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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, no cramps, no birth control pills, no aching lower belly. No tampons and pads in every purse, overnight bag, bathroom cabinet, glove compartment and desk drawer, just in case. No planning vacations around the periods (only to have them interrupted anyway by kamikaze between-period assaults).

This is the story of my hysterectomy 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. I had been in the university hospital all week as they tried to determine what was causing the incredible abdominal pain 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 or would wake up with only one ovary. (I had been told that if both ovaries needed to be removed, they would schedule a second surgery.) The surgeon put a scope in my belly button and verified the presence of the cysts: one on each ovary. The left cyst 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," 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, 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 to suppress ovulation 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 detailed in the package insert (blood clots, stroke, heart disease, death death death), I loved the pill. I enjoyed the extremely regular cycles--my menstruation 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 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. Now my periods were not even heavy enough to fill a junior-sized tampon in eight hours. It was grand.

Fibroids

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.

"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, or the need to urinate 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

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 demon periods returned. The loss of blood made me dizzy and nauseated, 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, "Oh, that's nothing, honey, I've passed clots the size of my foot!")

Again terrified, 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), 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 or starving or pimply or queasy. 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 didn't seem concerned.

However, the significant thing about this first ultrasound is that it revealed that my fibroids were "intramural," that is, embedded within the uterine wall (the myometrium) 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 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 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. 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 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 has been linked to many serious diseases, including breast and ovarian cancer.

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, 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 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 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 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; 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 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, 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, 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, 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 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 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. "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 woman and a great feminist in her fifties, who was deeply concerned that I was being railroaded into this decision by an overeager 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 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, probably a thousand" We discussed anesthesia. He recommended a new method being used often: an epidural, plus a sedative. Epidural is an injection into the spine which numbs the lower body; the sedative would relax me generally. This is safer than general anesthesia, 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, 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 wouldn't perform her extraction.)

Finally, the day arrived. At my preoperative 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. I myself had more questions to ask at this point, particularly about the anesthesia: when would I be able to talk to the 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 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, 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. 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 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 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

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;

* 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 sheet by the U.S. Office on Women's Health in the Department of Health and Human Services (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 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, 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. 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 (ACOG) 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.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 (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.
Copyright 2004, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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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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