Women’s Health

There was a time when it seemed every second woman was having her uterus removed. In fact she was. Well, nearly. In Australia until recently, about 40 per cent of women could expect to have a hysterectomy during their lifetime. The figures are likely to be altered in the future by the use of endometrial ablation as an alternative to hysterectomy, and the wider use of hormone replacement therapy, which has a protective effect against the development of endometrial cancer.

Hysterectomy has been a contentious issue for some time, as it has been seen by some as an over-used treatment, not without potential side-effects. Gynaecologists have been accused, as a group, of whipping out uteri willy-nilly, as a cure-all, without much consideration for the risks and benefits for the individual woman.

Of course there are many women who benefit from hysterectomy, and for whom it is the treatment of choice, after careful consideration of the options. Now that there are more options available, and women are becoming more aware of the issues surrounding hysterectomy, hopefully we will see a more rational approach and response to this operation.

A hysterectomy is simply surgical removal of the uterus. The ovaries are not necessarily removed at the same time, although they may be.

Aims:

To remove a diseased or damaged uterus.

Indications. These include:

1. Cancers—cancer of the uterus, or cancer of the cervix which has spread to involve the body of the uterus.

2. Benign (non-cancerous) tumours such as fibroids, particularly if large (greater than 6 to 8 centimetres).

3. Abnormal bleeding which has failed to respond to other treatments (like hormone treatment or endometrial ablation).

4. Painful conditions which have failed to respond to non-surgical treatments.

5. Emergency life-saving measure such as for some complications of childbirth, or following damage to the uterus during another surgical procedure.

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Some women have specific problems after surgery. Because the axilla is operated on, the normal drainage of lymphatic fluid from the arm can be disrupted. Swelling of the arm can occur in some women, although this particular side-effect has decreased considerably since less extensive operations became more popular. Also, the nerves to the arm may be affected, which can cause some abnormal sensation to the skin around the armpit.

Depending on the extent of the surgery, the muscles to the arm may be damaged, leading to some change in function. More commonly, though, the problem is a stiff shoulder, due to lack of movement following the operation, and this can gradually recover. After a mastectomy it is important that a woman has information about possible problems and ways of preventing complications. Physiotherapy and exercise can be helpful in avoiding them.

Success rates. Earlier detection of breast cancer and the newer methods of treatment seem to be associated with improved survival rates from this disease, but we may not see great improvements in the statistics for breast cancer for several years.

The overall five-year survival rate from breast cancer in Australia is about 70 per cent. Like most cancers, survival rates vary with the stage the disease is at when treatment is started. For example, a woman who has a tumour of less than 2 centimetres, and no evidence of spread beyond the breast, has a five-year survival rate of around 90 per cent.

Breast cancer can unfortunately sometimes recur, often years after initial treatment. Distant or local spread may suddenly become apparent even thirty years after initial treatment, which makes it difficult to give women the ‘all clear’. It is impossible to predict who will have a late recurrence, but a small chance usually remains. This chance is less if the disease is detected and treated earlier.

Women who are being treated for breast cancer will be given more information about their own chances of cure and recurrence, based on their individual circumstances.

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Q. Do I have to get my partner’s consent if I want to have micro-inserts?

A. No, as with other methods of sterilization, you don’t need your partner’s consent It is good to talk over such a big decision together and it is best if you agree. However, in the end it is your body and your decision.

Q, If I have micro-inserts, will that bring on menopause?

A. No, micro-inserts have no effect on menopause. Your ovaries function as usual and you still have periods until you would normally experience menopause.

Q. Will the micro-inserts affect the way I feel about sex?

A. Micro-inserts have no physical effect on your body other than to block the egg from meeting a sperm and being fertilised. So they should not affect the way you feel about sex except that you may enjoy it more if you feel relieved that you will not get pregnant.

Q. Can you have an operation to remove the micro-inserts so that you can get pregnant again?

A. It is extremely unlikely that there is any way to reverse the blockage caused by the micro-inserts so you could get pregnant again. It is not even possible to have IVF (in-vitro fertilization), since the micro-inserts would still be inside the uterus where the pregnancy would be growing. You must look at having micro-inserts as absolutely permanent.

If you have any doubts about having this procedure, it is best to wait and use another method of contraception until you feel sure it is what you want. Then if your life changes in ways you had not imagined, and you regret having the micro-inserts, you will know that you really felt it was the best decision at the time.

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How is the Progestogen IUD removed? The Progestogen IUD can stay in place for five years. If you want to become pregnant or if you decide that you do not want the IUD anymore for other reasons, it can be removed earlier. You will be given another vaginal/pelvic examination. Then the doctor will use a special instrument to remove the IUD by gently pulling on the string that can be seen coming through the cervix. This only takes a couple of minutes. Some women find it a little uncomfortable but some women don’t feel much at all.

Things to remember if you use a Progestogen IUD

• It’s really important to learn to check the suing each month after a period to make sure your IUD is still in place.

• If you have any unusual symptoms, like a discharge from your vagina or pain low in your abdomen, that could be an infection, so see your doctor right away.

• If your period is more than a week overdue, you should see your doctor or go to a clinic for a pregnancy test.

• If you or any sexual partner ever have casual sex, or if you have a new sexual partner, use a condom every time you have sex until you both have been checked for sexually transmitted infections (STIs).

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Q. If I take the Pill every day just as it says on the pack, how could I get pregnant accidentally?

A. The Pill is not 100 percent effective even if it is taken exactly as directed. Also if you are sick you could lose the effects of the Pill by vomiting or having diarrhoea before it has a chance to work. If you do vomit or have diarrhoea it would be best to follow the instructions for missed pills to be sure you are protected.

Another thing to watch for is that some antibiotics and other medications, and even natural therapies, may react with the Pill and stop it from working. You really need to talk to your doctor about this. If you have to see a different doctor for any reason, tell them that you are taking the Pill, so you are not given medication that could react with it.

Q. If I want to get pregnant, can I stop taking the Pill and get pregnant right away?

A. It takes the average woman about six months of trying to get pregnant even if she’s not taking the Pill and maybe a couple of months extra if she has been on the Pill. The problem is that this is an average. Some women get pregnant in the first month after they stop taking the Pill, and some perfectly normal women will still not be pregnant after 12 months of trying. If your periods aren’t back to normal after three or four months, or if you have been trying to get pregnant for more than twelve months, see your doctor or Family Planning Centre for advice.

Q, What if I miss a period when I’m taking the Pill?

A. You may miss a period while you are on the Pill. This is common and is usually nothing to worry about. As long as you have been taking the pills as directed, just keep taking them as usual. If you miss a second period see your doctor or Family Planning Centre for advice.

Q. Since I started taking the Pill my periods have been really short, and only last a few days and there hasn’t been much blood. The colour is darker too. Is this okay?

A. This is quite normal and happens to most women when they are taking the Pill.

Q. Should I have any special check ups when I am on the Pill?

A. You should check your own breasts every month after your period. If you don’t know how to do it, ask your doctor or a nurse to show you, or ask for a pamphlet on how to do it.

It’s a good idea to have your blood pressure taken, and your breasts checked for lumps when you go for a new prescription for the Pill. Ask the doctor or nurse to do these checks if they are not routine. You should also have a Pap test every two years, and sometimes more often if your Pap tests have been abnormal in the past.

Q. I know of someone who got brown blotches on her skin when she was sunbaking after she started taking the Pill. Is this common?

A. No, it isn’t common, but it can happen. These type of blotches are called chloasma, and are caused by an uneven skin response to the sun because of the oestrogen in the Pill. Once you are on the Pill it’s good to wear a hat and use a factor 15+ blockout sunscreen on any exposed skin if you’re out in the sun. If you get this skin reaction and it becomes a problem for you, the minipill (or other methods of contraception that don’t contain oestrogen) may suit you better.

Q. I have to have an operation and a friend told me I’ll have to stop taking the Pill before I go in to hospital. Is that true?

A. Yes, probably it is. You need to talk to your doctor as soon as possible because most women are asked to stop taking the Pill from between four to six weeks before they have surgery. If you do have to stop taking the Pill, remember to use other contraception like condoms, if you have sex. You should also stop taking the Pill if you have to stay in bed for a long time, or you have a leg in plaster. This is because if you are not moving around normally there is a risk that you could get blood clots.

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