The procedure of hysteroscopy can be used for diagnosis or treatment, but in either case the uterus must be filled with something so that there is space for the hysteroscope to move about. The materials most commonly used to achieve this are carbon dioxide gas, or fluids such as glycine, dextrose, sorbitol/mannitol, saline and dextran.

Carbon dioxide has been found to be particularly useful for diagnostic hysteroscopy, but it has limited usefulness during surgery because blood causes the formation of bubbles that obscure the view. Consequently carbon dioxide gas tends to be reserved for diagnosing the cause of a problem, while fluid is the norm when hysteroscopic surgery is performed.

Occasionally the fluid or the gas is absorbed into the bloodstream, causing significant problems including an electrical imbalance of the body fluids, fluid overload, or swelling in the lungs or brain. There are several effective methods to prevent complications associated with the absorption of gas or fluid, the most important of which is for the medical team to keep a meticulous record of the amount of material instilled in the uterus and recovered from it.

Who should I see about heavy and prolonged bleeding around the time of menopause?

It would be a good idea to see a gynaecologist as heavy and prolonged bleeding near the time of menopause may be due to cancer. This possibility must be excluded before you embark on treatments such as drug therapy, endometrial resection or hysterectomy.

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Caffeine is a stimulant and could therefore be classed as a ‘drug’. It has an adverse effect on fertility but it can also cause problems once a woman is pregnant.

In a study of 2967 pregnant women, carried out by the Department of Epidemiology and Public Health at Yale University School of Medicine, the researchers found that drinking three or more cups of tea or coffee a day was associated with an increased risk of miscarriage. Other research has shown that caffeine during pregnancy can increase the probability of chromosomal abnormality which could lead to a miscarriage.

Since 1980 the US Food and Drug Administration has advised pregnant women to minimize their caffeine intake, citing the dangers of possible miscarriages or having a mentally retarded baby. Some studies suggest that there is a doubly increased risk of foetal loss when as little as one to three cups of coffee are consumed a day. So the logical advice is to err on the side of caution and avoid caffeine altogether, especially if you have a history of recurrent miscarriages.

Even decaffeinated coffee has been linked to an increased risk of miscarriage, since there is still some caffeine left even after decaffeination. Moreover, decaffeinated coffee contains, two other stimulants, theobromine and theophylline, which are not removed when the coffee is decaffeinated. Also most decaffeinated coffee has been decaffeinated by a chemical which can remain in the product.

An important point to remember is that caffeine comes in many other forms besides tea and coffee. It is there in colas and other soft drinks, as well as chocolate and pain-relieving medication, such as headache remedies.

Selenium Deficiency

Selenium is a powerful antioxidant which may help prevent DNA damage. Researchers have found that those women who miscarry have low levels of selenium in their blood compared to women who don’t miscarry.

Radiation

Visual Display Units (VDUs) on computers emit non-ionizing radiation, as indeed do microwaves, televisions, electric blankets, mobile phones and other electrical appliances. A number of studies have looked at the effects on women who work in front of computers, but the results are not conclusive.

Concerns about VDUs originated in Canada. In 1980, it was reported that a large number of birth defects were present in one group of VDU operators. Another study in 1984 showed that, out of 55 pregnancies of VDU users, 14.5 per cent ended in miscarriage, as compared to 5.3 per cent in non-VDU users. A further 22 per cent of the pregnancies had resulted in a malformation, compared to 11 per cent in non-VDU user. And 6.7 per cent had suffered a stillbirth, as compared to only 1 per cent in the other group. The Royal College of Obstetricians and Gynecologists in the UK suggests that VDUs are not a hazard.

With the evidence as it stands at present, I personally feel it is sensible to limit time on VDUs during pregnancy. This is not only because of the possibility of unknown risk factors but also because working for long, uninterrupted periods in front of VDUs is stressful and can cause other symptoms such as headaches, nausea, fatigue, insomnia and menstrual disturbances. There is good evidence to show that stress in some women can stop them ovulating, and may also have adverse effects during pregnancy.

If a woman is going for an X-ray she is usually asked to do it in the first half of the cycle so that she cannot be pregnant without knowing it.

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A support group such as the Endometriosis Association ends that feeling of being alone. You can meet and talk to other women suffering from the same condition as you.

It is a time of sharing and learning and provides an opportunity to express your thoughts when your family and friends are tired of listening. On a very practical level, joining a support group offers a chance for you to hear how other women have coped with pain, to discuss difficulties in getting a diagnosis and to learn about choices of treatment, side-effects and outcomes. Support groups can help to overcome confusion by providing easily understood information and access to relevant material which can help you to make decisions about your treatment.

Your questions are answered and your feelings of being overwhelmed are lessened. Receiving current and accurate information about endometriosis makes it easier to talk to your doctor and gives you the confidence to ask questions without feeling intimidated by the medical profession.

In a time of crisis, you can discuss your problem with other women who have been through similar experiences.

But belonging to a support group does not mean dwelling on the negatives — it is an opportunity to share the good and to provide mutual support. It is a give and take situation where women can share their own experiences with others which, in turn, helps to eliminate the myths and fears about endometriosis and its treatment.

Partners and friends are also encouraged to attend discussion sessions so they too can learn about this chronic illness.

Through a support group, you can look for ways of producing positive action to help make doctors aware of the suffering and debilitating effects this disease can cause.

Endometriosis Association (Victoria)

The Endometriosis Association (Victoria) was established in 1984 by a small group of women who believed a support and information group was very much needed.

This was the first endometriosis self-help group established in Australia. Since then support groups have been set up in most states.

The Association now has a large and active group of women working together to further the Association’s aims of providing relevant and current information on endometriosis as well as offering mutual support and help to sufferers and their families. It also aims to promote public awareness of endometriosis and conduct and support research into aspects of this condition.

The Association has a comprehensive telephone network of members for personal contact and support as well as a library of books, articles, audio tapes and videos.

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? Buy a small metal screening device (available at a hardware store) that you put over your shower drain to prevent the large quantities of hair from blocking your drain.

? Keep an empty plastic bowl in the shower to collect the hair as it comes out.

? Adjust the water volume on the showerhead to protect your scalp, which may become quite sensitive.

A satin pillowcase may be more comfortable on a tender scalp.

? You can put a linen tea towel over your pillow to facilitate morning cleanup while you are shedding. Some people like to wear a disposable cap (the kind cafeteria workers use) to bed.

? Be aware that you may experience additional hair loss elsewhere or everywhere on your body; this may include eyebrows and eyelashes, as well as body hair.

? Stop by a cosmetics counter in a department store. Ask about using powdered eye shadow to draw eyebrows.

? You may wish to join a “Look Good . . . Feel Better” program, which is designed to assist women undergoing cancer treatment. See the resources section or ask.

? When your treatments are completed and your hair begins to grow in, you may be able to speed up the process if you take brewer’s yeast or wheat grass tablets and massage your scalp with conditioner.

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You can start to take care of your skin as soon as your surgical wounds are healed. Starting before radiation begins may help you avoid skin problems. You may use unscented Lubriderm or 100% Pure Aloe Gel (the clear kind); both of these are widely available. After showering and at bedtime, apply to your whole breast and up to your armpit. Your radiation nurse will give you more information about skin care, acceptable soaps, and so forth. The basic theme is purity: Avoid using anything containing additives, fragrance, or metals on your affected skin. It is best to skip using deodorants (except fully natural ones) for the time being.

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Adult children who live far away from home may feel guilty about the distance and their inability to be of much practical help to you. Encourage frequent telephone calls and plan visits as you can. A good time for a trip home might be after your surgery when you could use some extra assistance for a few days. You might also plan time together when your treatment will be over. This will be something for both of you to look forward to.

They may want to accompany you to an appointment with your doctor(s) and may have questions to ask. It is extremely important to respect their maturity by including them, when it seems appropriate, and by fully sharing information about your diagnosis and treatment.

Mothers of adult children do not have to worry about who would raise their children should they die, but they otherwise have all the same feelings as mothers of young children do. None of us wants to face the possibility of leaving our children prematurely. We all hope to live long enough to see our young adult children settled, and we look forward to celebrating important milestones with them.

NEVER LIE TO YOUR CHILDREN.

ALWAYS LOVE THEM unconditionally and reassure them that your illness is not anyone’s fault. Let them know repeatedly that you will always love them, even when you do not like or appreciate their behavior at all times.

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Your husband’s male friends may have a difficult time providing him with any real emotional support. They may stare at their shoes when they ask how you are doing, clearly indicating that they are not really able to say anything further. If your husband is lucky, he will have one or two friends who Will seek him out—perhaps over the telephone—and ask how he is feeling. Your husband can try telling them how he feels and see if they pick up on it. If he is lucky enough to have male friends capable of real empathy, he is very fortunate.

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For others who are not in the habit of daily or frequent prayer, the structure of a familiar religious service within one’s own tradition and house of affiliation can be very comforting at this time. Such services may provide a level of grounding and connection to a community of worshipers that offers much-needed comfort. In addition, many religious groups offer specialized services of healing to their congregants on a weekly or monthly basis. Many people find these services to be particularly helpful.

Even the least religious among us might be surprised by the force of the sudden urge to communicate with a higher power or a divine force, in whatever way we may conceive of this. Frequently the usual motivation is to try and strike a bargain. When you are feeling very stressed, and sometimes desperate, you may find yourself pleading and begging with a divine power you have repudiated for many years. You may be truly stunned by the force of your need to feel that you are being heard and listened to and that this, your most urgent request, is being received. This may well be the first time in your life since your childhood that you are asking wholeheartedly for a reprieve—literally, a new lease on life—and the chance to continue living.

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