Will I age prematurely if my ovaries are removed?

The answer to this depends on whether you go on hormone therapy, your body size, whether you had your ovaries removed before or after your menopause, and your genetic make-up. Before menopause the ovaries are the body’s main source of hormones such as oestrogen, which has wide-ranging influences on a woman’s body. Some of the areas it affects are:

• the thickness and tone of the vaginal lining and the vagina’s production of secretions

• the fullness, tone and secretions of the vulva, cervix and urethra

• bone structure and growth

• temperament and sexual interest

• the appearance and perhaps function of many other body tissues such as the skin, hair, heart, blood vessels, breasts, liver and joints.

After menopause, most women continue to make measurable and useful amounts of oestrogen in fat and muscle tissue and in the ovaries and adrenal glands (two small organs near the kidneys). How much body fat you have, and your genetic make-up, are among the most important influences on oestrogen levels after menopause.

If you have a slight build and your ovaries are removed before your menopause you are likely to experience more severe, acute menopausal symptoms (such as hot flushes, vaginal dryness, and bladder problems) than if you are well-built and you lose your ovaries after menopause. If you are in the former group, you may also find that your hair seems drier and your skin has less tone and you will also be at increased risk of heart disease and bone thinning (osteoporosis) in later life. For all these reasons you should consider oestrogen replacement therapy (a form of hormone therapy).

Women who are well-built and whose ovaries are removed before menopause tend to experience an intermediate level of symptoms and a slight to moderate increase in their long-term risk of heart disease and osteoporosis. Although such women may find oestrogen supplements useful, they may not be vitally important to their well-being.

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Scientists used to think that adult illnesses (like heart disease, breast cancer, diabetes and obesity) were either the direct result of what we have inherited through our genes or were due to unhealthy living patterns. Current research, however, suggests instead that we are programmed to be susceptible to these illnesses depending on what we were exposed to in the womb. This concept – that the diseases of adult life could be connected to conditions in the womb – is called foetal programming.

The research by Professor David Barker mentioned earlier (which showed the link between our birth weight and the possibility of heart problems) is just one aspect of this programming. It seems that whatever conditions in the womb stunt the baby’s growth also increases their risk of cardiovascular disease. Scientists are now taking this research further by looking at other traits which may be influenced in the womb, such as high cholesterol, obesity, diabetes, breast cancer, mental illness and intelligence.

This new science of foetal programming is even causing a rethink of genetic influences. For instance, it has always been thought that identical twins are more likely to share a similar characteristic because this characteristic was controlled by their genes. But identical twins also share the same conditions in the womb so could other factors be at work?

Recent research, published in the American Journal of Clinical Nutrition, monitored the daughters born to those women who were pregnant during the Dutch famine of 1944 – 45.They found that those women whose mothers were malnourished during the early stages of pregnancy because of the famine had a significantly greater chance of being obese at the age of 50. If the mothers had been starved after the first four months of their pregnancy there was no difference in the Body Mass Index for these daughters, compared with an average cross-section of similar age. The researchers concluded that the obesity developed as a result of permanent changes ‘fixed’ in the womb, rather than as the result of the usual lifestyle factors.

Further findings from this research also suggest that the children of the women who were pregnant during the famine have a greater risk of developing late-onset diabetes.

Professor Barker is suggesting that, because different issues in the foetus have different critical periods of development, the timing of an effect on a woman is crucial. The converse is also true. If we nourish the baby in the womb as healthily as possible we can lessen the risk of the child developing future illnesses.

This does not mean that we have no control over our health as adults. But it may put us more at risk of developing a certain problem like heart disease later on in life, requiring us to be more careful about our diet, exercise etc. But, more importantly, this research shows that certain adult illnesses could be prevented if we concentrated on making the environment in the womb as healthy as possible.

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? Because you have had breast cancer, you probably cannot take estrogens. Currently there are clinical trials underway to determine the safety of HRT (hormone

replacement therapy) for women who have had breast cancer. You may want to talk with your doctor about this in the future. There are other strategies for dealing with menopausal symptoms. Find a gynecologist who is experienced with women who have had breast cancer.

? Some women find that hot flashes are helped by eating soy products or drinking soy milk or taking vitamin E (800 units a day). Look carefully at any holistic menopause treatments: many contain natural or plant estrogens. Before taking them, be sure to consult your physician.

? A few prescription medicines you can safely take may help. Ask your doctor about the clonidine patch (otherwise known as a blood pressure medicine), bellemene s, or about a low dose of Effexor.

? Remember the handheld fans which your mother or grandmother used. They are still available (look in Asian markets), and they still work.

? Hot flashes tend to be worse at times of stress—another good reason to try to reduce the stress in your life.

? Dress in layers. Try V-neck shirts or blouses with a cardigan-style sweater or jacket over them for warmth. The outer layers can then be removed when the flash strikes. Scoop-neck or jewel-neck tops make an excellent choice for a first layer, too. You will probably want to avoid turtlenecks at this time.

? If you have hot flashes at night, keep an extra pillow near you. When you awaken in a sweat, switch to the fresh, cool pillow. It helps. Also, keep fresh drinking water next to your bed along with a few mints or suckers.

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The most important thing is your health, now and in the future. You need to do what is best for you and what has the best chance of ensuring your long and healthy life. Remember that there is no single right choice of treatment. It is important that you receive appropriate chemotherapy, but there are likely to be several treatment regimens that are equally right for you.

Many women are more frightened by the prospect of chemotherapy than they were of surgery. It can be difficult to forget images you have seen in the movies or read in books of cancer patients being desperately ill from the chemotherapy treatments. Fortunately, times have changed and real progress has been made with controlling the nausea and vomiting you may be dreading. There are new and powerful drugs, such as Kytril and Zofran, which eliminate or greatly reduce these side effects. Over time, there will be additional new drugs discovered and recommended as well.

You may also be fearful of having such powerful drugs injected into your system. It can be hard to think of chemotherapy as lifesaving rather than as toxic poisons. Talk with your doctor about your concerns, and remember that a drug strong enough to kill cancer is going to be strong enough to have some other side effects. All of this is temporary. You are trying to save your life.

Talk with other women who have undergone chemotherapy about their experiences. What you hear from them will be somewhat different from what you hear from your doctors. Most women will tell you that their fantasies about chemotherapy were much worse than the reality. No one would suggest that receiving chemotherapy is pleasant, but it is completely manageable. Use all the information to help you make the best decision for yourself.

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Several types of reconstruction may be available to you. Following a mastectomy, reconstruction can be done either immediately (at the time of the mastectomy) or at a later date (many months or even years after). (There is usually no need for reconstruction after surgery less than mastectomy.) In either case, further procedures may be necessary in the months that follow—for example, placement of a nipple/ areolar complex, reduction of the other side to match the reconstructed one, and so forth.

Reconstruction has become more common, but remember that you do have another option: mastectomy alone. In some hospitals immediate reconstruction is the standard of care, and women are told in the same breath that “you need to have a mastectomy, but you can have reconstruction at the same time.” For many women, this may indeed be the best option, as they never have to deal with the total absence of a breast and do not have to make a decision to return in the future for more surgery. However, for others, this may be a mistake. You will find it hard to think clearly about these choices, some of which involve major surgery with long recoveries, while you are still trying to absorb the initial diagnosis of breast cancer. Remember that you can opt to take care of the cancer now, with a mastectomy, and then revisit the question of reconstruction next year or even five years from now.

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Very young children will not understand the facts and details about what is happening; they will, however, know that something is very wrong. In reaction they may be more clingy and irritable, or conversely, they may be too well behaved and anxious to please. What they need most is reassurance that someone (ideally someone whom they already know and trust) will always be there to care for them and reassurance that they are not responsible or to blame for what has happened. The normal magical thinking of young children may lead them to believe that their anger or words have caused your illness; tell them directly that this is not so.

You must also distinguish between your cancer treatment and the more ordinary illnesses ttiat may happen to them. We have heard stories of young ch iidren panicked about taking an antibiotic because “momrviy’s medicine” made her hair fall out! Many mothers worry* that their young children will be especially upset if they lose their hair because it is harder to explain the process to them. Our experience has been that preschool children accept their mother’s baldness as one more interesting and new thing about the world. One woman said that her three-year-old daughter wanted her to come to nursery school as her show-and-tell exhibit!

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Here are some things to remember as you choose your medical team:

? First and foremost, you are looking for the best doctors in your area with whom you feel comfortable.

? Most likely your medical insurance plan will place some limits on your choices. Your doctors will need to be on their list of approved providers/specialists.

? Geography matters. Although it is certainly worth traveling a reasonable distance for better care, remember that you will be spending a fair amount of time with doctors and treatments in the site you select. Since one overall goal is to make your life easier, not harder, whenever possible, you might want to consider geographic location very carefully.

? Trust your gut. Remembering that it is hard to like the messenger of bad tidings, pay attention to your reaction to the doctors with whom you are speaking. Do they treat you respectfully? Do they spend enough time to answer your questions? Do they talk to you and not to your spouse or partner? Do they tell you how to reach them or their coverage at any time, and do they suggest the best way to ask them questions at times other than during office visits?

? Ask to tour the treatment area. It will nor be as scary as you imagine, and different practices are set up in different ways. Would you be more comfortable in a large and airy space, where you can see other patients and the nurses at all times, or would you prefer a small and private room away from others?

? Ask who administers the chemotherapy and whether you can be introduced. Most often chemotherapy is given by skilled and experienced oncology nurses; some oncologists, however, do it themselves. One way is not better than the other; they are just different systems.

? Ask about available support services. Is there an oncology social worker on site? Can you and your family meet with her or him? Are there support groups? Peer support programs? Educational materials? Resources for your family—your partner, husband, children?

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What to do if you are sexually assaulted

• Tell someone you trust, immediately. Before you change your clothes or wash, call your local rape-crisis hot line or women’s center—look under “rape” in the telephone book. They will send someone to help you.

• Get medical help. Have someone you trust with you. You may need emergency contraception as well as treatment for any injuries or infections you may have received. You may also be asked to agree to be physically examined for rape evidence.

• Decide whether you want to report the rape to the police or other authorities. If you do, you may have to recount what happened in detail.

• Take time to recover. You may want to take a few days off from work or school and find a safe place to stay for a few days.

• Get counseling. Recovery takes time and lots of support. You may choose to join a rape recovery group as well.

• Don’t blame yourself for what happened. No matter how you behaved, no one deserves to be raped.

Recovering from Sexual Assault

The effects of sexual assault include physical and psychological problems. Psychological effects include loss of self-esteem, impaired body image, eating disorders, anxiety, depression, and sexual inhibition and conflict. The victim may lose interest in sexual contact, be unable to become sexually aroused, or have flashbacks of the assault while trying to have sex with someone who is loved and trusted. Victims may feel dirty, ugly, and unloved. These painful responses are common. They may stress the victims’ relationships with their partners.

Rape trauma syndrome is the physical and emotional pain that begins during sexual assault and continues afterward. The acute phase begins with the assault and can last for several weeks. A woman may appear calm and controlled, or she may be very expressive. Her feelings may include anger, sadness, shame, shock, fear, anxiety, guilt, and a loss of control.

The acute phase is followed by the long-term reorganization phase, which may last a year or more. During this time, a woman tries to reorganize and regain control of her life. She may want to move, change her phone number, or look for a new job.

The silent assault victim does not tell anyone about her experience and will go through the process of rape trauma syndrome without the support of professionals or friends. Survivors who express their feelings to supportive professionals, families, and friends may be able to recover more completely and quickly.

Some women go through rape trauma syndrome a long while after the assault. The trauma may cause the survivor to deny the incident, even to herself. She may not be able to deal with her memories and feelings, and they become hidden within her, unremembered. She may feel hurt, sad, angry, and sexually inhibited and not know why.

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Here are some ways to avoid sexual assault:

• Have and use locks on doors and windows, and change the locks in a new home.

• Do not open your door to strangers. Ask for identification when service people come to the

door, and call the company to verify that they are on legitimate business.

• Always show self-confidence with your body language and speech when you are in public.

• Have first dates with groups of friends or in public places.

• Do not tell new acquaintances that you live alone. Use only initials on your mailbox and in the

phone book.

• Avoid controlling or demanding men who may try to control your behavior by planning all the

activities and making all the decisions.

• Share dating expenses. Men who are willing to share expenses may be less likely to use sexual

coercion to “get what they pay for.”

• Lock your car when you drive and when you park.

• Avoid dark and deserted areas and always be aware of your surroundings so that you can try to

get away if someone pursues you.

• Have house or car keys in hand before coming to your door.

• If your car breaks down, attach a white cloth to the antenna, lock yourself in, and wait for a

uniformed officer in an official car. If other people ask to help, tell them to call the police or a

garage, but do not unlock the car door.

• Carry a device for making a loud noise. Sound an alarm at the first sign of danger.

• Don’t lead anyone to believe you are more sexually available than you want to be.

• Avoid using alcohol or other drugs when you definitely do not wish to be sexually intimate

with your date.

• If assaulted, try to get away, but don’t struggle if the struggle seems to arouse your assailant.

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Painful intercourse occurs in women and men. It is often caused by infection and conditions like vaginitis. It is much less common in men, who may experience painful intercourse because of a physical condition such as a tight foreskin.

Dyspareunia is painful intercourse for women that may be caused by hormonal imbalances, especially those that happen after menopause. Dyspareunia also happens in up to one out of five women because her partner tries to have intercourse with her before she is fully aroused. Some women are so sexually inhibited that they are unable to let their partners know that they are in pain. Some are in poor relationships and fear telling their partners. Others have such fears and anxieties about sex that they mistakenly suppose that sex is naturally painful.

Vaginismus occurs when a woman’s fear and anxiety about vaginal intercourse cause the muscles around her vagina to go into spasm when her partner tries to insert his penis. Vaginismus was extremely common in the nineteenth century when women were taught to fear intercourse. Today, it is much less common. It results not only from fearful attitudes toward sex but also from sexual abuse, rape, brutal early sexual experiences, or painful pelvic examinations.

Dyspareunia may be relieved by open communication with partners who are prepared to be more attentive to a woman’s need for complete arousal before intercourse begins. Physical causes may be relieved by the use of medication, lubrication, or estrogen therapy. Vaginismus may be relieved by psychosexual therapy.

Sexual dysfunctions are often a combination of physical and psychological problems. Those caused by physical conditions often develop psychological challenges. That is why psychotherapy is an important component of holistic treatment of sexual dysfunctions and inhibitions

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