Your recovery time is influenced by many factors. The type of hysterectomy you have being the most important In general, women who have a vaginal or laparoscopic hysterectomy can return to work after three to four weeks. It usually takes about two weeks longer to recover from an abdominal hysterectomy.

Other important influences on time to recovery are general fitness and weight. The fitter a woman is, the quicker her recovery, while the more overweight she is, the longer the recuperation time. Women who exercise regularly and are not overweight before hysterectomy tend to recover faster. A plan of regular exercise also helps after the operation and can commence within a few days of a vaginal or laparoscopic hysterectomy and two weeks after an abdominal hysterectomy. (The extra time is needed for wound repair.) Some women fear that activity will harm them or undo their surgery; but in virtually all gynaecological procedures, except prolapse operations, physical activity speeds recovery.

Will I put on weight after a hysterectomy?

food intake so that it corresponds to your activity level. Boredom after surgery may result in increased eating and deleterious weight gain.

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However, pioneering work by Professor David Barker has shown that what we weigh at birth can have an immense effect on our health later on in life. Low birth weight has been linked to an increased risk of high blood pressure, a higher risk of coronary heart disease, and a greater risk of non-insulin dependent diabetes.

As David Barker says, ‘Research suggests that coronary heart disease and stroke and the associated conditions, hypertension [high blood pressure] and non-insulin dependent diabetes, originate through impaired growth and development during foetal life and infancy.’

A 1997 study looked at women who were born with low birth weights. The scientists then monitored the same women through puberty and adolescence, and found that they started their periods about three to six months later than average. When they became pregnant, the course of pregnancy and delivery was within the normal range but their chance of giving birth to a low birth weight baby was double that of other women. This is why preconception care, and what you do once you are pregnant, is so important.

The World Health Organization uses two markers for the health of any nation: birth weight and longevity. In the UK 54,000 low birth weight babies are born each year and the incidence has not changed in 30 years.

These consequences of low birth weight affect the babies throughout their lives and it is now suggested that there is a link between weight at birth and asthma. Researchers from a number of London hospitals found that low birth weight was a risk factor for asthma by the age of 26.The incidence of asthma among adults fell as birth weight increased.

Nutrition plays a key role in helping you to get pregnant and then having a healthy pregnancy and a healthy baby.

As Isobel Jennings says in her book Vitamins in Endocrine Metabolism, ‘It seems that much more could be done in the field of preventative medicine to cut down the large numbers of preventable congenital defects. In human foetal development, most abnormalities are established by the eighth to the tenth week of gestation. This means of course that the most important period for nutritional care occurs in the few weeks before and immediately after conception.

A few years ago, Scandinavian doctors linked diets rich in fish with a decrease in premature births. They felt that three fish meals a week would be enough not only to reduce premature births but also to produce a good weight baby.

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? There are good over-the-counter products to alleviate vaginal dryness. It makes sense to try several brands to see what works best for you. Astroglide is a frequent favorite. It may be helpful to use a product like Replens every other day as you begin chemotherapy to minimize vaginal dryness. You can also use plain yogurt as a lubricant for intercourse.

? Like lots of things in life, the old cliche of “use it or lose it” applies here.

? A vitamin E capsule opened and spread on the vagina increases vaginal lubrication.

? There is some research suggesting that the topical vaginal use of Retin-A may help with dryness and elasticity. Ask your gynecologist.

? When your treatments are completed, if you are experiencing chronic difficulties with your libido, ask your oncologist about the possibility of taking a low dose of testosterone.

? Remember Kegel exercises? These are still one of the best ways to strengthen your pelvic floor and enhance sexual sensation. The easiest way to practice these exercises is during urination. As you begin to pee, squeeze your muscles together to stop the flow. Stop and start it several times. After doing this a few times, you will have identified the correct muscles to contract and can then practice at other times. When you do so, contract the muscles and hold them for a slow count of ten; then relax.

? Expect some changes in your sex life. Be willing to adapt.

Your sexual interest and response will probably return to normal after your treatments end.

If this doesn’t happen, be creative and find other, new ways of both receiving and giving physical pleasure.

? Make up your mind to deal with your cancer. Be determined to get through it.

? Know that you will need to face painful and difficult changes, including an altered image of yourself, both physically and emotionally.

? Allow yourself to grieve for these losses—of full health, of body parts, and of your former self. Never again will you feel carefree in the same innocent way.

? Be good to yourself.

? Try to see the humorous side of life. Rent funny movies.

? Enjoy what you do and do what you enjoy.

? Tell people who ask what you need. They want to help you.

? Learn to both ask for help and accept it.

? Be kind to yourself and remember to laugh often.

? Let yourself cry.

? There is light at the end of the tunnel!

? YOU CAN DO THIS. YOU ARE NOT ALONE.

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Chemotherapy for breast cancer is a changing science. As you talk with other women who were treated a few years ago, you will find that their regimens were somewhat different. There may also be differences of opinion among doctors and medical centers. Although this can seem frightening and confusing, it does not mean that one treatment is right and all the others are wrong. Conversely, research has shown that standard adjuvant chemotherapy treatments for breast cancer are virtually identical in outcome. You will make choices that reflect your personal needs.

Some adjuvant chemotherapy programs for breast cancer have been used for years and have proven their value over time. Clinical trials, carefully designed studies using different drugs or different schedules of treatment, are always in progress as doctors try to find even more effective ways to treat breast cancer. Slightly different treatment regimens are likely to be used in different parts of the country. All of them have the same goal: saving your life.

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Depending on how much tissue needs to be removed to achieve clean margins relative to the size of your breast, you may look more or less different than you did before the surgical procedures. Breast conservation may leave you completely satisfied with the cosmetic result, but be aware that some women are less happy with the outcome than others. If you feel truly unhappy with the appearance of your breast after all your treatment is over, it may be possible to undergo partial reconstruction. Talk with a plastic surgeon. Most women, however, decide over time that a less-than-perfect breast is a small price to pay for life.

Mastectomy, or Breast Removal

There are two types of mastectomy surgery, and you may be presented with options.

¦ A simple (total) mastectomy (including the nipple/areola), in which all breast tissue, but nothing else, is removed

¦ A modified radical mastectomy, in which all breast tissue and some axillary lymph nodes are removed

Keep in mind that there are also variations on these options which your surgeon or oncologist might also describe to you. You may also be told that you can choose to have breast reconstruction, either at the same time you have a mastectomy or at a later date. You may decide to have a mastectomy and no other surgery. Many women find they adapt comfortably to life with a prosthesis, and for them, this is an entirely acceptable choice.

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? Never lie to your children. If you don’t know the answer to a question, say so.

? If your child/ren ask you if you are going to die from your breast cancer, it is honest and right to say no. Most women with breast cancer do well. If it eventually turns out that you are not so fortunate, there will be plenty of time to talk about that and to prepare your children. No one ever dropped dead from breast cancer, and right now what your children need most is to be reassured and comforted. Fears about your future health belong in discussions between you, your husband, and your adult family and friends, not in conversations with your young children. They have more than enough to deal with just now.

? Explain what is happening in words age-appropriate for each child. Children are excellent observers but terrible interpreters of what they see around them. Even though you may be trying to protect them by not talking about your experience, their fantasies are probably much worse than the reality. A good model of communication can be the way you have talked with them about sex. In both cases, you are using honest and age-appropriate language and hoping to make the subject safe and acceptable for future conversations.

? Try to keep their lives and their routines as normal as possible. For more than ten years now, Hester has been part of a longitudinal study of children of women with breast cancer. Regardless of the age of the children or the specifics of the mother’s illness, the consistent finding has been that children who are given honest information in age-appropriate language and whose own routines are not disrupted unnecessarily do fine.

? Remember to tell the appropriate person (teacher, guidance counselor, principal, etc.) at the child’s school what is happening at home. This also applies to coaches, music teachers, or other adults who are part of the child’s life.

* Whatever their ages, your children will take their cues from you. If you are straightforward and positive about your diagnosis and treatment, they will be, too.

? Do not be. surprised or hurt if your children quickly become blase about your diagnosis. This means you are doing a good job!

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All of this sounds harder than it really is. You have already heard the worst news, the fact that you have breast cancer, and you heard those words from a physician. If you do only what your first doctor suggests, the chances are good that you will be referred to specialists who are respected in your community. However, since breast cancer is a potentially life-threatening illness, and since you want to do everything possible to ensure the very best care for yourself, it is wise to select your medical team thoughtfully and carefully. If you don’t know where to go, ask others. The breast cancer network is far-reaching, and you will quickly find that you have resources you were previously unaware of. You probably already know some women who have had breast cancer; talk with them and they will refer you to others. Ask these women about their doctors and about their level of satisfaction with their care. Would they make the same decisions if they were starting out now? You can call one of the breast cancer organizations listed in the resources section of this book. They will probably not be able to suggest individual physicians, but they can give you a list of cancer centers and accredited oncologists in your community.

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Specific testing of the endometrium needs to be performed. This is usually a microscopic examination of samples collected from the endometrium. Sampling can be done using either dilatation and curettage (D and C), or using an endometrial sampling device or hysteroscopy.

If abnormal cells are found, further examination and investigation will be done to assess the type and extent of the disease. The stage of the disease is determined at an operation. The extent of the spread and the type of cancer are determined, and a plan of management can be formulated.

Treatment. Depending on the type and spread, and the age, well-being and wishes of the

woman, the options include:

• Surgery—hysterectomy. The ovaries are also removed, as they can be another potential site of cancer. More extensive surgery may be considered if there is local spread into the muscle of the uterus, or into the cervix, tubes or ovaries. Under these circumstances, the lymph glands in the area would also be removed.

• Radiotherapy—this may be given after surgery.

• Chemotherapy—standard anti-cancer drugs are effective in the treatment of this cancer. About 40 per cent of tumours respond, but this response may only last for a few months.

• Hormonal therapy—progesterone-type medications, and anti-oestrogen drugs are often used in treating advanced adenocarcinomas. Treatment, not surprisingly, is more successful when the disease is caught early, and has not spread far. The five-year survival rate for stage 1 adenocarcinoma is about 85 per cent. Fortunately, because this disease has a tendency to cause irregular bleeding fairly early, it is often investigated and treated before there is significant spread.

The outlook for sarcoma is less bright, because it is usually a more aggressive cancer, but fortunately sarcomas make up a very small proportion of all uterine cancers. The symptoms, investigation and treatment options are similar to those outlined for adenocarcinoma.

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