Mens Health Blog. Medical Blog

A hysterectomy for endometriosis is surgery which involves the removal of the uterus and as many remaining endometrial implants and adhesions as possible. It may also involve the removal of one or both ovaries and fallopian tubes.

A hysterectomy is often said to be the only cure for endometriosis apart from the natural menopause. However, it does not always cure endometriosis, especially if the ovaries are not removed.

A hysterectomy in which the uterus and cervix are removed is known as a total abdominal hysterectomy (often abbreviated to a TAH). Sometimes all or part of an ovary and/or fallopian tube will be removed at the same time if they are diseased but at least part of one ovary is always left.

Following a total abdominal hysterectomy a woman will no longer menstruate but she will continue to ovulate until the time of her natural menopause.

A hysterectomy which involves the removal of the uterus and cervix as well as both fallopian tubes and ovaries is known as a total abdominal hysterectomy and bilateral salpingectomy and oophorectomy (often abbreviated to a TAH and BSO). It is also sometimes known as a radical hysterectomy.

Following a radical hysterectomy a woman will no longer menstruate or ovulate and she will undergo the menopause almost immediately.

To simplify matters and avoid confusion we will refer to a total abdominal hysterectomy as a total hysterectomy; and a total abdominal hysterectomy and bilateral salpingectomy and oophorectomy as a radical hysterectomy. We will use the term hysterectomy if we are referring collectively to both types.

Hysterectomy is usually only used as a last resort to treat women whose endometriosis is so chronic and their symptoms so severe that their quality of life is intolerable. The most common reasons that women with endometriosis have a hysterectomy are the persistence of intractable and incapacitating pain or severe and persistent heavy bleeding. It should not be used, except in a few rare life threatening situations, until a range of other hormonal and surgical treatments have been tried without success.

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Comments (0) Apr 22 2009

Anxiety, loneliness, and anger are common emotions, feelings that are part of being human.

What is a feeling? It’s a response that occurs on a non-intellectual level. Feelings are subjective experiences that can’t be verified by someone else.

Feelings can spur us into action, usually some form of self-preservation. If we touch something hot, we draw back our hand. Similarly, if something makes us unhappy, we may act by changing the situation or pulling away from it -whatever it takes to save our psychic skins.

Unpleasant feelings can actually serve a healthy purpose: They may prompt action that attacks a problem directly. Yes, an oral final in history can be terrifying, but one way of handling that feeling is to study. Someone who knows everything about the War of 1812 can walk into the exam with confidence. That person conquers anxiety by confronting it. The same with loneliness, or anger, or fear, or any of the dozens of other emotions we experience every day. Emotions can also help guide future actions. A student whose heavy course load causes anxiety may be more careful in planning her schedule the following semester.

Easy to say. But for some people with eating disorders, not so easy to do. Emotions spur them into action, sure, but sometimes in twisted and unhealthy ways.

For years now it seems as if everyone has been running around trying to “get in touch with their feelings.” The phrase has been the psychobabble cliche of the last two decades.

Cliche or not, for the person with an eating disorder, getting in touch with her feelings is exactly what she needs to do.

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Comments (0) Apr 22 2009

Being elected to the U.S. House of Representatives was great for congressman Matt Salmon’s political career. But it was lousy for his health, not to mention his waistline.

The 41-year-old congressman from Arizona had been active for most of his life. Tennis, racquetball, and basketball were his favorite sports. But once he took office in 1994, his exercise program ground to a halt. Instead, he spent most of his time sitting—on airplanes, on the floor of the House, and in legislative hearings.

His eating habits went downhill, too. All of those political fundraisers and charity events provided ample opportunity for consuming all the wrong kinds of food. Between legislative meetings, he’d nosh on whatever was within reach—usually cookies or a piece of cake. “And I ate more than my share of Big Macs while waiting for flights between Washington, D.C., and Arizona,” he says.

Within 2 years of his election, Congressman Salmon added 70 pounds to his post-high school weight of 165 pounds. But it wasn’t only his waisdine that suffered. He developed back pain, and he had frequent nighttime bouts of heartburn. A visit to the doctor revealed that his cholesterol was too high.

Congressman Salmon hated the way that he felt. And he hated the way that he looked. As much as he loved being a public official, he wasn’t about to let it ruin his health. He committed to changing his lifestyle for the better.

His first step was to make time for exercise in his daily routine. Because his schedule was so hectic, he decided to get up earlier to work out first thing in the morning. He began his days at 6:00 A.M., with a 20-minute walk. Within a month, the walk became a run. Within 2 months, he dropped 40 pounds, and his physical symptoms all but disappeared.

Encouraged, Congressman Salmon looked for ways to improve his eating habits. He found out that he could request low-fat meals at most political dinners and fund-raisers, so he did. He carried an apple or a banana in his briefcase so he wouldn’t binge on junk food between meetings or during long congressional sessions. And if one of his frequent flights included meal service, he ordered a vegetarian or low-fat entree in advance.

Congressman Salmon’s renewed commitment to a healthy lifestyle paid off. Within 12 months, he lost 70 pounds. He decided to celebrate with a victory run in the grueling Marine Corps Marathon. After 7 months of training, he succeeded.

WINNING ACTION

Think in terms of permanent changes, not temporary fixes. Congressman Salmon believes that the key to weight-loss success is to acknowledge that you’re making permanent lifestyle changes. I couldn’t agree more. You can’t go back to your old, unhealthful ways once you achieve your goal weight. Eating healthfully and exercising regularly are for life. That may seem like

a tall order. But keep in mind that over time, the lifestyle changes that you make now will become second nature to you—so much so that you won’t think of them as new anymore.

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Comments (0) Apr 22 2009

- Instead of taking progestogen each month, is it safe to take it, say, every three to six months so that I don’t have so many withdrawal bleeds?

Researchers are now looking into this possibility. The available evidence suggests that, in some women taking oral oestrogen each day and progestogen for ten to fourteen days every second month, the endometrium is protected sufficiently for this to be a safe and convenient option. Further research is needed to determine which women are best suited for this approach, however. Women who have a very light monthly bleed or no bleed at all could turn out to be suitable. Until the research under way has been completed, it seems likely that most doctors will continue to prescribe some progestogen each month.

- I am taking oestrogen and progestogen, with five days at the end of each cycle when I don’t have any hormones. Is this approach widely used?

There doesn’t seem to be any justification for this once-popular approach as menopausal symptoms can return during the hormone ‘break’.

- I’ve had a hysterectomy. Is there any reason why I should take progestogen as part of HRT?

It was suggested at one stage that progestogen might protect the breast from cancer development, and this remains controversial. At the 8th Congress of the International Menopause Society in Stockholm in 1993 there was considerable discussion of whether oestrogen or progestogen, or both, stimulate breast cell growth. It may be that less stimulation occurs in women on low-dose oestrogen and progestogen throughout each cycle. It was suggested that even women without ovaries should be on this combination. Research is assessing this. Meanwhile women without a uterus usually receive oestrogen alone. This does not seem to increase breast cancer risk in the short term (less than five years).

- I am fed up with hot flushes and night sweats and am considering HRT, but I have fibroids. Should this affect my decision? HRT can be prescribed to women with fibroids. However, if fibroids are bulging into the cavity of the uterus heavy bleeding may occur, and this will need to be investigated and may need to be treated before HRT is prescribed.

- My vagina is dry and itchy and sex is often painful. I have started using a vaginal cream that contains oestrogen and wonder if I also need a lubricant?

You will find that your oestrogen-containing cream improves lubrication and reduces itchiness within a week or two. Until then, you may want to use a lubricant when having sex.

- Are hysterectomy rates going up?

After peaking in the late 1970s, rates of hysterectomy appear to have stabilised in Australia, with about 25 per cent of women having the procedure by the age of sixty-five. A NSW study found women aged from thirty-five to forty-nine years were most likely to have it, particularly in their late forties. Most of the operations were for benign disease such as endometriosis or fibroids.

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Comments (0) Apr 21 2009

About a quarter of women starting on HRT experience a small weight gain (up to 3 kg) during the first cycle and for a few months after. A smaller proportion put on considerable weight, part of which seems to be due to fluid retention. Some other women gain weight because of increased muscle mass — because they have discovered exercise in midlife. In older women who already have trouble moving freely, further weight can present problems because it makes regular activity more difficult.

Heather was sixty-eight when her doctor suggested she go onto HRT because of a personal and family history of heart disease. (She had already had coronary bypass surgery and her mother had died of a heart attack.) Heather’s weight shot up after starting on a twice-weekly oestrogen patch and daily progestogen tablets. The doctor reduced the dose of the patch but her weight increase continued, amounting to 13 kg over a ten-month period. In consultation with her doctor she embarked on a program of exercise and dieting aimed at getting her weight down and benefiting her heart. At the time of writing she was trying to decide whether HRT was worth the trouble. ‘I’m looking at the information and making up my mind whether to continue with HRT,’ Heather said.

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Comments (0) Apr 20 2009

women CONSIDER HRT for many different reasons, the most common being to relieve symptoms associated with the menopause. In addition, women at risk of fractures due to osteoporosis, or likely to develop heart and blood vessel disease, may have HRT recommended to them by their medical practitioners. The same advice is increasingly given to women with existing osteoporosis, or those with a diagnosed heart or blood vessel condition, the rationale being that HRT may prevent these problems getting any worse.

HRT and menopausal symptom control

Hot flushes and sweating often prompt menopausal women to seek medical assistance. Other common reasons for consultations include psychological symptoms like loss of concentration and ‘feeling blue’, general tiredness, irritability, vaginal dryness and pain with intercourse, loss of libido, urinary frequency and persistent urinary discomfort.

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Comments (0) Apr 20 2009

Research shows that when the ovaries stop releasing eggs at the menopause, and the lining of the uterus no longer changes in preparation for a possible pregnancy, most women continue to make measurable and useful amounts of active sex hormones. The major source of oestrogen is chemical conversions that take place in fat tissue, hence the amount of body fat has a good bit to do with oestrogen levels in postmenopausal women. The brain and the adrenal glands (two small organs near the kidneys) also continue to produce hormones that control the reproductive system at this stage of your life. Like body weight, your genetic make-up is an important factor in the output of these hormones.

Overall, we produce relatively smaller amounts of oestro-gens, progesterone and androgens (a class of hormones that includes testosterone) after menopause than before it, and the balance of the various hormones changes. Testosterone, for example, becomes a more dominant hormone, even though less is produced after menopause than beforehand. The altered hormone balance explains some of the rapid and not-so-rapid changes to the body associated with menopause.

These hormones act on chemical structures called hormone receptors in many parts of the body. Their influence extends to the ovaries, fallopian tubes, uterus, cervix, vagina, vulva, skin, heart, blood vessels, liver, joints, bone, breasts, brain and urethra (the passage from the bladder to the outside). Various forms of oestrogen affect tissues such as the vaginal lining and the blood vessels in quite different ways. For each of us, changes in our hormone balance will be different, and consequently the effects will vary from woman to woman. Thus the increased prominence of testosterone after menopause may cause an increase in facial hair, altered libido (interest in sex), and a change in the distribution of body fat that is quite apparent to some women but goes almost unnoticed by others.

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Comments (0) Apr 20 2009

Bowel function varies a great deal from one person to another, making it difficult to say exactly what diarrhoea is. For most people, one bowel movement a day seems to be the norm, but some people only go once every three or four days, while others go twice a day or more. An important question here is whether ‘average’ is the same thing as ‘normal and healthy’. One survey of 301 apparently healthy adults found that almost a third of them reported bowel symptoms of some sort (diarrhoea, constipation etc), although most had not consulted a doctor for their problem. This study can be interpreted in two ways. It either shows that everyone’s bowel function is different and there is no such thing as a normal pattern – or it shows that a large percentage of the population are suffering from minor bowel complaints. We would lean towards the latter view, and suggest that some of those people, at least, are sensitive to the food they eat.

In general, a healthy bowel pattern feels healthy, whether you go three times a day or twice a week. There is a regularity to the pattern – it is not erratic. The stools are fairly firm and well-formed and there is no particular urgency, nor any great difficulty in going. There is no sense of malaise or pain, either before or afterwards, and the movement feels complete – not as if you still have some faeces left to pass. In diarrhoea, soft, loose or semi-liquid stools are passed several times a day; there is usually a sense of urgency and, usually, some feeling of malaise. Diarrhoea is basically a means of ridding the body of toxins, harmful bacteria or other unwanted substances – it is a healthy reaction to infection, and should only be considered a problem when it serves no useful purpose. However, acute diarrhoea can lead to dehydration because so much water is lost, and this can be dangerous.

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Comments (0) Apr 20 2009

It used to be the custom in country homes to cover the mattress with a quilt for greater warmth and softness. But it is hard to understand how it was possible for the habit of sleeping on a soft foundation to creep in, especially in areas where the people are usually tougher. Soft beds that sag when you lie down are not healthy. And if there is a bolster and thick pillow as well, do not be surprised to find that the spine will adopt a distorted position. If the sleeping person could be X-rayed from the side, this would be seen quite clearly. That is why old beds in country homes, where great-grandmother had had difficulty in sleeping, are far from ideal for healthy sleep today.

A good bed must have a certain degree of firmness, because if it is too soft the blood vessels, in particular the veins, become congested and this impairs the circulation. Many people do not sleep properly on foam rubber, and those who suffer from rheumatism may find metal springs unfavourable to their condition.

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Comments (0) Apr 09 2009

The conclusion we must draw is that we should never go beyond what does us good. Brief spells of indirect sunlight are more beneficial and healing than the more common sunbathing. Moving around in the half-shade is a healthy exercise. People who suffer from high blood pressure and heart trouble should never expose themselves to intense heat or strong sunlight. Doing so could lead to sudden death.

When it is extremely hot you must be careful to avoid cooling down suddenly. Bathing in very cold water, for example in a mountain lake or a river with glacier water, can pose a great risk. Although I have mentioned the matter of drinking before, I would like to reiterate in this context that it is bad for us to drink water that is too cold. So, if you are on a mountain tour and nothing but cold water from a spring is at hand, add a little thirst-quenching Molkosan but no sugar and sip the water slowly while insalivating well. In this way you will avoid the chilling effect your body would otherwise experience and your thirst will be quenched much better than if you had taken a sweet soft drink. It is thus worthwhile putting a small bottle of Molkosan in your rucksack when going on a hike in the summer.

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Comments (0) Apr 09 2009