Health News. Lots of resources and information

Each year hundreds of thousands of women worldwide have their uterus surgically removed, many find the experience a landmark event. Some feel very positively about it, others have mixed feelings, and some experience intense regret. Deciding whether or not to have a hysterectomy and which type is most suitable can be difficult, especially when the views of trusted advisers are in conflict. In the case of Lisa, aged forty-two, friends, relatives, her partner and doctor held strong but differing opinions about the merits and drawbacks of the procedure. Some were enthusiastic about it, others thought there were other options, such as endometrial resection, that Lisa should investigate before agreeing to the removal of her uterus. Still others were adamant that hysterectomy was only to be considered in the most exceptional circumstances which, they assured Lisa, hers were not. She felt confused, a feeling made worse by criticism from her doctor that she was talking to too many people.

The distress of women who, like Lisa, are in the invidious position of having to decide whether to have a hysterectomy or find other ways of resolving their problems is evident. Even women who have an intimate acquaintance with the anatomy of the female pelvis can find the situation daunting. For example, when Sydney gynaecologist Caroline de Costa was contemplating a hysterectomy in 1992, she was nagged by fears right up to her arrival in the operating theatre.

The story told by de Costa, one of the few gynaecologists in Australia ever to have had a hysterectomy, reflects the anguish and ambivalence of many women contemplating the procedure. One of her fears was that she would feel enormous regret for the loss of her uterus and for her inability to bear any further children. She told herself this was ridiculous — at forty-five years of age and with seven children spaced over twenty-four years, why not put an end to the increasingly long, heavy and painful periods she was experiencing more and more often? De Costa also had a prolapsed uterus, had postponed her decision for several years and felt it was irrational to delay having the operation any longer. Another lingering concern was how she would actually feel, within her abdomen and pelvis, once her uterus was removed. ‘Perhaps there was something my patients hadn’t told me,’ she thought. ‘Perhaps I will feel a kind of black hole between my bladder and bowel.’

The experience of contemplating a hysterectomy over a long time, then going ahead with it, brought home to de Costa the emotional turmoil that many women in the same situation go through. It resulted in a change in the way in which she conducted her consultations. ‘I am certainly spending more time now in discussion with patients in an attempt to allay these fears,’ she said after making a full recovery and returning to her practice.

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Mycoplasmas

Mycoplasma hominis and Ureaplasma urealyticum are small organisms which are very common in all of us but found in higher quantities in couples who are not conceiving.

In the lab, mycoplasmas (including Mycoplasma hominis and Ureaplasma urealyticum) have to be grown on a special culture and whether they are tested or not can literally come down to a question of cost. For this reason they are not routinely tested on the NHS and most couples will need to go privately. But, as you will see, it is very important that, as a couple (whether trying to conceive or having experienced a previous miscarriage), you are screened for these very small pathogens.

In some clinics, when a sperm sample is analyzed it is also cultured to see whether any ureaplasma is present. This is because the presence of this infection can affect the quality of the sample, in some cases creating adhesions within the sperm. It has been found that the higher the number of ureaplasmas in the semen, the lower the zinc concentration. And we have seen how crucial good levels of zinc are for fertility.

The same study also found that the higher the number of ureaplasmas in the semen, the lower the fructose content. Fructose is a sugar normally found in semen. The absence of fructose in the semen can mean that the seminal vesicles are blocked, stopping both sperm and fructose from getting through. Some researchers have gone so far as to say that ureaplasmas are associated with male infertility, because when men were treated for the infection there was a significant improvement in the motility of their sperm.

The increase in these infections may be due to changes in sexual attitudes and the fact that certain conditions may increase their growth. For instance, it is known that mycoplasma proliferates when the Pill is used.

Unfortunately if a pregnant woman has an ureaplasma infection she can pass it on to her baby. Some interesting research, published in the New Scientist magazine in 1997, showed that if babies were infected by Ureaplasma urealyticum in the womb then they were more likely to develop asthma in later life. The researchers suggested that asthma could be prevented in some children if the parent were treated before conception.

Rubella (German Measles)

German measles contracted during childhood is a mild disease; and, once infected, the person builds up antibodies which give lifelong immunity to the illness. These antibodies can be measured by a blood test and the woman then knows whether she is ‘rubella immune’. The risk of contracting German measles during pregnancy is not to the mother but to the baby. If the mother develops this illness during the first 12 weeks of pregnancy, there is up to five times greater a chance of the baby being born with congenital abnormalities (such as deafness, blindness and heart disease) or being miscarried.

If the woman finds out that she is not rubella immune then she may opt to be immunized before embarking on a pregnancy. One woman I know of, who did not want to be immunized, used a homeopathic remedy to which her body produced the rubella antibodies when subsequently measured on a blood test.

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A herbalist has a holistic approach – that is, treating the whole person and not just the disease.

Although no two women are alike, similarities often emerge which include the need to correct biochemical imbalances, assist in the elimination of toxic waste and treating the inherited miasm.

We asked a herbalist to answer some following questions.

What is miasm

A miasm is the term alternative therapists give to a genetic weakness which is the foundation of a chronic disease. Samuel Hahnemann, the founder of homeopathy, considered there to be three basic miasms (taints): psoric, sycotic and syphilitic (having their ancient origins from leprosy, gonorrhea and syphilis respectively.)

There is also a tubercular taint which is a mixture of psoric and syphilitic. From a homoeopathic view, these miasms have the potential to express themselves in various symptoms which are particular to the taint and each miasm can show an identifying pattern in the iris.

The herbalist explained that from a homoeopathic point of view, there are three main inherited factors which are the miasms discussed above. She said that someone back in the family tree may have had one of four things: tuberculosis, psoric, gonorrhoea or syphilis. Generations ago, these illnesses were treated with suppressive methods or left unresolved and there will still be a modified form of the disease present in the-family tree today.

This doesn’t mean that you are going to inherit these diseases, hut you will have a potential towards certain complaints. For instance, the gonorrhoeal (sycotic) taint bequeaths a tendency to pelvic discharges, inflammations and adhesions.

The inherited taint itself will initially be dealt with by herbs but finally with homeopathies of a very high potency.

Homeopathies are also used for treating thrush, bladder pain or infection, infertility, hormonal imbalance, Candida, imbalances in blood sugar levels, pain or other problems needing a specific focus.

She believes that in women with endometriosis the immune mechanism is possibly altered in a way which allows the implantation of tissue outside the normal area. Such an internal environment allows the hereditary weakness (defective immune mechanism) to come to the surface. Her theory is that it also might be likely that many women have retrograde bleeding at some stage of their menstruating life without consolidating it into a long-standing problem.

What type of woman do you see

As far as I am concerned there are three different types: many are post-endometriosis in as much as they have had surgery and are still unwell; there are those who have been diagnosed with endometriosis and who are either dissatisfied with the treatment or who want to investigate further before making a decision about what they should do — hormone therapy, surgery, get pregnant or whatever; then there are those who have a vague suspicion they have endometriosis but have been told they were either imagining it or needed a holiday and consequently have decided to investigate further.

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The problem may lie in one of these areas:

• The woman—70 to 75 per cent of infertile couples have a female factor.

• The man—30 to 35 per cent have a male factor.

• The couple—40 per cent of infertile couples have more than one factor. In some couples no cause will be identified.

However, the most common causes of infertility are:

• Anovulation (not producing an egg)—about 30 to 40 per cent of infertile couples have this problem.

• Having blocked fallopian tubes—about 20 per cent.

• Sperm problems—about 20 to 30 per cent.

Rarer causes include problems with the uterus, cervix, chromosomes and male anatomy.

Tube problems. Not only do the sperm need to travel up the tube to meet the egg, but the fertilised egg must also make it down through the tube to the uterus. If the tube is kinked or narrowed it is less likely that a pregnancy will result. If the tube is completely blocked, then it’s pretty unlikely indeed.

Things that muck up tubes, such as the most common causes, infection and endometriosis. Chlamydia and gonorrhoea are the main causes of sexually transmitted pelvic inflammatory disease (PID). Non-sexually transmitted PID, for example infection following an abortion or other gynaecological operation, or related to an intrauterine contraceptive device (1UD), accounts for some cases. Scarring following pelvic surgery or appendicitis can also affect the tubes.

Endometriosis can damage the tubes if it causes scarring. It can also slow the rate at which things travel through the tubes, by exerting a type of hormonal effect.

Having an ectopic pregnancy (a pregnancy which settles in the tube or ovary rather than in the uterus) can damage the fallopian tube, as an operation is usually performed to remove the ectopic pregnancy. Generally that means removing some or all of the tube on that side. Surgeons try to be as careful as possible, and in some cases are able to conserve the tube.

Another reasonably common cause of tube problem is previous surgery. Some women who have had their fallopian rubes operated on (either cut and tied, or had clips applied), will request reversal of their operation to restore their fertility. Men who have had a vasectomy may also change their minds, and seek a reversal operation. Reversal may work, but success rates would vary depending on the surgeon and the degree of damage to the tube from the sterilization procedure. You should never have a sterilisation operation thinking you can change your mind later, because the results of reversal are so unpredictable.

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There are several ways of working this out. The most common is by dates. The first day of your last period is counted as day 1, and an average pregnancy is about forty weeks. The ‘expected due date’ is calculated in this way. Most babies arrive between thirty-eight and forty-two weeks, not necessarily on their ‘due date’.

If your first missed period was two weeks ago, you would be about six weeks pregnant, because it is counting from your last real period, (only thirty-four weeks to go!). This method assumes that most people have cycles of about four weeks and regular periods, as most people do.

However, if you have a usual cycle of five weeks, and your missed period was two weeks ago, you may not be seven weeks pregnant (which you would be by counting from your last real period). You are more likely to be six weeks, because most women ovulate about two weeks before their period, regardless of how long it is between periods. If you have irregular cycles it may be impossible to tell the gestation (stage of development of the pregnancy) from the dates alone.

It is generally not absolutely necessary to know the exact gestation. If it is, then an early (less than ten weeks) ultrasound can be used to assess gestation. This measurement will be accurate to within a few days.

Less accurate, but still useful, is a physical examination. The size of the uterus can give an idea of how far the pregnancy has progressed. The limiting factors in this method are the experience of the doctor performing the examination and the fact that the uterus may not be that easy to feel.

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Again, some blood tests will tell you:

• if you have ever been in contact with the bug, and have developed antibodies

• if you still have the infectious part of the virus, the ‘antigen’, floating around your blood stream, and are infectious to other people—a carrier

• if your liver has been damaged by the virus, if you are a carrier.

Again, there is a ‘window period’, as explained in the previous section on AIDS—HIV infection, so sometimes a repeat test may be necessary to exclude infection.

Treatment. Unfortunately, there is no effective cure. Being a virus, it doesn’t respond to antibiotics. The best we can do is try to stop it spreading, and give symptomatic relief to those who are in the ‘sick’ phase of the disease.

There are drug treatments being tried on people who have chronic hepatitis, with varying success. Ultimately some people will be treated for liver failure, as the chronic stage progresses, and they will sometimes be candidates for liver transplants.

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The drug companies realized that there would be ‘gold in them there pills’, and consequently there are lots on the market. This breeds a bit of confusion among the pill takers, when they realize they are on one type of pill, and all their friends are on different ones. Are some better than others? Generally no. In fact some of the ‘different’ pills are in fact identical, but made by a different company, so have a different brand name and packaging. Some have different doses and some contain different types of progesterone, but they all work in the same way.

There are many presentations of the pill. All contain combinations of oestrogen and progesterone. Some of the commonly prescribed ones include:

• 30 microgram oestrogen—stable dose—21-day or 28-day (which includes seven ‘sugar’ tablets as well as the twenty-one hormone tablets). The idea of the sugar tablets is so the taker gets into a routine of taking a pill every day. The sugar pills do not make you fat. You don’t actually have to eat them if you don’t want to. Trade names: Microgynon 30, Microgynon 30 ED ‘every day’, Nordette 21 and Nordette 28.

• 35 microgram oestrogen—stable dose—21-day or 28-day package. Trade names: Brevinor, Brevinor-1.

• 50 microgram oestrogen—stable dose—21-day or 28-day packets. Trade names: Microgynon 50, Microgynon 50 ED, Nordette 50, Nordiol, Nordiol 28, Norinyl-1, Ovulen.

• Triphasic and Diphasic packets—21 -day or 28-day. These vary the amount of hormone taken throughout the month, but work in the same way to prevent ovulation. Some triphasic preparations have a lower overall dose of hormone when added up for the month. Trade names: Triphasil, Triphasil 28, Triquilar, Triquilar ED, Synphasic 28-day (35 microgram oestrogen), Biphasil (50 microgram oestrogen), Sequilar ED (50 microgram oestrogen).

• Preparations with other progesterones are also available. These specific progesterones may be more suitable for some people, as they are less likely to adversely affect skin (acne and hair growth). Trade names: Diane 35 ED, Marvelon.

When starting the pill for the first time, often the lower dose (30 microgram) pill, or a triphasic preparation will be prescribed. If ‘breakthrough bleeding’ occurs regularly, a higher dose may be prescribed. Breakthrough bleeding or spotting is not uncommon when first starting any pill, and will usually settle down within three months. If it doesn’t it may be worth trying a different pill.

The higher dose (50 microgram) pills may be better for people with certain problems, such as acne, breakthrough bleeding, or people taking certain medication already. Tablets for epilepsy, among others, can interfere with the effectiveness of the pill, so a higher dose is required to provide adequate contraception. If you are on a regular or frequent medication, check with your doctor about interactions with the pill. Together, a woman and her doctor can work out the alternatives. It is not uncommon for women to find they tolerate one type of pill better than another. Women may try several different ones before finding a pill they are happy with.

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Then there are the bits we can’t see, like hormones. Hormones are chemical messengers which float around in the blood stream, telling different bits of your body to do their jobs. Like little floating supervisors, there are hormones which control a variety of body functions. For example, growth hormone tells the various growing cells to multiply at a particular pace, mainly during childhood and adolescence. Without sufficient growth hormone we do not grow at the usual rate. Insulin is a hormone, made in the pancreas, which controls the sugar level in the blood. Diabetes is the condition which arises when insulin it not made, or stops having its effect, and blood-sugar levels rise. There are many hormones floating around the body at any particular time, regulating the many functions of the body. The ones are the ones which affect the reproductive organs.

There are two major female sex hormones. One is oestrogen (also spelled estrogen). Progesterone is the other. There arc other hormones related to reproduction, with poetic names like follicle stimulating hormone (FSH), luteinising hormone (Ml), and women also possess the ‘male’ sex hormone testosterone.

These hormones are produced by, and act on, a variety of organs.

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