Less regular periods at forty-three years of age may be a sign of early changes in the function of your ovaries. This is a normal stage on the way to menopause when you will stop menstruating altogether. Longer and heavier periods have many causes including fibroids, endometriosis, prolapse, hormone imbalance and, rarely, cancer.

Severe premenstrual symptoms affect me for about ten days each month. Will a hysterectomy help?

Hysterectomy may help to reduce some premenstrual symptoms you may be experiencing, particularly pain, feelings of fullness in the abdomen and fatigue. It is, however, unlikely to help some other common premenstrual symptoms such as breast soreness, fluid retention, irritability or depression.

What is a Wertheim’s hysterectomy?

This is another name for a radical hysterectomy, which entails the removal of the entire uterus including cervix and support structures, both ovaries, Fallopian tubes, nearby lymph nodes, and the upper portion of the vagina. It is usually performed to remove a cancer of the uterus or cervix.

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Some clinics have used a treatment called immunotherapy to stop miscarriages where there may have been several in a row. This treatment is based on the theory that a woman needs to produce special blocking antibodies to prevent her body rejecting the baby whose cells are different from her own. Normally our bodies try to reject any cells that are not ours and yet 50 per cent of a baby’s cells are the partner’s. This treatment is highly controversial. If the theory is right you may wonder why our bodies don’t just reject the sperm to begin with, as they would any foreign object.

It is thought that the immune system’s normal level of activity has to reduce slightly in order to ‘accept’ the growing baby. This reduction in immune activity is one reason why women who have rheumatoid arthritis can lose all their symptoms while pregnant. Rheumatoid arthritis is an inflammatory disorder with an auto-immune component and so benefits from a ‘quieter’ immune system. Immunotherapy treatment works like a vaccine and involves injecting the woman with her partner’s blood to help her produce these antibodies. There have been doubts as to whether the treatment actually works and concern that it may cause sterility in some women, along with other problems such as transfusion reactions and hepatitis.

Incompetent Cervix

In a healthy pregnancy the neck of the womb (the cervix) remains closed until near the birth. However, when the cervix is incompetent the neck of the womb painlessly dilates without contractions, resulting in miscarriage or premature birth. The condition may be congenital (i.e. the woman was born with it) or may be the result of a previous pregnancy. With an incompetent cervix, the miscarriage is usually later – often into the second trimester of pregnancy. The usual treatment is to hold the cervix together with a stitch. Some doctors put the stitch in before conception, others in early pregnancy, and others only after the third month. The diagnosis for this condition is difficult and the research has not led to any clear-cut conclusions as to how beneficial the stitch really is. Obviously if it is inserted too early it could stop nature miscarrying an abnormal baby.

Anatomical abnormalities

An unusually shaped womb may cause problems with implantation. Some women can be born with problems, such as a double uterus (womb), and yet can go on to have healthy pregnancies, while the same condition in others can cause them to miscarry. Surgery is a possibility if your womb is abnormal.

Abnormal Sperm

Because it is the woman who miscarries, greater emphasis has been placed on looking at problems in the female reproductive system. But if you keep miscarrying when nothing can be found wrong it is logical to wonder if the problem might be with your partner’s sperm instead. Early studies have shown that there is an increased risk of miscarriage where there are sperm abnormalities. So it really is important that both the man and woman get themselves into optimum health before conception.

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Legally, a private health practitioner’s files are her or his own property. A woman has no legal right to see or get copies unless they are subpoenaed by a court.

X-rays and test results are paid for by you so you have the right to request them. In private practice, you may have to use powers of persuasion to get the information you need. If you wish to have your X-rays and test results then discuss this issue at the outset of the relationship. Make it clear you want copies of records, specialists’ reports, etc. and explain why you think it is in your best interests to obtain copies of your records. For example, you may want to get a second opinion or you may plan to move interstate and would need to see another doctor. Your doctor has every right to refuse your request.

Public

The Freedom of Information Act gives everybody the right to obtain any of their medical records held by public hospitals. A fee is usually levied for access and copies.

Access to your medical records varies in other Australian states so if you want access to them contact the hospital concerned. If this proves unsuccessful then contact the health department in your state to find out what your rights are.

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The desired anti-cancer effects of chemotherapy are in no way directly related to the presence, absence, or intensity of side effects. The putative relationship is a kind of old wives’ tale that springs from the same source as the stories that frighten women unnecessarily about side effects during pregnancy—for example, if you are not violently ill with morning sickness, then something must be wrong with your baby.

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Be easy on yourself as you recover from surgery. Remember that you are healing both physically and emotionally.

If you have had reconstruction, your plastic surgeon will give you detailed instructions about what you can and cannot do. Anticipate many weeks of some restrictions on your physical activity.

If you have had a less major surgery, you will still have some limits imposed on your activity. Do not try to be a superwoman and do too much too soon. You will hurt yourself and slow down your recovery. This is still the hardest time psychologically, and that difficulty is now compounded by the real physical changes you have experienced. You are well on your way to the time when it will seem a little easier, but do not expect to be there until you have made all of your treatment decisions and have embarked on whatever will come next.

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These issues become particularly acute at times of major life changes and transitions, such as finishing high school, beginning a new job, and/or going off to college. Although these transition periods are also very stressful for young men as well, for a variety of reasons (some societal, some cultural, some individual), young women who are daughters of women newly diagnosed with breast cancer may have an especially difficult time with these life passages.

During the years between eighteen and twenty-two our daughters typically strike out on their own, move away from home, and become independent adults, developing their own identities and their own lifestyles. However, our daughters may feel more than the usual level of conflict during this normal process because they are coping simultaneously with unusual demands on their time, attention, and energy from their moms who are ill back home, usually in a different physical location and often at a considerable distance. They feel conflicted, torn between wanting to be available (both physically and emotionally) and wanting to separate and live their own, individual lives.

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He may be expected to listen to your fears and grief, to take on some of your usual responsibilities, to accompany you to doctors’ appointments, to support and reassure your children. Like you, he is sad and scared and unsure how to best help you and your family. Unlike you, and this may be difficult to contemplate, he must also worry about how to care for your family if you should not survive this illness. The burdens of these real worries are enormous, and many men are ill prepared to cope with them. Husbands of women with breast cancer often talk about how overwhelmed they are feeling, and how much they miss their wives “as they used to be.” No one expects you to pretend that you are carefree, but it will help your husband if you can sometimes focus on the happiness of the moment.

The best advice, again, is open and honest communication. Tell him how you are feeling. Let him know what frightens you. Ask him to hold you. Talk about the changes you may be experiencing in your body and your libido. Remember the joys you have shared and plan for the future together.

Encourage your husband to find someone he can talk to. He will feel that he can’t share with you all of what he is feeling; he worries about burdening you and protecting you. Some hospitals have support groups for husbands; ask what is available to help him. Suggest that he continue with activities that have been fun for him in the past; playing golf or fishing or going out with friends will help him manage the harder days.

Most husbands rise to the occasion and provide unlimited love and support to their wives. Some, however, do not. If your husband seems angry or rejecting or preoccupied or otherwise unavailable to you, remember that what you are seeing is likely his problem and his issues. Try to talk with him. If you cannot, find your support elsewhere and encourage him to do likewise.

We recognize that there are other kinds of partnerships in the world. Many who are not husbands may experience the same feelings as their married brothers. Newer boyfriends often become more loving and involved and appreciative of what you share together. Lesbian couples experience all of the same feelings and may have some concerns about how others will react to them. The incidence of breast cancer is even higher in the lesbian community, so most lesbian women will already be familiar with the problem. This may be a moment when the fact that your partner is also a woman means that it is easier for her to truly empathize and understand what, you are going through. There are support groups in many areas specifically for lesbian women and their partners facing breast cancer.

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