What is the cause of prolapse and what treatments are effective?

Prolapse occurs when the ligaments that support the pelvic organs are damaged. This may happen during childbirth or there may be an inborn weakness of the pelvic support tissue that worsens as a normal part of the ageing process. Treatments for prolapse that have been shown to be effective in some women include hormone therapy, pelvic floor exercises, vaginal support pessaries and surgery. Of these treatments, the available evidence suggests that surgery is the most effective. It would be preferable, however, if greater emphasis was put on prevention of prolapse problems. This could be achieved by educating young women about the value of pelvic floor exercises and teaching them how to do them. Ideally these exercises should be performed regularly from the teenage or early adult years onwards.

I have endometriosis but it is not causing any problems at the moment. Is there any reason why I should consider having it treated?

Yes, you should consider having your endometriosis treated rather than letting it progress, as it tends to worsen in most women without treatment. Once it has progressed, it is more difficult to treat by surgery or drugs. There is, however, one circumstance in which it may be safe to ignore this advice—if your endometriosis is mild and is known not to have progressed for some years. In these circumstances, regular check-ups with ultrasound assessment are advisable.

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Adopting a Healthy Lifestyle

Look at your lifestyle, including alcohol, smoking and street drugs, and make sure you and your partner eliminate these during the four months. Remember, it takes around three months for a man to produce a new batch of sperm so by the end of the Four-Month Plan these new healthy, mobile sperm will have a much greater chance of fertilising your egg. It also takes three months for your egg to start from a group of follicles, and then to be selected as the egg that is released on the cycle.

Eliminate any unnecessary over-the-counter drugs both of you may be taking. You should also ask your doctor whether any prescribed medication you may be taking could be affecting your fertility and whether there are alternatives to these drugs.

Get your partner to buy looser underwear and trousers and take showers instead of hot baths. If he sits down all day, suggest he thinks about taking breaks and walking around, especially if he is sitting down driving in a hot vehicle.

Being Screened for Infections

Make sure that both you and your partner are checked for any genitourinary infections (GUIs). This is especially important before you embark on any fertility testing because, if an infection is present, certain investigations via the vagina could push the infection higher up inside the body.

This step is also crucial if you have had a previous miscarriage, just to rule out the possibility that an infection was not the cause.

Your GP may organize this screen for you or you can go to the GUI clinic at your local hospital. Both you and your partner should be tested.

At the moment, in my opinion, not enough emphasis is placed on this kind of testing. If you have any problems organizing these checks then my contact details are at the back of the book.

If an infection shows up, you and/or your partner will be treated. You should then have a re-test to make sure the infection has cleared up.

Most infections will require treatment with an antibiotic. This is not ideal, and in complementary medicine it is usual to try to avoid the use of antibiotics. In this situation, however, the infection may be long-standing and it must be cleared up fairly quickly because it may be stopping you conceiving. Antibiotics wipe out the infection but they will also wipe out the beneficial bacteria which live in the gut, leaving you prone to thrush. So, as soon as you have finished the course of antibiotics, you need to take a good probiotic (the opposite of an antibiotic which helps to re-colonize the gut flora). Use:

• BioCare s Replete – one sachet per day for seven days

• Then go on to BioCare s Bio-acidophilus for one month

Avoiding Environmental Hazards

Think about your environment. Could your occupation or your partner’s be affecting fertility (e.g. farming with pesticides, hairdressing with dye, hairspray, etc, or painting)? And can you do anything to reduce the problem? In your home, can you limit the amount of chemicals used? For example, can you avoid using pesticides in the garden, and flea sprays in the house? If you are decorating the house, finish the work before you begin the Four-Month Plan.

Timing Your Fertility Investigations

Now you have put into place a good food supplement programme, looked at your diet and your environment and know that you are free from infections. The next step is that of fertility investigations.

However, the speed with which you take this next step depends on a number of factors and I would like to suggest a guide for assessing this.

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Very often the drugs administered during chemotherapy will cause the suspension of your monthly periods. During chemotherapy, if your periods continue, they are very likely to be different from your usual periods in duration and flow. Some women experience an increase in flow, accompanied by fairly heavy cramping, during the first month or two; other women notice a decrease in flow that precedes cessation. Depending on your age and how close you are to naturally occurring menopause, your menstrual cycle may resume or it may not. Although there has been a great deal of attention directed to the experience of passing through menopause, you may find, as many of us did, that when you are coping with cancer, menopause pales in comparison; it is simply not that big a deal.

Yet, in spite of the understanding that being alive is much more important than unexpectedly having an early menopause, it is also true that some of us really hate it. Women who have not completed their families may have the most painful adjustment. Even if they would have decided not to have (more) children, having the choice taken away can be devastating. We often feel out of control and victimized or “done to” because of the cancer, and this can be one more significant example of what we have lost.

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? Again, you may bring and listen to a Walkman.

? You will spend time after undressing in a waiting room. Bathrobes are provided, but you may bring a jacket or wrap of your own. You can also wear a regular button-down-the-front blouse.

? Talk with other women in the waiting room. You will see the same people there each day; lifelong friendships have been formed in this environment.

? Consider bringing a friend. It can be a good time for a visit.

? Let the technicians know if you like to chat or prefer silence.

? Apply your moisturizer immediately after treatment and before you get dressed.

If you have moderate or worse burning on your skin (which is unlikely), ask your doctor if you can use goat’s milk soap or Radia Care, a cream available at medical supply stores.

If you are using special creams or ointments on your skin, it may be helpful to wear a thin paper diaper liner between your breast and your bra to prevent stains on your clothing.

? Even if you generally take showers, try warm baths during radiation. They are very soothing.

? Cotton athletic bras and cotton camisoles are the most comfortable. There are pretty ones, and this is the time to splurge. Try searching through the natural fiber catalogs as well as the stores.

* Plan your daily radiation treatment as something you do on the way to somewhere else—not as the main event of your day.

? Parking may be a concern. Ask about places to park and the possibility of a reduced parking rate.

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Either of the surgery options is likely to include an axillary node dissection, in which some of the nodes under your arm are removed by your surgeon to be studied by the pathologists). The pathologist’s examination of these tissues gives information about the stage and prognosis of the breast cancer. This information is considered in making additional treatment decisions, such as chemotherapy and hormonal therapy and possible radiation treatments to the axilla (armpit) and breast or chest wall. Side effects of an axillary dissection vary among individual women, but may include discomfort, numbness, and/or swelling.

In order to minimize the surgery to be done in the axilla and to diminish possible, unpleasant physical changes, a less invasive surgery has been developed. This procedure is called selective lymph node dissection (SLND) and resection of the sentinel node. This smaller surgery has been offered in some hospitals for several years and has been found to provide all the same important information as the more invasive standard axillary node dissection does.

The sentinel node is the first draining node of a regional lymph node basin. For women with breast cancer, this is most commonly the axilla or underarm area. The theory is that the sentinel node is the first node where cancer cells would lodge if they have traveled through the lymphatics. By removing and testing a sentinel node for cancer cells, your medical team can determine if further surgery is necessary. This is done at the time of definitive surgery for breast cancer. There are two ways the sentinel node can be located. Some surgeons perform one technique or the other, and some use a combination of the two. The first technique uses a radioactive material called technetium (the same tracer used for bone scans), which is injected at the site of the breast tumor. The tracer is then taken up into the lymphatic channels and accumulates in the sentinel node. The surgeon then uses a handheld probe that detects signals from the tracer to locate and identify the node.

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Women from nonwhite middle-class cultures bring their own experiences and expectations to breast cancer. For example, in the Haitian community, it is still sometimes considered inappropriate to even talk about breasts and quite shameful to have cancer, especially in the breast. The main reason for the higher mortality rate from cancer in minority communities is later diagnosis. This is due to less good access to medical care, poor or no medical insurance, less information about self-care and health, and less comfort in general with talking about cancer or sexualized body parts.

If you are from a minority community, you have the same rights as anyone else to the best care and best support services. You may not feel comfortable being an assertive health care consumer if you have been raised to believe that any authority figure, and especially a doctor, is always right. You may find it harder to ask questions or go after a second opinion. Remember that your first responsibility is to yourself and that you deserve the very best care you can find.

There are intrinsic supports in the community that can be helpful to you now. Many African-American churches have support groups for cancer patients or women’s alliances that can help with transportation, child care, meals, or whatever you need. Call the local office of your American Cancer Society and ask what is available in your own community.

If you do not feel comfortable and respected in your hospital or doctor’s office, speak up. Bring a friend or family member with you and ask for what you need. You might also want to contact the National Black Women’s Health Project in Washington, D.C.

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Consider the following possible treatment settings:

? Academic or teaching hospitals are likely to have the biggest names in your community on their staffs and to have access to current clinical trials.

? Community cancer centers may be located closer to your home and may also participate in some research programs.

? Private oncology practices may be the most convenient, and you may prefer the small size of the whole operation. This would feel comparable to going to your regular doctor’s office.

? Combinations of the above exist in many areas. For example, you may be able to meet with your oncologist in her/his private office away from the hospital and receive your chemotherapy either there or in a hospital-based unit.

Breast cancer care varies in complexity depending upon the clinical circumstances. Most situations require an integrated approach involving a number of specialists:

? A breast surgeon, who does the initial biopsy (unless that has already been done by another surgeon) and then the second surgery of either wide excision/partial mastectomy (also referred to as a lumpectomy) or mastectomy. Both of these definitive surgeries are likely to include an axillary node sampling.

? A plastic surgeon, if you are having a mastectomy and considering reconstruction.

? A radiation oncologist, if you are having a lumpectomy followed by radiation. Some women also have radiation following a mastectomy.

? A medical oncologist, who plans and delivers your chemotherapy or hormone therapy.

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This disease will affect about one in seventy women in Australia. It is typically a cancer affecting older women, usually aged between 50 and 70. It is less often found in younger women.

Types. Cancer may develop in either the lining or the wall of the uterus. The most common type of uterine cancer is adenocarcinoma, or endometrial cancer, in which the cancerous change happens in the gland tissue of the uterus lining (the endometrium). The other form, sarcoma, is rare, accounting for only 3 per cent of cases of cancer of the uterus. Sarcomas develop when other cells, such as muscle cells, undergo malignant change. The way these two forms present and are created may be similar, although the outlook for sarcomas is, in general, poorer than for adenocarcinomas.

Symptoms. The most common way uterine cancer presents is with abnormal bleeding. This is usually bleeding after menopause, or less often bleeding between periods. This is why abnormal bleeding should always be investigated.

There are some other symptoms which may give a hint that there is something wrong, but usually these, including pain, fever and bladder and bowel problems, occur late in the disease.

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