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Supracervical Hysterectomy
I decided to write this blog because I have had several people who were confused as to how I could still have light bleeding after my my hysterectomy. The reason is because I had a supracervical hysterectomy. Let me explain.
There are many different types of hysterectomies. Below are some examples:
- Total abdominal hysterectomy – the uterus and cervix are removed. Fallopian tubes and ovaries may or may not be removed depending on the individual case.
- Radical hysterectomy – this type is more extensive than the total because it also removes the upper part of the vagina. It is usually done if cancer is present.
- Oophorectomy – removal of the ovaries. It is usually done if there is a history of cancer or if cancer is present.
- Salpingo-oophorectomy – removal of the ovaries and the fallopian tubes. It is usually done if there is a history of cancer or if cancer is present.
- Supracervical hysterectomy – the uterus is removed, but the cervix, ovaries, and tubes remain.
So if someone has told you that she has had a hysterectomy, it is important to know what kind of hysterectomy it is if you plan on having an in-depth discussion about it. I don’t think I made that clear in my book, so I am sorry about that!
So let’s get into the details of a supracervical hysterectomy. This is the way it was explained to me:
There is no definitive “line” between the uterus and the cervix. The two tissues kind of intermingle with each other at the top of the cervix/bottom of the uterus where they meet – the cervical tissue and the uterine tissue are not clearly separate. So, when doing this kind of surgery, there is really no way to tell if all of the uterine tissue has been removed or if some of that tissue still remains at the top of the cervix which will remain. If uterine tissue is left at the top of the cervix, that tissue will continue to respond to hormonal stimulation from the ovaries since the ovaries still remain. This means that the uterine tissue left behind will continue to bleed.
Now, since the majority of the uterine tissue is gone, the bleeding is greatly reduced. In my case, I went from flooding for 3 days and regular bleeding for a total of 10 to 14 days before my supracervical hysterectomy to just spotting for about 3 days after the surgery. There is a HUGE reduction in the amount of blood lost after this kind of surgery.
Personally, if I had to do it over again, I would have told my surgeon to take my cervix because the spotting became annoying to me. The spotting wasn’t bad at all…it was just annoying. Little things like that annoy the crap out of me, so it got on my nerves quick…lol! But some women prefer to keep the cervix intact, and if that is what you want to do in your case, please know that the light bleeding/spotting after a supracervical hysterectomy is minimal. If you are used to flooding, this small amount of light bleeding should be a cake walk for you 🙂
Hope that helps to clear things up a bit!
Have a great day!
Brand New Book on Adenomyosis!!
New for 2020!!
Now available on Amazon:
Adenomyosis: The Women Speak
by Maria Yeager
This book contains the results of questionnaires that were posted in the Adenomyosis Fighters Support Group on Facebook over the course of 1 1/2 years. Hear what adenomyosis is really like from the women who are forced to deal with it on a daily basis!! Paperback and Kindle versions available.
During My Adenomyosis Struggle, My Non-Fat Diet Almost Killed Me!
Barry Sears said it best in his book, The Omega Rx Zone:
“Fat has become a foul three-letter word in our society. We’ve become a nation of fat phobics, and some of us try to avoid this nutrient at all costs in an effort to lose weight and improve our health. Yet this war on fat has been completely misguided.”¹
During the time that I dealt with adenomyosis, the non-fat diet fad was quite popular. In my attempt to eat healthy, my ex-husband and I tried to buy as much non-fat food as we could, thinking at the time that this was the right thing to do. Boy, were we ever wrong!! My struggle with adenomyosis was at its worst during the time that I was on this non-fat diet – excruciating abdominal pain, very heavy menstrual bleeding with clots, severe bloating – it was just horrible.
After putting up with these monthly symptoms for several years, I read an article about the health benefits of flaxseed. I learned that this food contained high levels of omega-3 fatty acids and was found to be helpful in a slew of medical issues. I was intrigued. After years of different birth control pills, antispasmodics, and pain killers, I was ready to try just about anything.
I began to sprinkle ground flaxseed on just about anything I ate – yogurt, spaghetti sauce, salad…even a peanut butter and jelly sandwich. The taste was rather earthy if eaten on its own, but when added to these dishes, I couldn’t really taste it at all.
Several months went by, and I began to notice a significant decrease in my pain level and heavy bleeding. I still had problems, but it was definitely better than where I had been before I added flaxseed to my diet. This led to more research on omega-3s, and I quickly realized that a non-fat diet was, in fact, not healthy. I learned that some fat is necessary for optimum health. At the same time, I learned how the Western diet is overloaded with omega-6 fatty acids while deficient in omega-3s. Let me explain further.
Fat is needed for both immediate and reserve energy as it supplies two times as many calories per molecule as compared to carbohydrates or protein. It is needed for the formation of hormones, cell walls, enzymes and brain tissue. Fats are also needed for the proper absorption of many vitamins and minerals and for the proper functioning of nerve synapses.
Fats can be divided into two groups: saturated and unsaturated. Saturated fats are solid at room temperature and are known to increase cholesterol. Examples are lard and butter. Unsaturated fats can be further subdivided into monounsaturated and polyunsaturated fats. Monounsaturated fats are liquid at room temperature but cloudy when refrigerated. Examples include olive, peanut and canola oil. Polyunsaturated fats are liquid at both room temperature and in the refrigerator. Examples are fish, corn, soybean and sunflower oils.
Fats can also be found in their natural and unnatural forms. In their natural forms, the hydrogens of the fatty acid are on the same side of the carbon chain. Since these hydrogens naturally repel each other, the carbon chain will bend away from the hydrogen side. These kinks help the cell to be more fluid and flexible which allows a healthy exchange of nutrients in and out of the cell. Trans fats, widely regarded as very unhealthy today, are the unnatural forms of fats. These fats are made through a process called hydrogenation, and this process is known to destroy omega-3 fatty acids. The hydrogen atoms in trans fats are on opposite sides of the carbon chain, so no bending of the chain takes place, and they jam the “plug” for the natural fats. Examples of trans fats include partially hydrogenated vegetable oil, solid shortenings, hydrogenated lard, and solid margarine.
A specific group of unsaturated fats, called the essential fatty acids, are particularly important in overall health. These fats are called “essential” because they must be included in the diet as they cannot be made by the human body. Three classes of essential fatty acids exist: omega-3, omega-6 and omega-9. The omega-3s include alpha linolenic acid (LNA), eicosapentenoic acid (EPA), and docosahexanoic acid (DHA). The omega-6s include linoleic acid (LA), arachidonic acid (AA), and gamma linoleic acid (GLA). An example of an omega-9 fatty acid is oleic acid. It is a monounsaturated fat and can be found in olive oil, avocados, and nuts.
The omega-3 fatty acids help to keep cell membranes fluid and flexible which allows for effective exchange of nutrients in and out of the cell. These fatty acids in general produce good eicosanoids, a type of hormone. Good eicosanoids prevent blood clots, dilate blood vessels, reduce pain, enhance the immune system, and improve brain function. Since these fats are polyunsaturated, they tend to oxidize and turn rancid easily. To overcome this problem, the food industry came up with the process of hydrogenation as discussed earlier. Hydrogenation makes the fats more stable, but it also destroys the effectiveness of omega-3s. As a result, the Western diet is now dangerously deficient in these important fatty acids.
The omega-6 fatty acids are the most common polyunsaturated fat found in food. In general, they lead to the production of bad eicosanoids. These eicosanoids promote blood clots, constrict blood vessels, promote pain, and decrease immune and brain functions. Although this seems like a bad thing, it is necessary to have these fatty acids present for optimum health.
Both omega-3s and omega-6s need to be present in the human body in the right ratio. The National Institute of Health recommends the following daily intake of essential fatty acids:
EPA/DHA – 650 mg.
LNA – 2.22 g
LA – 4.44 g
With today’s Western diet that is predominant in processed food, our intake of omega-6 fatty acids is too high whereas our intake of omega-3 fatty acids is lacking. I found that when I added flaxseed (high in omega-3s) to my diet, my symptoms of adenomyosis reduced significantly. This makes sense as these fatty acids make the good eicosanoids which reduce inflammation. To reduce adenomyosis symptoms, I recommend getting the balance of omega-3 to omega-6 fatty acids back into a healthy range. Reduce your intake of processed foods and eat more natural and organic fruits and vegetables. In addition, get a good omega-3 supplement such as flaxseed or fish oil. You might be surprised at the results!
For more information, please check out my book, Adenomyosis: A Significantly Neglected and Misunderstood Uterine Disorder.
¹Barry Sears, The Omega Rx Zone: The Miracle of the New High-Dose Fish Oil (New York: Harper Collins Publishers, Inc, 2002) 20.
Top Ten Research Priorities for Endometriosis in the UK and Ireland
Interesting post from Endo the World? blog. Glad to see these workshops!
A few weeks ago I had the privilege of taking part in the James Lind Alliance priority setting workshop for endometriosis, which took place in London. The aim was to bring together a mix of healthcare professionals, patients, family members, and carers to decide on the top ten questions to be prioritized in future endometriosis […]
via Research priority setting for endometriosis- the top ten questions announced! — The Endo The World?
Adenomyosis and Estrogen Dominance – Is There a Link?
Today I would like to delve into the links between estrogen dominance and adenomyosis. I have written previous posts on the subject, but in the past couple of days, I have seen things posted on a site regarding this subject that are misleading. I find this tremendously concerning because it is imperative that the correct information be available to all women who suffer from adenomyosis. Misleading or inaccurate information can do tremendous damage to the cause of education of the disorder.
The following is a portion of a discussion that I had with a member of the group (names excluded):
1.”*** posted a comment in a response to a post that estrogen dominance caused the adenomyosis. I stated it was not; could bring out symptoms for sure, no disagreement there.”
2. “I have yet to see any information which would indicate that estrogen dominance causes the endometrium to invade the myometrium. If it exists, I am open to reading it.”
3. “But linking an Amazon page doesn’t actually benefit the conversation that was taking place…” (this was the Amazon link to my book which discusses estrogen dominance in women with adenomyosis at length).
4. “Our admin, *** explained that the apparent disagreement was really a case of semantics: what causes adeno to occur vs. what makes adeno symptoms present themselves.
5. A different person told me that estrogen dominance and it’s role in adenomyosis was “controversial”.
I am going to address these statements one by one.
- Is estrogen dominance the cause of adenomyosis?The short answer is that we don’t know. The statement that it was not the cause is false. It very well may be the cause, but enough research hasn’t been done yet to actually prove it. However, many studies have been done that point to the role of estrogen dominance in reproductive disorders and endometriosis, and many studies have been done on xenoestrogens and how they adversely impact the reproductive system. Margaret Schlumpf et al. found that the xenoestrogen 4-MBC applied to rat skin doubled the rate of growth in uterine tissue before puberty. Tyrone Hayes from the University of California at Berkeley found that with increasing exposure to atrazine (a xenoestrogen), some frogs began to show both male and female sex organs. Toxicologist Michael Fry found female cells in the reproductive tracts in male gulls after they were injected with DDT, DDE and methoxychlor (all xenoestrogens). These are just some examples. But the most relevant and damning study was done by Upson et al. in 2013. β-HCH, a xenoestrogen, was studied, and the women in the study with the highest levels of β-HCH in their blood serum were 30 to 70 percent more likely to have endometriosis than the women with the lowest levels of this chemical in their blood. This evidence should lead you to the logical conclusion that these dangerous chemicals may in some way be involved in adenomyosis. Also, please remember that very little is known about adenomyosis. If we only accept what is scientifically proven about adenomyosis, we pretty much wouldn’t have anything to help with the symptoms right now. In order to help women who are suffering now, it is advisable to come to some logical conclusion based on the very limited information that we do have. As far as the statement “could bring out symptoms for sure” while stating the estrogen dominance is not the cause, I would just like to see some studies that show that viewpoint (there are none).
- This issue is addressed in #1. I did send her a list of several studies and urged her to research this topic on PubMed through the NIH. I didn’t receive a response of any kind.
- If the topic was on estrogen dominance, the link to my book is quite relevant to the topic as I have written a chapter on it which includes research of actual scientific studies.
- “What causes adeno to occur vs. what makes adeno symptoms present themselves” – this really makes no sense. Adenomyosis is a collection of symptoms. If the symptoms are there, then adeno is occurring. Maybe she meant what causes adeno to occur vs. EXACERBATION of the symptoms?? That would make some sense. But as you can see, her wording is quite ambiguous and confusing.
Here is what we know for sure through scientific studies:
- Both adenomyosis and endometriosis are both estrogen-dependent disorders. This is a known fact. These two disorders cannot progress unless estrogen is present.
- Xenoestrogens are dangerous man-made chemicals that are known to be endocrine disruptors. What does that mean? Basically, it means that these chemicals mess with your hormones. The following chemicals are just a few of the known endocrine disruptors: 4-MBC (banned in the U.S. and Japan), alkyl phenols (restricted in Europe), atrazine, BPA (debates persist on safety – banned from use in baby bottles in Canada and Europe), BHA, DDT (banned), dieldrin (banned), endosulfan (use currently being discontinued), hepatachlor (restricted in the U.S.), methoxychlor (banned), parabens, PBBs, PCBs, and phthalates (restricted use in children’s toys in the U.S. and Europe). As you can see, the regulatory authorities are very much aware of the dangers of these chemicals as many of them are restricted or banned. It is important to look at these chemicals as many of them do not break down easily and are still prevalent in the environment even though their use has been restricted/banned. So, the point is that the estrogen-like activity is well-known and very well-documented. We know these chemicals to be very dangerous and have estrogen-like activity in the human body.
- Estrogen dominance does appear to occur in a lot of women with adenomyosis and endometriosis. Estrogen dominance DOES NOT mean that you just have a high estrogen level. I have seen quite a few women say that they are not estrogen dominant when talking about adenomyosis, and they seem to immediately come to the conclusion that since they are not estrogen dominant, it can’t be the cause of adenomyosis. Two things here: First of all, to be truly estrogen dominant, you must have a special test run – not one that is readily available at your OB/Gyn office. A ratio of Pg/E2 must be calculated (progesterone to estrogen ratio). It is possible to have estrogen and progesterone levels that fall into the normal range but have an abnormal Pg/E2 ratio. My levels were a perfect example of this. I always had normal estrogen levels and normal progesterone levels each time my OB/Gyn tested them. When I finally sent out my saliva to have the ratio calculated, it came back abnormal and indicated estrogen dominance. My estradiol was 2.3 (normal is 1.3-3.3), my progesterone was 154 (normal is 75-270). My Pg/E2 ratio was 67 (normal is 100-500). As you can see, the ratio was abnormal. Anything under 100 indicates estrogen dominance. The second thing – please remember that medicine is not black and white. When these studies show links such as estrogen dominance with adenomyosis, that does not mean that all women will be estrogen dominant. It only means that there is a significant link between the two. Think of it this way – there is a very clear link between smoking and lung cancer. Does that mean that every single person who smokes will get definitely get lung cancer? Of course not! There are many other factors at play with genetics being one of the big ones. Also this disorder could very well be multifactorial. There are many gray areas in medicine – it is not black and white.
In conclusion, it is imperative that correct information is given to the women who suffer from this disorder. I urge everyone to do their own research and read up on the actual studies. If someone makes a claim but can’t back it up, question it!! In particular, I do not like the term “controversial” when discussing estrogen dominance and adenomyosis. As you can see from the above information, the role of xenoestrogens and their effect on the reproductive system is well-documented and known. It is not controversial. Presently, physicians are prescribing progesterone for women with adenomyosis and other disorders such as fibroids because they are increasingly becoming aware that estrogen dominance is playing a role in these disorders. “Controversial” is very misleading and highly inaccurate.
Bulayeva and Watson stated their concerns over xenoestrogens in a study done n 2004. “These very low effective doses for xenoestrogens demonstrate that many environmental contamination levels previously thought to be subtoxic may very well exert significant signal- and endocrine-disruptive effects, discernible only when the appropriate mechanism is assayed.”
Bulayeva and Watson (2004). Xenoestrogen-induced ERK-1 and ERK-2 activation via multiple membrane-initiated signaling pathways. Environmental Health Perspectives, 112(15), 1481-87. Retrieved from http://www.bvsde.paho.org/bvsacd/ehp/v112-15/p1481.pdf
Fry, M. (1995). Reproductive effects in birds exposed to pesticides and industrial chemicals. Environmental Health Perspectives, 103 (Suppl 7), 165-171. Retrieved from http://www.ncbi.nlm.nih.gov/PMC/articles/PMC1518881/pdf/envhper00367-0160.pdf
Hayes, T. et al. (2003). Atrazine-induced hermaphoroditism at 0.1 ppb in American leopard frogs (Ranna pipiens): Laboratory and field evidence. Environmental Health Perspecives, 111(4), 568-575. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/ PMC1241446
Schlumpf et al. (2008). Developmental toxicity of UV filters and environmental exposure: A review. International Journal of Andrology, 31(2), 144-51. doi: 10.1111/j.1365-2605.2007.00856.x
Upson et al. (2013). Organochlorine pesticides and risk of endometriosis: Finding from a population-based case-control study. Environmental Health Perspectives, 121, 11-12. doi: 10.1289/ehp1306648
Endometriosis in Men?
Yes, you read that right! There are a few rare cases of endometriosis that have been found in men. I read an article the other day that addressed this issue, and I was shocked! Before I wrote this blog, however, I wanted to verify that this is actually true. Well, it is. It’s rare, but it has happened.
A study published in 1985 by Martin and Hauck¹ looked at an 83-year-old man who had an endometrioma on his lower abdominal wall. The researchers reference several other cases that have been reported in the literature. The theory for the development of endometriosis-like tissue in the male at that time was that it developed from remnants of the prostatic utricle, or remnants of the uterus. They discuss how female remnants may be present as some men may be genetically mosaic – that is, they may have some female cells (46,XX) along with the normal male cells (46,XY). However, they point out that in this case, the 83-year-old man had only 46,XY cells (a normal male karyotype). The researchers go on to say that this man was thought to have prostate cancer but was later found to have adenocarcinoma. He had been placed on 25 mg. TACE which he took for ten years. It is extremely interesting to note that TACE, also known as chlorotrianisene, is a type of estrogen. It has since been discontinued from use.
A more recent study done in 2014 by Jabr and Venk² addresses a case of abdominal pain in a 52-year-old man with a history of cirrhosis and hepatitis C. He had two previous surgeries for an inguinal hernia within a two-year period. He presented to the emergency room with excruciating pain in his right lower abdomen and pelvis. A mass was found attached to the urinary bladder, and it extended into the inguinal canal. The mass was removed and tested, and it was found to be positive for both estrogen and progesterone receptors. The findings were consistent with endometriosis. The researchers note that cirrhosis is known to be associated with high estradiol levels.
Jabr and Venk go on to discuss several other previous studies. Endometrial-like tissue was discovered in two men with prostate cancer, both of which had been treated with estrogen for several years. The researchers also point out that another man was diagnosed with endometriosis after inguinal hernia surgery. They hypothesize that inguinal surgery coupled with high estrogen levels may increase the risk of development of endometriosis in the male. They also state induction appears to be a likely pathway for the development of endometriosis. Induction is the formation of endometriotic-like tissue as the result of unknown factors, endogenous or exogenous, inducing change in undifferentiated mesenchymal or embryonic cells.
Most people think of endometriosis as a disorder that affects women only; however, it has been seen in men. It is important to note this as it may give us much-needed information as to what factors play a role in the development of this disorder. According to these few studies, it appears that estrogen (estradiol) may play a pivotal role in the development of endometriosis and adenomyosis. I hope that more studies in men are forthcoming.
¹Martin, JD Jr., and Hauck, H.E. (1985). Endometriosis in the male. Am Surg, 51(7):426-30. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/4014886
²Jabr, F.I., and Mani, V. (2014). An unusual case of abdominal pain in a male patient: Endometriosis. Avicenna Journal of Medicine, 4(4):99-101. doi:10.4103/2231-0770.140660
Endometriosis in the psoas major muscle
A very interesting article on endometriosis that was found in the psoas muscle. Just another case that shows endometriosis can be found in just about any area of the body. Recommended reading….thanks to Lisa at Bloomin Uterus!!
An article was published on October 30, 2016 in the International Journal of Clinical and Experimental Medicine, which caught my interest. We know that Endometriosis can grow in a lot of places ot…