Before such modem prostaglandin inhibitors were developed, it was not unusual to hear of women who became addicted to laudanum—a tincture of opium—to relieve their pain. Others tried nonmedical treatments like hot sweat baths with massage, hoping to perspire out the disease. The rundown, or “salt glow,” following the bath was concentrated in the abdominal area to stimulate blood Bow to the area. “Galvanism,” a less fearsome cousin of shock treatment, applied electrical current to the area to reduce pain. Along with the staple family recipes for healing that were handed down generation to generation, liniments, douches, decoctions, poultices, and brews were available from doctors, mail-order catalogs, pharmacies, and quacks.

Modern pharmacology can manufacture drugs from synthetics, plants, minerals, whatever, but turn-of-the-century cures relied on plants. Although few women nowadays partake of hemlock tea (made from the leaves and inner bark) to “tone the uterus,” there is a renewed and growing interest among women with endometriosis in drug-free therapies that are as young as TENS (transcutaneous electrical nerve stimulation, a form of biofeedback and stress control) and as old as acupuncture. Some of these therapies require the ministrations of experts on an individual basis; others, like dietary changes and stress management, can be, in general, incorporated into the daily lives of most sufferers of the disease.

Are these therapies effective? Let’s examine them, starring with the 5.000-year-old practice of acupuncture.

*58\43\4*

Doctors classify excessive heavy bleeding (menorrhagia) as the repeated loss of more than 80 ml of menstrual blood in each menstrual cycle. If this volume is lost consistently during menstruation, women can become anaemic, lethargic and prone to sickness. While this is a concern for health reasons, the social impact is often more worrying still, with the added burden of possibly creating financial difficulties. Some women find they need to plan their activities carefully to minimise the embarrassment of bleeding accidents, or they may take time off work coping with the problem or trying to find out the underlying cause. Kath’s experience of heavy bleeding coincided with a very hot summer. After a couple of bleeding accidents when she ‘flooded’ on her way to, or at, work she took the precaution of wearing dark-coloured clothing that would disguise any such episode, as well as using tampons and sanitary pads of increased absorbency. A number of colleagues unwittingly added to her embarrassment by making disparaging comments about the inappropriateness of her clothing given the sweltering heat. Initially Kath tried to shrug the comments off and joked about getting dressed before the lights came on. But one day she decided enough was enough and, when quizzed about her clothing, she simply said, ‘I’m having a hellish time with my periods at the moment and, believe me, I’ll be celebrating when I can wear white again.’

In normal day to day living, measuring how much blood is lost in a menstrual bleed is virtually impossible. When careful studies are conducted, however, women are found to lose about 35 ml of blood (less than a quarter of a cup) in a cycle on average. Clearly, the 80 ml marker of menorrhagia is set quite high.

The diagnosis of excessive heavy bleeding is usually based on a joint assessment by women and their doctors. Factors taken into account include the number and degree of saturation of pads and/or tampons, the duration of bleeding, and the presence or absence of clots and flooding. This assessment is subjective and various research studies suggest that women may think they are losing more or less blood than is revealed by a careful analysis of sanitary products. In one study, for example, while 59% of women with concerns about menorrhagia were losing more than 60 ml of blood in most cycles, another 20% had average losses of less than 35 ml. Younger women in particular seem to be more likely to regard moderate blood loss as heavy. Reassurance about bleeding patterns, if this is appropriate, or information about how to better organise and cope with tampon and pad use can result in management of the problem without drugs or surgery.

A specific cause for heavy bleeding may never be found, although there is usually much speculation about possible reasons. Fibroids are thought to be the culprit in about a quarter of cases, while in others polyps, endometriosis, polycystic ovaries, abnormalities of the body’s blood-dotting mechanism, chronic liver or kidney disease, ectopic pregnancy, pelvic inflammatory disease, and side-effects from hormone therapies and intra-uterine contraceptive devices are implicated. Where possible, likely causes should be avoided, removed or treated.

Where there is no explanation for recurrent heavy blood loss, doctors usually describe the bleeding as ‘dysfunctional’. Drug therapies or removal (resection) of the endometrium are the usual strategies in trying to correct the problem. If these approaches do not work, a hysterectomy may be the last resort.

*11\198\4*

For the first twenty four hours after your operation the nurses will observe you closely. They will chart your pulse, breathing rate, blood pressure and temperature frequently, and check your wound and record any vaginal bleeding. During this time your gynecologist will come and discuss the operation with you.

The physiotherapist may visit you again to help you with your breathing and foot and leg exercises.

You may experience some nausea and/or vomiting immediately after the operation. To help relieve this you may require an injection.

You will usually feel drowsy and experience pain for the first few days following your surgery, particularly from your wound. The tube that was placed in your throat may give you a sore throat for the first day or so. Two to four days after your operation you will probably experience wind pain which can be very unpleasant and uncomfortable.

For the first day or two you will either be given painkilling drugs continuously through your intravenous drip or you will be given painkilling injections every four to six hours. You will then progress to painkilling tablets.

When you first start to drink again you will be allowed only to suck ice and sip small quantities of fluid. Once you are able to cope with fluids and any nausea and vomiting has ceased your intravenous drip will be removed. When you have passed wind you will be able to progress onto a light diet of semi-solids and then onto a normal diet if you have no problems. You will probably not open your bowels for the first two to four days after your operation but if constipation becomes a problem you may be offered suppositories.

You will sit out of bed for a short time on the day after your operation and you will be encouraged to move around a little more each day as your condition improves.

When you return home you will then require another three to five weeks of recuperation if you have had a conservative laparotomy, or another three to seven weeks if you have had a hysterectomy. It is important that you do not just rest in bed but that you move and walk around each day and gradually increase your activity level as you recover and feel better.

You may tire quickly for the first week or two, so you will need some help with household tasks for the first one to three weeks, especially if you have children. When you start to do the household jobs again you should do a little at a time and still have plenty of rest. Do not try to be a superwoman as it will only slow down your recovery in the long-term.

For the first week or two after you return home you may still have some discomfort or pain so a mild painkiller such as Panadeine or Panadol may be necessary. The vaginal discharge, if you have had it, usually persists for about two weeks after surgery but it may last for up to six or eight weeks following a hysterectomy.

Most of the healing of the wound occurs in the first two weeks after surgery. After that you can lift light loads but it is probably best to avoid lifting heavy loads if possible for the first month or so. You can drive the car again when you are fit enough to do light gardening and walk up stairs quickly, generally about three to six weeks after surgery. You can have sexual intercourse again when your doctor has examined you about six weeks after your operation.

You should notify your gynecologist immediately if you develop any of the following symptoms:

• a fever

• your wound becomes tender, swollen and red

• a discharge appears from your wound

• severe abdominal pain or cramps

• urinary frequency and scalding when passing urine

• pain or bleeding when using your bowels

• your vaginal discharge develops an unpleasant odour

• your vaginal discharge persists beyond six to eight weeks

• tenderness and/or swelling in your calf muscles

• increasing soreness of the calf muscles when walking

• shortness of breath, chest pain or pain when breathing.

*50/41/5*