Health News resources and information

How long should I wait before resuming walking and tennis after having a hysterectomy?

Most women who have had a laparoscopic or vaginal hysterectomy can walk short distances within a week and longer distances after about three weeks. For abdominal hysterectomy, add a further two weeks. From then on, be guided by how you feel. By all means play tennis if this does not unduly distress or tire you.

I had a hysterectomy with removal of the uterus and cervix two years ago when I was twenty-eight Am I still ovulating? What is happening to the eggs?

The ovaries should not be affected by removal of the uterus and cervix and so they are probably still releasing eggs. These pass into the abdomen where they quickly disintegrate. It is, however, not possible to give a categorical answer about what is happening to your ovaries. Even though they have not been removed, they may have been adversely affected by the hysterectomy, perhaps because of adhesion formation or perhaps due to some disturbance to their blood supply. Ovarian sex hormone production and release of eggs may diminish and menopause may occur four or so years earlier than expected.

If I have an endometrial resection, will I still have heavy menstrual periods?

After this procedure about 25% of women have no periods afterwards, 60% are having light or normal periods a year later, and 15% continue to have heavy bleeding. Within four years of an endometrial resection about 20% of women experience heavy bleeding again. Many of these women go on to have a hysterectomy.

Will I still be fertile after an endometrial resection or ablation?

Pregnancy is unlikely. If it occurs, however, the risk of complications will be above average.

Is there an increased risk of uterine cancer after endometrial resection or ablation?

There is no evidence of any increased risk at this stage. Follow-up studies to date have been reassuring although they have been of relatively short duration (covering a period of four to six years since the operation). In order to watch for any pattern of adverse effects and to study the outcome of treatment, consideration should be given to the establishment of a national register in Australia of women who have had an endometrial resection or ablation.

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Insertion of an IUD can be done by a clinician within five to seven days of unprotected intercourse.

The Copper T-380 A IUD (ParaGard) is used for emergency contraception. It can be left in place for up to 10 years to provide very effective contraception. Or, if you prefer, the IUD can be removed after your next menstrual period, when it is certain that you are not pregnant.

IUD insertion for emergency contraception is not recommended for women who are at risk for sexually transmitted infections:

• women with more than one sex partner or whose partners have more than one partner

• women with new partners

• women who have been raped

The side effects, advantages, and disadvantages of using IUDs for emergency contraception are the same as those associated with using IUDs for ongoing contraception.

Effectiveness of Emergency Contraception

Of 1,000 women who use emergency IUD insertion, only one will become pregnant.

Of 100 women who use emergency hormonal contraception, up to two will become pregnant.

The closer a woman is to ovulation at the time of unprotectected intercourse, the less likely the method will succeed. If 100 women have vaginal intercourse without contraception during the second î third weeks of their cycle when they are most fertile, eight will become pregnant. Using emergency contraception reduces a woman’s chance by about 75 percent—two out of 100 during her most fertile days.

Emergency contraception is meant for emergencies only. It is not as effective as the regular use of reversible contraception—Norplant, Depo-Provera, the IUD, or the Pill.

Morning-after pills only help prevent pregnancy from one act îf unprotected intercourse. They do not continue to prevent pregnancy during the rest of the cycle. Other methods of birth control must be used.

Emergency contraception offers no protection against sexually transmitted infections.

Where to Get Emergency Contraception

Emergency contraception is available at Planned Parenthood health centers, public clinics and women’s health centers, private doctors and hospital emergency rooms—unless they are affiliated with religions that oppose the use of birth control.

You can get the name, address, and phone number of three emergency contraception providers nearest you by calling, toll-free, the emergency contraception hot line—800-584-9911.

Take-home packs

Packs of morning-after pills are available from some women’s health centers for women whose medical histories are well known to their clinicians. Take-home kits allow women to use the medication u emergency situations without having to wait to see their clinicians.

What Emergency Contraception Costs

Costs vary. Costs depend on which of the following services are needed. Here are some estimates:

Morning-after pills

Morning-after pills kit $8 to $15

One pack of combination pills $20

Two packs of progestin-only pills $50

Visit with health care provider $35 to $150

Pregnancy test $10 to $20

Total cost $75 to $245

Fees may be less at family planning clinics and health centers.

IUD

The ParaGard IUD costs about $450 for exam, IUD, and insertion. It lasts for 10 years, however, which works out to only $45 a year if left in place.

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After you take the pills

• Your next period may be earlier or later than usual.

• Your flow may be heavier, lighter, or more spotty than usual.

• If you see other health care providers before you get your period, remember to tell them that you have taken morning-after pills.

• Schedule a follow-up visit with your clinician if you do not menstruate in three weeks or if you have symptoms of pregnancy.

• Be sure to use another method of contraception if you have vaginal intercourse before your period.

Side effects

Side effects associated with the use of morning-after pills usually taper off one or two days after the second dose has been taken.

• Nausea, usually mild, is experienced by 50 percent of women who use morning-after pills.

• Up to one out of three women experience vomiting.

• Breast tenderness, irregular bleeding, fluid retention, and headaches may occur.

If you use emergency contraception frequently, your periods may become quite irregular and unpredictable. Repeated use is not advised.

Emergency contraception may not prevent ectopic pregnancy. Ectopic pregnancies develop outside the uterus. They must be treated or they will cause complications that may cause death.

If you think you may have an ectopic pregnancy, get medical attention immediately. Signs of ectopic pregnancy include:

• severe pain on one or both sides of the lower abdomen

• abdominal pain and spotting, especially after a missed menstrual period or a very light one

• feeling faint or dizzy

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Emergency hormonal contraception is a sequence of two doses of certain oral contraceptives. The most common “morning-after” pills are “combination” pills that contain estrogen and progestin—synthetic hormones like the ones produced by a woman’s body. Progestin-only pills—mini-pills—may be used by women who cannot take estrogen.

Women who request morning-after pills should review their medical histories with their clinicians before receiving the medication.

You should not use morning-after pills if:

• you are pregnant from a previous act of intercourse

• you have missed your period or it is late

• you are allergic to the medication

How to Use Morning-After Pills

There are several kinds of pills that can be used. Your clinician will designate the brand and dose for you. The pills are taken in two doses, 12 hours apart. You must use only one type of pill and use it for all doses.

Using Progestin-Only Pills

Progestin-only pills may be more appropriate for women who cannot take estrogen. Take 20 tablets of Ovrette within 48 hours of unprotected intercourse and then take another 20 tablets 12 hours later.

Using Combination Pills

Combination pills that are currently used for emergency contraception include Ovral, Lo/Ovral, Nordette, and Levlen. If ó take your pills from a regular 28-pill pack of combination pills, ó can use any of the first 21 pills for emergency contraception.

You can also use Triphasil or Tri-Levlen. The first 21 pills these pills are in three different colors—you must use only the yellow ones.

If you are using Ovral, each dose is two pills. If you are using any other kind of combination pill, each dose is four pills. The dose repeated in 12 hours.

Don’t use the last seven pills in a 28-day pack. They are only reminder pills that contain no hormones.

First dose: Swallow the pills in the first dose as soon as possible a no later than 72 hours—three days—after having unprotected intercourse.

Nausea is a possible side effect when combination pills are used. You may want to eat a snack of saltines or soda crackers or drink a glass of milk 30 minutes before taking each dose to avoid vomiting. Your clinician may prescribe an antinausea medication or suggest ó use an over-the-counter product such as Dramamine.

The side effects of antinausea medication may include light headedness, dizziness, or feeling spacey. Please follow the precautions on the package insert.

Second dose: Swallow the second dose 12 hours after taking the first dose. If vomiting occurred after the first dose, be sure to use an antinausea medication 30 minutes before taking the second dose. Or ó may want to take the second dose as a vaginal suppository.

If you vomit the second dose, do not take any extra pills—it unlikely that they will reduce the risks of pregnancy any further. It is likely that they will increase your risk of nausea.

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Emergency contraception is designed to prevent pregnancy after unprotected vaginal intercourse takes place. It is also called postcoital or “morning-after” contraception.

At some time in their lives, most women are faced with the fear that they might have an unintended and unwanted pregnancy. In fact, the average woman spends 75 to 80 percent of her fertile years trying to avoid pregnancy. During that time, she may forget to use a contraceptive, her contraceptive may fail, or she may be coerced into having unprotected vaginal intercourse.

You may want emergency contraception if:

• his condom broke or slipped off, and he ejaculated inside your vagina

• he forced you to have unprotected vaginal intercourse

• your diaphragm or cervical cap slipped out of place, and he ejaculated inside your vagina

• you miscalculated your “safe” days for periodic abstinence or fertility awareness methods

• you forgot to take your birth control pills

• you weren’t using any birth control

• he didn’t pull out in time

Contact your health care provider immediately if you have unprotected intercourse when you think you might become pregnant.

Emergency contraception is available from health care providers, Planned Parenthood health centers, and other women’s health and family planning centers. It is for use only if a woman is sure she is not already pregnant. It prevents pregnancy by preventing fertilization or implantation. It will not cause an abortion.

Emergency contraception is provided in two ways:

• emergency hormonal contraception—doses of birth control pills

• insertion of an IUD

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Diaphragms and cervical caps are reversible barrier methods of birth control that are available only by prescription. Both are soft rubber barriers that are intended to fit securely over the cervix. Both are used with a contraceptive cream or jelly.

The diaphragm is a shallow, dome-shaped cup with a flexible rim that fits securely in the vagina to cover the cervix.

The cervical cap is thimble-shaped, smaller than the diaphragm, and fits snugly over the cervix itself.

How Diaphragms and Cervical Caps Work

If you choose the diaphragm or cervical cap, you must coat it with spermicide and insert it deep into the vagina before intercourse. Each blocks the entrance to the uterus, and the jelly or cream immobilizes sperm, preventing it from joining the egg.

The diaphragm can be inserted up to six hours before intercourse and may be left in place for 24 hours. Each time sex is repeated, more jelly or cream must be inserted in the vagina (without removing the diaphragm).The cervical cap may be left in place for up to 48 hours. Using additional spermicide with the cap is optional.

Effectiveness of Diaphragms and Cervical Caps

Of 100 women who use diaphragms, 18 will become pregnant during the first year of typical use. Six will become pregnant with perfect use. Of 100 women who have not given birth and who use the cervical cap, 18 will become pregnant during the first year of typical use. Nine will become pregnant with perfect use. Of 100 women who have given birth and who use the cervical cap, 36 will become pregnant during the first year of typical use. Twenty-six will become pregnant with perfect use. You may increase protection by checking that the cervix is covered every time you have intercourse.

Diaphragms and cervical caps may provide some protection against certain sexually transmitted infections, including chlamydia and gonorrhea.

Advantages of the Diaphragm and Cervical Cap

• Once learned, insertion is easy. Insertion can be part of bedtime routine, or it can be shared by both partners during sex play.

• If properly placed, the devices are generally not felt by either partner during intercourse.

• These barrier methods may reduce the risk of developing cervical cancer.

Who Can Use Diaphragms and Cervical Caps

Diaphragms can be worn by most women when they are not menstruating. They are not recommended for women who have:

• poor muscle tone of the vagina or a sagging uterus

• a history of toxic shock syndrome

• recurrent urinary tract infections

Cervical caps can be worn by most women when they are not menstruating. They can be used by women whose pelvic muscles are too relaxed to hold a diaphragm in place. Some women cannot be fitted with existing sizes.

Compared to the diaphragm, the cervical cap may be more difficult and time-consuming for a professional to fit and for a woman to learn to insert and remove.

Women who are not comfortable touching their genitals will probably not like the diaphragm or cervical cap.

It is not wise to use a diaphragm or cervical cap during any kind of vaginal bleeding, including menstruation. Infection may result.

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Breasts are important. They serve many functions during different times of our lives. They are the warm, soft milk bottles we drink from as babies. They are the first sign of our physical maturation from little girls to women during puberty. They are a signal of our sex, which distinguishes us from, and therefore attracts, men. They are the warm, soft milk bottles with which we feed our own babies.

No wonder we may feel rather sensitive about them if they are threatened by disease.

There are many conditions which can affect breasts, and cause women to go to their doctor. The problem may involve the skin of the breast, as in the case of a rash, or a boil. Many women suffer from breast pain, which is rarely associated with cancer, but which still requires diagnosis and management. Breast lumps, however, are always treated with suspicion, and should be investigated thoroughly.

A breast problem may be found by the woman herself, by her sexual partner, or by a doctor performing a routine breast examination. Once an abnormality is identified, it should be investigated until a diagnosis is made.

Certain information can be obtained from the history and examination, but the definitive investigation of breast problems usually involves having some tests performed. Most women can expect to undergo some, or all of the following:

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Physical reasons. If there is something affecting die lining of the uterus, making it more difficult for the conceptus to implant, it is more likely to miscarry. Physical barriers to a pregnancy continuing include an abnormally shaped uterus, or trauma, such as pelvic procedures, operations or infections.

Psychological factors. There is thought to be a relationship between stress and anxiety, and hormones, the nervous system, blood vessels, muscles, etc. This may play a part in some miscarriages, but it would be difficult to prove or quantify. Some researchers have shown a relationship between anxiety and recurrent abortion.

Diseases. Some specific infections are associated with an increased risk of miscarriage, but any severe illness (acute or chronic), may affect a pregnancy.

Medications. There has been some suggestion that some drugs, like anti-cancer treatment, and possibly anaesthetic gases, may increase the risk of miscarriage.

Maternal age. Older women (in medical terms, those over 35) have a higher chance of miscarriage than younger women, perhaps because some developmental problems in the conceptus are more common with age.

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