesn't work that way. I really felt like I was getting away with something. I told all my friends. (In fact, my nurse practitioner now tells me that a majority of her patients who take the pill are now doing the extended cycle.)

Then the headaches started. Sometime during the first few days of my period, I'd get these crushing, impossible-to-ignore headaches that would send me to bed for a day or two, sometimes even carrying over into a third day. I would take megadoses of ibuprofen ibuprofen (ī`byprō'fən), nonsteroidal anti-inflammatory drug (NSAID) that reduces pain, fever, and inflammation. , which would make me queasy. I would sleep as much as I could get away with, but often I had to tough it out and go to work. I was in agony; I felt like I was blinking through a sick yellow fog, as if I had a devil in my head, a demon residing in my temples and the base of my skull. It took a few menstrual cycles for me to make the connection since my periods were now so infrequent. But I started charting them, and indeed, it was a menstrual headache. I went back to see my general practitioner general practitioner
n. Abbr. GP
A physician whose practice consists of providing ongoing care covering a variety of medical problems in patients of all ages, often including referral to appropriate specialists.
 and was told that they had never heard of menstruation causing headaches. She told me, "You can increase the ibuprofen if you want." I didn't much like that solution, and a friend suggested acupuncture. The acupuncturist asked me a ton of questions, put needles in me head to toe, and gave me noxious-smelling herbs to brew into a tea--but the acupuncture worked. More or less. For a while. Oh well, they were only four times a year. I could live with that.

I had another ultrasound: large grapefruit.

In January of 2002, I went on a yoga retreat. It was in a lovely rustic setting, three large teepees in the thickly-wooded mountains by a rushing river. I had been doing Ashtanga In the Yoga Sutra, Patanjali describes asana as the third of the 8 limbs of classical, or Raja Yoga. These eight limbs are the yamas (restrictions), niyamas (observances), asanas (postures), pranayama (breath work), pratyahara (sense withdrawal or non-attachment), dharana (concentration),  yoga daily for four or five years by this point and was thrilled to be at this gorgeous place with other serious practitioners, sharing vegetarian food, dipping into the hot tub, walking through the woods.

In the middle of an afternoon practice session, I felt the familiar sensation of a period starting--but I was only in week nine, still three weeks away from my period. I rushed out of the asana asana: see yoga.  room to the dark privy down the hill: yes, I was bleeding. I didn't even have any pads or tampons with me; I used toilet paper until I could borrow a tampon from another woman. I bled on and off for the rest of the retreat and called my nurse practitioner in yet another panic when I got home.

"Maybe twelve weeks is too long for you. Maybe you should back off a little, to nine weeks," she suggested. "Go ahead and stop taking the pills now, have a period, and then start up again." I hated the idea--I didn't want any more periods, with the mess and the pain and the inconvenience and now the headaches--but the breakthrough bleeding was scary. Perhaps the twelve-week cycle was not for everyone.

She also offered, "I can make an appointment for you to talk to a surgeon if you like."

I said, "But I can't have a myomectomy, my fibroids are embedded in the lining of the uterus."

"True, but there are some new procedures coming along. One of them might be appropriate for you." I told her I'd think about it.

The nine-week cycle seemed to work, and then it too failed. I went to a six-week cycle. Soon I would be back where I started and would have twelve, three-day headaches a year as well: thirty-six days, a month of pain. I started computing my sick leave: I would use it up quickly at this rate. I did not want to be a sickly person; I had always been healthy. My body seemed to be rebelling against me, taking over my life.

I tried total vegetarianism vegetarianism, theory and practice of eating only fruits and vegetables, thus excluding animal flesh, fish, or fowl and often butter, eggs, and milk. In a strict vegetarian, or vegan, diet (i.e. ; I tried lots of meat-eating; I tried giving up alcohol. A friend performed "energy work" on me, holding my feet as I lay on the floor in her warm dark room, crystals sitting on my abdomen over my womb, as she visualized the fibroids breaking up and passing away harmlessly. I now could feel the fibroids often, as I turned and twisted in yoga, if I ate a big meal, during sex. It felt like a tightness, not so much painful as pressure-full, an impediment. I asked for something stronger than ibuprofen for the headaches and was given a migraine drug which made me loopy and lightheaded light·head·ed  
adj.
1. Faint, giddy, or delirious: lightheaded with wine.

2. Given to frivolity; silly.



light
 but enabled me to function.

I was now bleeding almost all the time. I was on the six-week cycle, so I would have a heavy period (with the accompanying headache) every six weeks. Then a few days after my period had ended, it would start up again: a slow dribble, sometimes more, sometimes almost nothing. Sometimes it would stop again for a few days, but as soon as I let my guard down (wore light-colored pants or didn't make sure I had a pad in my purse), there it would be again: red in my underwear, red on the toilet paper: Surprise! I'm still here!

End Game

And at some point, I just decided, That's enough. I would deal with this, once and for all. I would talk to a surgeon and find out what my options were, what these new procedures were. Yet somehow, in my heart of hearts, I think I knew that I wanted a hysterectomy. I didn't know how long it would take to convince the doctor; I didn't know what would be involved, and I was worried about taking so much time off work to recover. I knew thirty-six was still young and that they would probably not be willing to do the surgery. But I knew I had to do something.

I went to see my nurse practitioner and told her I was ready to see the surgeon. There was a six-week wait for an appointment with him. During those six weeks, I bled, I waited, I thought about how nice it would be not to bleed. I made lists and lists of questions. I researched on the Internet and found few options: myomectomy, hysterectomy, a new procedure called uterine artery embolization Uterine artery embolization (UAE) or Uterine Fibroid Embolization (UFE) is a procedure where an interventional radiologist uses a catheter to deliver small particles that block the blood supply to the fibroids. See also
  • Uterine fibroids
  • Embolization
, a few drugs with drastic side effects.

I met the surgeon and liked him instantly. He was tall and gawky, just doctor-like enough to reassure, but refreshingly informal. He spent forty-five minutes with me, answering every question. He had looked at my charts and records and knew what I had been going through. I admitted to him that I was considering hysterectomy, and he didn't dismiss the idea. He told me hysterectomy was a good, permanent solution to fibroids, but that it was major surgery and that (obviously) I would be rendered unable to have children.

He went over every option with me, slowly, in great detail:

1. Do nothing. Live with the symptoms as I had been living with them. In fifteen or twenty years TWENTY YEARS. The lapse of twenty years raises a presumption of certain facts, and after such a time, the party against whom the presumption has been raised, will be required to prove a negative to establish his rights.
     2.
, I would arrive at menopause, and most fibroids shrink at menopause.

2. Myomectomy. Surgical removal of the fibroids. I did not think this was an option because my fibroids were embedded in the uterine lining, but he wanted to do a hysteroscopy to see for himself. He had already scheduled a room, and we would go straight there after this consultation.

3. Uterine artery embolization. This is a surgical procedure that interrupts the blood supply to the fibroid tumors Fibroid tumors
Fibroid tumors are non-cancerous (benign) growths in the uterus. They occur in 30-40% of women over age 40, and do not need to be removed unless they are causing symptoms that interfere with a woman's normal activities.
, causing the fibroids to shrink and disappear. As the surgeon explained it, this is far less invasive than hysterectomy, but in his experience, it causes a lot of pain and is not a permanent solution: the fibroids tend to grow back. Because the blood supply to the fibroid fibroid /fi·broid/ (fi´broid)
1. having a fibrous structure; resembling a fibroma.

2. fibroma.

3. leiomyoma.

4. in the plural, a colloquial term for leiomyoma of the uterus.
 is also part of the blood supply to the uterus, it cannot be cut off completely, so the process of the fibroid "death" is slow and, reportedly, agonizing. He did not recommend this procedure.

4. Ablation. This procedure cauterizes--burns off--the endometrial endometrial /en·do·me·tri·al/ (en?do-me´tre-il) pertaining to the endometrium.
endometrial,
n relating to the end-ometrium or cavity of the uterus.
 lining of the uterus. In many cases, bleeding completely stops after the procedure, sometimes permanently. According to the surgeon, this is an outpatient procedure and relatively painless; you can return to work within a day or two. But it is only about 60% effective, and it does not remove the fibroids.

5. Hysterectomy. Total surgical removal of the uterus, If the uterus is not too large, the surgery is performed vaginally (it helps if the woman has borne children). Options include removing the cervix or not and removing the ovaries or not. Recovery is generally six to eight weeks--on the lower side for younger, healthier women.

We went into the procedure room, and I climbed onto the table for another hysteroscopy. Same story: clean, smooth walls. "Well, you're right," he said. "No myomectomy for you."

"I really think I want the hysterectomy," I said, my feet still in the stirrups stirrups The footholds in a lithotomy table . "But I'm worried about my ovaries, if we leave them in: will the cysts grow back?"

"I'm willing to do the hysterectomy, if you want. And at your age, I would definitely leave the ovaries in, and I wouldn't worry about the cysts. I think the risk is pretty low. But you should go home and think about it. It's a major decision."

Wow, I thought. He's willing to do a hysterectomy! And he thinks the cysts won't grow back? That's news.

The surgeon explained that if I did decide to have the hysterectomy, I would need to come back in to sign a sheaf of papers. Then I could be scheduled for surgery. We set up an appointment for late the following week to go over whatever decision I had made.

I went home. I felt sure I had already decided for a hysterectomy. I tried very hard to remain undecided, to think seriously about all the options. I hated the other options, every one of them. I loved the idea of hysterectomy, of having the hateful thing gone out of my body, of having the bleeding guaranteed to stop forever. I was even beginning to love the idea of six weeks off work to lie around the house and recover.

The question of the headaches remained an open one. Since nobody knew what exactly was causing them--was it the bleeding, the oral hormones, my own hormonal cycle?--nobody could say whether the surgery would cure them.

I talked to my husband. I talked to my friends, my co-workers, my brother, my mom and dad. I still felt sure, though I tried to act as though I was still deciding. (I don't think I fooled anybody.) I discovered that many of our women friends, especially older women, had had hysterectomies, a surprising number of them in their thirties. "Greatest thing I ever did," I heard over and over again. "You'll never regret it for a moment." My grandmother had had one; all three of my aunts had had one. It began to seem like my mother and I were the only two women in our family who still had our wombs.

Almost all of my friends were extremely supportive of the idea, once I told them as many of the details as they could stand to hear. The one exception was a friend who lives in Vermont, a motherly moth·er·ly  
adj.
1. Of, like, or appropriate to a mother: motherly love.

2. Showing the affection of a mother.

adv.
In a manner befitting a mother.
 woman and a great feminist in her fifties, who was deeply concerned that I was being railroaded into this decision by an overeager o·ver·ea·ger  
adj.
Excessively eager; too ardent or impatient.



over·ea
 surgeon. She consulted her brother, also a surgeon; she researched on the Internet; the whole solution seemed quite drastic to her. Coincidentally, she would be out visiting us soon, and she promised to try to talk me out of major surgery.

My mother gave me a pleasant surprise: I had expected to hear one final lament about her wanting grandchildren, from her daughter, but instead she said, "Wow, you really have been through a lot with this," and she offered to come and stay, to take care of me when I came home from the hospital.

I also did try very hard to reconsider the question of having children. Yes, I'd been certain all my life, but was I really certain? Was I willing to close that door forever? I visualized being pregnant, having an infant, a child. Holding, carrying, dressing, playing with a child. Breast-feeding breast-feeding /breast-feed·ing/ (brest´fed?ing) nursing; the feeding of an infant at the mother's breast.  a baby. A little person who would be a part of my beloved husband and of me. But couldn't want it. It did nothing for me. I kept returning to my own life, the completeness of it, my satisfaction with it. Nothing was missing.

Se I went back for my next appointment with a host of questions--what exactly would my recovery be like, what exactly was going to happen in the surgery, how many days in the hospital, what were all the potential complications. Our Vermont friend was visiting now. She helped me draft the questions and offered five or six times to come to the appointment with me. (I declined, so she and my husband dropped me off at my appointment and drove around the neighborhood, cell phones on, in case I changed my mind.) The surgeon spent nearly an hour with me, answering all my questions in detail. I asked him how many hysterectomies he had performed; he laughed and said, "Oh, I don't know Don't know (DK, DKed)

"Don't know the trade." A Street expression used whenever one party lacks knowledge of a trade or receives conflicting instructions from the other party.
, probably a thousand" We discussed anesthesia. He recommended a new method being used often: an epidural epidural /epi·du·ral/ (-dur´il) situated upon or outside the dura mater.

ep·i·du·ral
adj.
Located on or over the dura mater.

n.
, plus a sedative sedative, any of a variety of drugs that relieve anxiety. Most sedatives act as mild depressants of the nervous system, lessening general nervous activity or reducing the irritability or activity of a specific organ. . Epidural is an injection into the spine which numbs the lower body; the sedative would relax me generally. This is safer than general anesthesia Anesthesia, General Definition

General anesthesia is the induction of a state of unconsciousness with the absence of pain sensation over the entire body, through the administration of anesthetic drugs.
, and he called it "the Cadillac of post-operative pain care." I was worried about being at all conscious during the surgery. He said I would probably not be conscious, but assured me that we could decide later after I had talked to the anesthesiologists; he put "epidural/ general" on the form.

The surgeon was a little concerned that because I had had abdominal surgery years before, there might be "adhesions": internal scar tissue scar tissue
n.
Dense, fibrous connective tissue that forms over a healed wound or cut.
, areas that would require extra work and could involve other organs. He thought the surgery would take anywhere from one and a half hours (if simple) to three hours (if he found lots of adhesions). There was no way of telling what would be the case until he opened me up.

I signed paper after paper. I agreed that I understood I would be unable to bear children. I acknowledged potential complications, such as infection, hemorrhage, injury to adjacent structures, trouble with anesthesia. I gave instructions about blood transfusions (if necessary). Then we scheduled the hysterectomy.

The surgeon was about to leave for a one-month vacation in Italy, se the wait would be six weeks. I thought that was good, that it would give me time to get used to the idea, to prepare at work. Actually, it turned out to be an excruciating period. I remembered how much I hurt after my first surgery recovery, and I spent a lot of time dreading the postoperative pain. I obsessed over increasingly bizarre worries: the surgeon would be off his game, just returning from vacation, jet-lagged, his concentration would be lax ... by the weekend before the surgery, I was imagining that there would be an earthquake while I was on the table and that the surgeon's hand would slip and injure me beyond repair. Also, I had been told that if I came down with a cold before the surgery, they would have to postpone it, so I became rigid about avoiding germs. (It didn't help that my sister-in-law was scheduled to have her wisdom teeth removed the weekend before. She came down with a cold, and the oral surgeon Oral surgeon
A dentist who specializes in surgical procedures of the mouth, including extractions.

Mentioned in: Tooth Extraction
 wouldn't perform her extraction.)

Finally, the day arrived. At my preoperative pre·op·er·a·tive
adj.
Preceding a surgical operation.



preoperative

preceding an operation.


preoperative care
the preparation of a patient before operation.
 appointment, the day before the surgery, a nurse took my vital signs, asked a ton of questions (including whether I had had a cold recently), and the assistant surgeon did a pelvic exam Pelvic Exam Definition

A pelvic examination is a routine procedure used to assess the well being of the female patients' lower genito-urinary tract.
. I myself had more questions to ask at this point, particularly about the anesthesia: when would I be able to talk to the anesthesiologist Anesthesiologist
A medical specialist who administers an anesthetic to a patient before he is treated.

Mentioned in: Anesthesia, General, Appendectomy, Parathyroidectomy

anesthesiologist
? The assistant surgeon told me there would be ample time before the surgery the next day.

I was so nervous I could barely sleep. Just knowing I was not supposed to eat or drink anything, even water, made me all the thirstier. Somehow the night passed.

My husband drove me to the hospital at 8:00 a.m. It seemed as though we waited forever. First, we were in a general surgical waiting room, then in a surgical prep waiting area where it was more private. A nurse started me on an IV: "Breakfast," she called it. I wasn't at all hungry, but I was relieved to see all that liquid going into my arm.

Then everything started to happen fast. I was wheeled into the surgery area where non-patients were not allowed. My husband got to walk with us to the doorway, then we had to say goodbye. A member of the anesthesia team came and introduced himself to me and said he'd be assisting in the operation. Did I have any questions? Oh yes, I did. I explained my concerns: it was vital that I not be at all conscious during the surgery. Suddenly, my surgeon was there too, bright and cheerful. "Let's just do the general!" he said. "Then you can be sure." I was so relieved. It seemed that one member of the team was there only to comfort me in my fear and pain. He stroked my head as I leaned forward for the long epidural needle to be inserted in my back and told me everything was going to be fine, that I was doing great.

Then I was wheeled into the operating room operating room
n. Abbr. OR
A room equipped for performing surgical operations.
 where it seemed all was confusion ... then there was nothing ... then I was starting to wake up in the recovery area, and several hours had gone by. I was very cold but couldn't easily move and was afraid to try. Then the surgeon was floating over me saying, "It went great! We got it out cleanly, there was no endometriosis endometriosis (ĕn'dəmē'trē-ō`sĭs), a condition in which small pieces of the endometrium (the lining of the uterus) migrate to other places in the pelvic area. , your ovaries looked great, it only took an hour and half!" Then he floated away.

Soon my husband was by my side, bearing gifts. My room was quickly filling up with flowers and orchids and books sent by all our friends--the first, and biggest, bouquet of all was from Vermont.

The next morning, a cheery nurse appeared and said, "Okay, we're going to get you walking!" I was horrified hor·ri·fy  
tr.v. hor·ri·fied, hor·ri·fy·ing, hor·ri·fies
1. To cause to feel horror. See Synonyms at dismay.

2. To cause unpleasant surprise to; shock.
. There was no way I was ready to walk! My legs were still half-numb. It was exhausting and painful; I held my hand rigidly to my abdomen. It felt like everything would fall out if I didn't.

Some time that day, the surgeon came to see me again and gave me more details about the surgery. He told me he had been more worried than he let on that the surgery would be difficult because of possible adhesions and endometriosis (where the lining of the uterus grows outside the uterus, causing complications), so he was really thrilled that it had gone so well. Also, he told me that my uterus was riddled with dozens of small fibroids, that it looked "like an asteroid." I sort of wished they had saved it to show me.

Recovery and Aftermath

My recovery was wonderful. The three days my mother stayed was just long enough for me to feel comfortable taking care of myself: the day she left, I was able to dress myself. I could go up and down the stairs Adv. 1. down the stairs - on a floor below; "the tenants live downstairs"
downstairs, on a lower floor, below
 slowly but easily. I walked every day, first inside the house, then outside, trying to increase the distance each time until I exhausted myself and cut back a little in the third week.

After about a week and a half, I started trying to do some yoga. I had read an article in Yoga Journal about recovering from abdominal surgery, which had recommended poses for when you first start to practice again. I found them very easy. I started doing baby versions of my regular poses, and after about three weeks I went back to my Ashtanga class. It took me a few months to build up to being able to do all the poses I had been doing before surgery (especially the backbends), but I could do more almost every day--with a few little relapses whenever I pushed myself too hard.

In the fifth week of recovery, my husband and I spent the week in a small town on the ocean. Walking on the beach really helped my recovery. At one point, my husband pointed out I was still walking rigidly, as if in pain; I realized that, yes, I was in some pain, but I was also holding back unconsciously. I tried walking more fluidly and found that I could. Also in the fifth week, we tried lovemaking love·mak·ing  
n.
1. Sexual activity, especially sexual intercourse.

2. Courtship; wooing.


lovemaking
Noun

1.
 again. We were both nervous at first, but everything went quite well, thank you.

After six weeks of this life of leisure, I went back to work. I was still a little weak, but my strength returned quickly.

It has now been seven months, and I have not had a moment of regret. My body feels great; I am at 100% capacity and have been for months. I am enjoying being hormone-free for the first time since I was nineteen. I have regular "menstrual" cycles: I think I can tell when I am ovulating, though I hardly remember what that was like. I am thrilled to report that the headaches have not come back. On the other hand, I am having increased sensitivity to alcohol: a much smaller amount of wine will give me a hangover these days, which is probably not a bad thing.

Oh, and I do still have periods ... since I still have a cervix, which is essentially just the stub-end of the uterus, there is a tiny amount of endometrial lining which sloughs off each month. It's all of one drop, the cutest thing you've ever seen. It's as if Barbie had a period. I can live with it!

Now if only the dreams would stop ...

Fibroid Factoids FREQUENTLY ASKED QUESTIONS ABOUT UTERINE FIBROIDS Uterine Fibroids Definition

Uterine fibroids (also called leiomyomas or myomas) are benign growths of the muscle inside the uterus. They are not cancerous, nor are they related to cancer.
 

What are fibroids?

Uterine fibroids are tumors or growths made up of muscle cells and other tissues that grow within the wall of the uterus (or womb). Although fibroids are sometimes called tumors, they are almost always benign (not cancerous). The medical term for fibroids is uterine leiomyomata. Fibroids can grow as a single growth or in clusters. Their size can vary from small, like an apple seed (or less than one inch), to grapefruit-sized, eight inches across or more.

Uterine fibroids are the most common, benign tumors in women of childbearing age. Fibroids rarely turn into cancer (less than 0.1 percent of cases). Having fibroids does not increase a woman's chances of getting cancer of the uterus.

Where can fibroids grow?

Health care providers put fibroids into three groups based on where they grow: just underneath the lining of the uterus, in between the muscles of the uterus, or on the outside of the uterus. Most fibroids grow within the wall of the uterus.

Some fibroids grow on stalks (called peduncles) that grow out from the surface of the uterus or into the cavity of the uterus.

What are the symptoms of fibroids?

Most fibroids do not cause any symptoms, but some women with fibroids have:

* heavy bleeding or painful periods;

* bleeding between periods;

* feeling of fullness in the pelvic area (lower abdomen);

* frequent urination urination

Process of excreting urine from the bladder (see urinary system). Nerve centres in the spinal cord, brain stem, and cerebral cortex control it through involuntary and voluntary muscles. The need to void is felt when the bladder holds 3.
;

* pain during sex;

* lower back pain:

* reproductive problems such as infertility, more than one miscarriage, or early onset of labor during pregnancy.

What causes fibroids?

No one knows for sure what causes fibroids although there are many theories. Most likely, fibroids are the result of many factors interacting with each other. These factors could be hormonal (affected by estrogen levels), genetic (running in families), environmental, or a combination of all three. Because no one knows for sure what causes fibroids, we also don't know what causes them to grow or shrink. For the most part, fibroids stop growing or shrink after menopause. But this is not always true.

Who gets fibroids?

Fibroids usually grow in women of childbearing age. While no one knows for sure what will increase a woman's chances of getting fibroids, U.S. researchers have found that African-American women are 2 to 3 times more likely to get them than women of other racial groups.

African-American women also tend to get fibroids at a younger age than other women. Women who are overweight or obese also are at a slightly higher risk for fibroids. Women who have given birth appear to be at a lower risk. Research is now being done to determine risk factors.

Source: Adapted from the U.S. National Institute of Child Health and Human Development's publication Uterine Fibroids and published as a FAQ (Frequently Asked Questions) A group of commonly asked questions about a subject along with the answers. Vendors often display them on their Web sites for use as troubleshooting guidelines.  sheet by the U.S. Office on Women's Health Women's Health Definition

Women's health is the effect of gender on disease and health that encompasses a broad range of biological and psychosocial issues.
 in the Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
Health and Human Services, HHS
 (January 2004). Available online at http://www.4woman.gov/faq/ fibroids.pdf

Fibroids: Race Matters

* Black women are three to five times more likely than white women to have fibroids.

* Black women are typically diagnosed with larger and more numerous fibroids than their white counterparts.

* Black women are commonly diagnosed with fibroids at a younger age than other women.

* Black women fibroid sufferers tend to have more symptoms than other women.

* Black women are overrepresented o·ver·rep·re·sent·ed  
adj.
Represented in excessive or disproportionately large numbers: "Some groups, and most notably some races, may be overrepresented and others may be underrepresented" 
 among patients that have hysterectomies for fibroids.

For more information about African-descendant women and fibroids visit the following websites:

Black Women's Health http://www.blackwomenshealth. com/fibroids.htm

Philadelphia Black Women's Health Project http://www. blackwomenshealthproject.org/ aafibroids.htm

It's A Sistah Thing: A guide to understanding and dealing with fibroids for Black Women http://www.sistahthing.com/

Hysterectomy: Not A Choice for Everyone

Every 10 minutes, 12 hysterectomies are performed in the United States. According to a recent report published by Obstetrics and Gynecology obstetrics and gynecology

Medical and surgical specialty concerned with the management of pregnancy and childbirth and with the health of the female reproductive system.
, nine of them probably did not meet the guidelines set out by the American College of Obstetricians & Gynecologists for hysterectomy.

As a result, 37% of all women in the United States have had a hysterectomy by age 60. The percentage is even higher for African-American women. The vast majority are performed due to the presence of uterine fibroids; in 2001 alone, over 200,000 women in the U.S. had hysterectomies for this reason.

Possibly as many as 80% of all women have uterine fibroids, but the majority usually have no symptoms. Only one in four women develop symptoms severe enough to require treatment.

There are a number of less drastic and often equally effective treatments for uterine fibroids, such as myomectomy and embolization embolization /em·bo·li·za·tion/ (em?bo-li-za´shun)
1. the process or condition of becoming an embolus.

2. therapeutic introduction of a substance into a vessel in order to occlude it.
. However, lack of awareness and information about these procedures, along with limited availability, means that far too many women undergo unnecessary surgery that permanently alters their health and leaves them unable to have children.

For more information and opinions. visit the following websites:

National Uterine Fibroids Foundation http://www.nuff.org/

Sex, Lies and Uterine Fibroids http://www.uterinefibroids.com/

Sans Uteri http://www.findings.net/sansuteri.html

Resources on Fibroids

American College of Obstetricians and Gynecologists The American College of Obstetricians and Gynecologists (ACOG) is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. It has a membership of over 49,000[1] and represents 90 percent of U.S.  (ACOG ACOG American College of Obstetricians and Gynecologists.
ACOG American College of Obstetricians & Gynecologists
) Resource Center http://www.acog.org/

Canadian Women's Health Network http://www.cwhn.ca/

Center for Uterine Fibroids http://www.fibroids.net/html/ frameset The HTML tag that divides a Web page into sections (frames). The following HTML divides the screen page into two horizontal frames with the top frame having 25% of the screen and the bottom frame having 75%. See frames.

<frameset rows=25%, 75%"> </frameset> re>
.htm

Medline on Fibroids (U.S. Government page) http://www.nlm.nih.gov/ medlineplus/uterinefibroids.html

National Institute of Child Health and Human Development Clearinghouse http://www.nichd.nih.gov/ publications/pubs.cfm

Women's Health Action Trust http://www.womenshealth.org.nz/fibroids.htm

Women's Health Matters Network http://www. womenshealthmatters.ca/ centres/pelvic_health/fibroids/

Shannon Page The author is a writer and Assistant Director of the Regional Oral History Office at the University of California at Berkeley (body, education) University of California at Berkeley - (UCB)

See also Berzerkley, BSD.

http://berkeley.edu/.

Note to British and Commonwealth readers: that's /berk'lee/, not /bark'lee/ as in British Received Pronunciation.
 (USA)
COPYRIGHT 2004 Latin American and Caribbean Women's Health Network
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Title Annotation:Opinion
Author:Page, Shannon
Publication:Women's Health Journal
Article Type:Column
Geographic Code:1USA
Date:Jan 1, 2004
Words:6952
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