Issue #27: handle. confront. EMBRACE
HYSTERECTOMIES + building resilience + 2 days in madison + THERESA love
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True story… when looking for images for this issue, these were the images that came up (with very few options) when searching for MENOPAUSE. We don’t talk enough about what real menopause looks like…according to this database of random images, it happens in our 70s! We deserve more.
what age does menopause start?
The average age of menopause (twelve months without menstruation) for American women is fifty-one. Perimenopause represents the months to years that precede menopause characterized by shifting hormones, irregular menstruation, and varying symptoms and occurs between the ages of mid-thirties to fifty and typically lasts anywhere from one to ten + years. To get a sense of when you might experience menopause or perimenopause, it can be helpful to ask the women in your family about their own transitions, as genetics often play a role in the timing of these changes.
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HELLO surgical MENOPAUSE, here I come.
“I think every year brings unknowns that you have to deal with and handle, confront and embrace.”
~ Björk
At 47, I (Theresa) have been experiencing perimenopause symptoms for many years. Symptoms like irregular cycles, broken sleep, hair shedding, a more erratic nervous system, and an increase in ovarian cysts and cyst rupturing. As a result of a BRCA2 gene mutation, family history with cancer, and my personal health profile, I will be going in for a full hysterectomy (hysterectomy with bilateral salpingo-oophorectomy) next week. It has been a lot to process in the last month but it has also positioned me to prioritize my health and deep dive into what menopause support means for me.
confront: let’s talk about HYSTERECTOMIES
A hysterectomy is the second most common surgery for women and menstruators (second to cesarean sections). Making the decision to have one is complex and deeply personal. Questions like “Which type is right for me?” and “Are there alternatives?” are important to consider. In this post, we’ll cover the different types of hysterectomies, reasons for choosing one over another, recovery expectations, and possible alternatives to surgery.
What is a Hysterectomy?
A hysterectomy is a surgical procedure to remove the uterus, sometimes including the cervix, ovaries, and fallopian tubes. After this procedure, one will no longer have periods or the ability to become pregnant.
Hysterectomies have historically been overused for conditions that could have been managed with less invasive treatments with menstruators of color experiencing higher rates of unnecessary hysterectomies, driven by healthcare disparities, racial bias, and a lack of access to alternative, less invasive treatments. Because of its life-altering effects, it’s important to understand the different options, implications, and possible alternatives before making a decision.
Types of Hysterectomies
There are several types of hysterectomies, depending on the extent of tissue removal and the medical reasons for the surgery:
Total Hysterectomy
In this procedure, both the uterus and the cervix are removed.
Why choose this? It’s commonly performed to treat uterine fibroids, endometriosis, heavy bleeding, or certain types of cancer.
Subtotal (Partial) Hysterectomy
Only the uterus is removed, leaving the cervix in place.
Why choose this? It may be preferred by some women for reasons related to sexual health or if there is no medical reason to remove the cervix.
Radical Hysterectomy
This more extensive surgery involves the removal of the uterus, cervix, part of the vagina, and nearby tissues.
Why choose this? It’s typically performed to treat advanced gynecologic cancers, such as cervical cancer.
Hysterectomy with Bilateral Salpingo-Oophorectomy
In this procedure, the uterus, cervix, fallopian tubes, and ovaries are removed.
Why choose this? It is often recommended for women with high risk of ovarian cancer or if the ovaries are affected by severe endometriosis or cancer.
Laparoscopic or Robotic Hysterectomy
A minimally invasive option using small incisions and robotic assistance to remove the uterus.
Why choose this? This approach typically results in a quicker recovery, less pain, and smaller scars.
Reasons You Might Consider a Hysterectomy
The need for a hysterectomy can stem from various health conditions:
Fibroids: Non-cancerous tumors that can cause heavy bleeding, pain, or pressure.
Endometriosis: A painful condition where the uterine lining grows outside the uterus, often leading to infertility or chronic pain.
Uterine Prolapse: When the uterus drops into the vaginal canal due to weakened pelvic muscles, causing discomfort or urinary issues.
Chronic Pelvic Pain: Severe pain linked to conditions like fibroids or endometriosis that haven’t responded to other treatments.
Heavy or Irregular Bleeding: If other treatments haven’t worked, a hysterectomy may be an option to control bleeding.
Cancer-Related Hysterectomies
A hysterectomy is sometimes necessary to treat cancers of the reproductive system, such as uterine, cervical, or ovarian cancer. If cancer is the reason for surgery, a more comprehensive removal of reproductive organs may be required, such as a radical hysterectomy or a hysterectomy with bilateral salpingo-oophorectomy.
Preventive Surgery for High-Risk Individuals
For those with a family history of cancer, genetic testing can be a critical step in deciding whether to have a hysterectomy or other preventative surgeries. Genetic mutations, such as BRCA1 and BRCA2, significantly increase the risk of ovarian and breast cancers. In such cases, a hysterectomy combined with the removal of the ovaries and fallopian tubes (bilateral salpingo-oophorectomy) may be recommended as a preventive measure, even if cancer hasn’t been diagnosed.
Why consider genetic testing?
If you have a family history of ovarian, breast, or uterine cancer, genetic testing can help identify whether you carry gene mutations that increase your cancer risk.
Those who test positive for certain gene mutations, like BRCA1 or BRCA2, are often offered the option of preventative surgery to reduce cancer risk.
Preventive surgery is a major decision that requires careful consideration of your overall health, life goals, and discussions with genetic counselors and healthcare providers.
Recovery: What to Expect
Recovery from a hysterectomy depends on the type of surgery and your overall health:
Hospital Stay: For traditional open surgery, expect a hospital stay of 1-2 days. For laparoscopic or robotic surgery, it may be an outpatient procedure or require just one night in the hospital.
Physical Recovery: Full recovery takes 6-8 weeks for traditional abdominal hysterectomies and 3-4 weeks for minimally invasive procedures. During this time, it’s essential to avoid heavy lifting, strenuous activity, and sexual intercourse.
Emotional Recovery: A hysterectomy can bring emotional challenges, especially if it impacts fertility or induces early menopause. Hormonal changes may cause mood swings or depression, so it’s important to address these concerns with your healthcare provider.
Long-Term Considerations: If your ovaries are removed, menopause will begin immediately (unless you are already menopausal). This can affect bone density, sexual health, and overall well-being.
Alternatives to a Hysterectomy
In some cases, less invasive treatments may offer relief and preserve the uterus:
Medications: For conditions like fibroids or endometriosis, hormone therapies or medications to shrink fibroids may help manage symptoms without surgery.
Endometrial Ablation: A procedure that destroys the lining of the uterus to control heavy bleeding, without removing the uterus itself.
Uterine Fibroid Embolization (UFE): A minimally invasive procedure that cuts off the blood supply to fibroids, shrinking them without surgery.
Myomectomy: A surgical procedure to remove fibroids while leaving the uterus intact, preserving fertility.
Pelvic Floor Therapy: For uterine prolapse, non-surgical options like physical therapy or the use of a pessary can help support the uterus and relieve symptoms.
Acupuncture + Herbal Medicine: Depending on the severity of the symptoms and a patient’s long-term goals, acupuncture and herbs can be helpful in relieving pelvic pain, regulating menstrual cycles, and reducing heavy bleeding.
episodes from the PODCAST
We have featured women on two different episodes of the INTERWOVXN podcast who have shared their personal experiences with hysterectomies– Hear Genyne and Leah’s stories.
TASTE: 2 days in MADISON. We are part of a women’s business mastermind (She Shines) and this past week I (Rebecca) had the wonderful opportunity to attend the retreat. We visited four different female-owned food and beverage businesses who are all doing incredible things. We started off at The Lazy Squirrel in the adorable town of Paoli , had dinner at James Beard nominated Ahan, a charcuterie workshop and amazing spread at Tricky Foods, and then finished the trip with a chat, brunch, and kitchen tour at the James Beard nominated Pasture + Plenty. A perfect way to eat your way through Madison with a stop in a cute little town for the perfect weekend!
SEE: On our WATCH LIST. Ali Wong: Single Lady. After a whirlwind couple of years, Ali Wong returns to the stage to dish on the highs, lows and surprises of dating post-divorce. Nobody Wants This. An agnostic sex podcaster and a newly single rabbi fall in love, but can their relationship survive their wildly different lives and meddling families? (And my (Theresa) old reliables to zone out to during recover: The Office, Parks and Recreation, and Brooklyn 99).
SMELL: How to use LAVENDER to calm Anxiety. Lavender has been shown to affect the parasympathetic nervous system. The parasympathetic nervous system controls bodily processes associated with anxiety, such as heart rate, breathing rhythm, and hormone secretion. Lavender can help in regulating these bodily processes by restoring a neutral state. Check out this article for What To Do With Lavender: 20 Fun Recipes + Ideas.
HEAR: Bach for Stress Relief. I (Theresa) recently heard that a few minutes of Bach (or classical music) in the morning unlocks parts of our brain and reduces stress. My mom also arrived to stay with us this week and listening to the sounds of my daughter, husband, and mom caring for each other brings me happiness. (Oh, and here are 5 non-classical, but Anticipated Albums of the Fall you might be interested in).
TOUCH: Cold weather Chinese medicine hack. Are you someone who gets cold right before bed, wears too many clothes to bed and then wake hot? Or are your feet just always freezing? Do you experience period cramps that feel better with heat? Well, give this a try! From a Chinese medicine perspective, warming the feet can improve energy and create a cozy uterus which is why we encourage patients to wear socks and slippers. I (Rebecca) have found it to be the perfect way to balance my temperature fluctuations when sleeping! Instead of overdressing/layering, I use a hot water bottle at my feet every night (or you could do hot foot soaks while relaxing before bed). It is amazing how it warms my whole body, soothes my aching feet, and I don’t wake overheated. * Don’t use boiling water, be sure to test the temperature and that the cap is on tight to ensure you don’t burn yourself.
What is appealing to your senses right now? What are you reading? watching? cooking? wearing? loving? obsessed with? We would love to share some of your picks in future newsletters!
handle: building RESILIENCE in difficulty
Why do some people seem to be better able to cope in these troubling times than others? While everyone’s situation is different, it is true that people with resilience tend to have a higher tolerance for the emotional distress generated by hard times. The more resilient you are, the better you’re able to tolerate the feelings of stress, anxiety, and sadness that accompany trauma and adversity—and find a way to rebound from setbacks. The tips from HelpGuide.org can help you face hardships with more confidence, better cope with these tumultuous times, and make it through to the brighter, more hopeful days ahead.
embrace: let’s send theresa some LOVE
“Every time women gather together in circles, the world heals a little more.”
If you would like to offer some words of support for her recovery or share your own story, we would love to hear from you and are grateful that you are here.
And we leave you with…
perhaps another film screening in our future;)
The (M) Factor premieres on PBS next Thursday!
Have a great weekend!
Theresa, you have seen so many of us through tough transitions. Please ask for lots of help to the point of being SPOILED during this recovery. Where's the meal train signup? I'm in!!!
Wishing you such smooth healing and liberation from ailments. Next chapter here we come.
Xx,
Kate
Sending positive healing energy your way Theresa! Thank you for sharing your story so openly with us. Take care of yourself!