Loss of interest in sex after hysterectomy may be due to reduced levels of sex hormones. This may, for example, result in less lubrication of the vagina making intercourse more painful for you. Loss of libido may also be due to feelings of depression caused by anxiety at losing the uterus and exhaustion due to the combined stresses of the condition for which you had the hysterectomy, the operation itself and the associated anaesthetic. Coincidental factors, such as relationship problems with a partner, reduced self-esteem or sexual difficulties that are unrelated to hormone levels, may be another source of difficulty. For instance, you and your partner may have drifted into a pattern of having sex which does not please you and which you are now rejecting, or your partner may have a medical condition which is making the achievement of erection more difficult for him. A general practitioner, endocrinologist, gynaecologist, psychiatrist or sex therapist may be able to help. Your doctor should be able to sort out who is best situated to provide this help, even if he or she cannot diagnose the cause of your problem.

Will I still menstruate after a hysterectomy?

No, menstruation will no longer occur. Whatever sort of hysterectomy you have will necessarily result in removal of the uterus complete with its inner lining, the endometrium, which is responsible for menstruation.

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This is the most important step because good nutrition is the foundation on which your health is built and the key to increasing your chances of conceiving. Look at what you are eating and drinking, buy organic food where possible, eat a good variety of food (including fish, nuts, seeds, fresh fruit and vegetables), and read labels to reduce or eliminate the amount of chemicals, additives and preservatives going into your body. It’s also important to get your weight back into the normal range, if you are underweight or overweight.

Carry on eating well over the four months and until you become pregnant, and through the pregnancy itself.

Checking and Correcting Your Nutritional Status

Where possible, at the very beginning of the Four-Month Plan, you should go to a nutritional therapist. Preferably choose one with experience in fertility and have a full assessment of your vitamin and mineral deficiencies. You will also be checked to see whether you have high levels of heavy toxic metals, such as lead, mercury and cadmium. You will then be given a programme of food supplements for four months to correct any deficiencies and to lower any toxic metals. At the end of the four months the assessment should be repeated, to make sure that the nutrients have been absorbed and the levels are back to normal. Once back to normal, you will be given a maintenance programme to stay on until you conceive.

If you are worried about the cost, bear in mind that IVF treatment is expensive. The investment in seeing a nutritional therapist, together with taking a programme of food supplements, therefore is minimal in comparison and may mean you avoid the IVF altogether. If you still need IVF treatment, the investment is still worthwhile because it increases the chance of it working.

For those who can’t get to see a nutritional therapist, I have devised a proposed supplement programme. Normally the programme would be personalized for you and your partner and would depend on what deficiencies you each had, but here you are both taking almost the same supplements.

Supplement Programme

Take:

• a multivitamin and mineral designed for pregnancy

• zinc citrate or amino acid chelate (total of 30mg of zinc a day, including what is in the multivitamin and mineral)

• l000 mg linseed (or flax oil) a day

• l000 mg vitamin Ñ a day

If your partner has a low sperm count or motility he needs to add 1,000mg of L-arginine a day to this programme for sperm health and 300-400ius a day of vitamin E to help fertilisation.

There are two supplements called Fertility Plus for Women and Fertility Plus for Men.

Fertility Plus for Women contains those nutrients known to help with fertility and you would only need to add the linseed oil and vitamin C. It is designed to provide the nutrients needed leading up to and during pregnancy. It contains the required amount of folic acid (400mcg a day) so you don’t need to take a separate folic acid supplement. It also includes a safe amount of vitamin A that you can take during pregnancy.

Fertility Plus for Men contains those nutrients which are helpful for men trying to conceive, including L-arginine, L-carnitine and also vitamin E.

If you are following this Four-Month Plan without being nutritionally tested then stay on the above supplement programme not just for the four months but until you conceive.

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? Big works best! Scarves should be at least forty inches square. In spite of what you may be told, there is no such thing as too big.

? Rayon is the fabric of choice. It clings to itself, drapes nicely, can be washed. Cotton is a good second option.

? Silk scarves are lovely second layers but slip right off bald heads!

? Fringed scarves can be used very successfully, and the movement of the fringe is reminiscent of hair.

? Look in fabric stores for material to use as scarves; you may find greater choice and many more bargains than in department stores. Buying fabric is cheaper than buying scarves. Don’t bother to hem the pieces; simply tuck the edges in.

? A soft cotton baby diaper can be worn under a scarf to increase the height and achieve a different look.

? Check out the scarf selection, too, at stores selling clothing from India or other import shops.

? Remember the possibilities of layering. Use a solid-color rayon scarf as the first layer, then top it with a print silk or cotton scarf twisted into a rope and wound around your head. Or top the bottom layer with an attractive, colorful man’s tie, a fabric belt, ribbons, or a hat over a scarf.

? Try putting pretty pins on your scarf or turban.

? Cotton bandannas can be sewn together to make informal, inexpensive (and big enough) colorful scarves.

? This is the moment to experiment with big earrings and maybe a bit more lip color and makeup than usual.

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You can bring a Walkman and listen to music. You can bring a companion to talk with. If you are still experiencing discomfort from your surgery when you raise your arm up above your head, take two Tylenol before you leave for the hospital. Marks (tattoos) will be put on your chest to guide the radiation. They are very small, but permanent. Rather

than what you imagine when you think “tattoo,” these will be tiny pinprick-sized marks that are usually indistinguishable from freckles. You will feel the tattoo pinpricks, but the process is not painful.

It is theoretically possible to have these marks removed later by laser. Most radiation oncologists prefer that you not do this. If you should ever again require radiation therapy to this area, it would be extremely important to be able to exactly identify the area previously treated. The same place in your body usually can not be safely irradiated more than once (i.e., one series of treatments).

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Surgical Choices (Local Treatment)

You have already had a biopsy. The primary treatment for breast cancer is almost always surgery, and you may have choices:

*Breast conservation or lumpectomy, in which only the tumor and surrounding tissue are removed

*Mastectomy with or without reconstruction.

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Single women may also worry about how they will continue in, or how they can rejoin, the social world with the physical changes and emotional issues which breast cancer brings. It has been our experience that women who have had breast cancer, whether they have two breasts or not, will have the same success with men that they have always had. We have even been told by a few women that “men find me interesting . . . I’m a little different from most of the women out there.” Any man who is worth having will appreciate and love you whatever your breasts look like. As someone said, “We all have scars in life; ours are just more visible than some others.”

This is not intended to minimize what you might be going through right now. It is hard enough to deal with the dating world when you are feeling at the top of your game. When you are feeling vulnerable and scared and less than attractive, it may feel overwhelming. We wish that we could reassure you that your social scene will not be different after breast cancer than it was before; but of course, we cannot guarantee this. However, you might be pleasantly surprised to find it may actually improve.

This story may help. Jennifer was a never-married woman in her mid-forties at the time of her diagnosis. She had a mastectomy and chemotherapy; two years later, she had a recurrence in a regional lymph node. She had just joined a dating service and found herself on the phone with a match the evening before she was to begin radiation treatment to her neck. It turned out that the man with whom she had been matched was a physician who worked in the emergency room of the hospital where she was to receive radiation. He suggested that they meet at the hospital after her first treatment. Now, several years later, she is well, and they are married.

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This period is the very hardest time emotionally. You will feel better after all the medical information has been gathered, after you have met with all of your doctors, and after the treatment decisions have been made. If you are managing to get through your day now, you are doing fine, and you can count on feeling stronger, saner, and less out of control in the future.

Do take someone with you to all of your consultations. You will not remember most of what is said to you, and your companion’s ears and memory will be extremely valuable. Prepare ahead! Take written questions with you and have your companion take notes during the consultation. Some doctors are glad to have you tape your meeting; some object to this practice.

In our system of health care, some decisions will likely be made for you based on your medical insurance. Most policies, especially most managed care plans, limit the number of doctors you can see. They may also limit their coverage to doctors who are on their list of approved specialists. If there is a specialist in your area whom you especially want to consult and who is not covered under your plan, it is worth a call to ask if a special referral/exception may be made for a second opinion visit. If the answer is no, it might still be worth it to you to pay out of pocket for a single visit. If you decide to do so, inquire at the physician’s office whether there are ways to minimize the bill. For example, you can avoid having any blood work or other laboratory tests done there; if those results are part of the consultation, they can always be sent to the specialist from your usual health care provider at a later date.

After talking with your doctors, you may decide that you want to get a second opinion. Most insurance companies will pay for this. Occasionally it even makes sense to seek a third opinion; this situation would most likely arise if each of two physicians recommends a different course of treatment and you wish to find a “tiebreaker.” In any case, you should prepare yourself both mentally and emotionally to become actively involved in the process of choosing your treatment.

Cancer care is delivered in several different kinds of settings, and you may feel more comfortable in one than in the others. With the exception of certain clinical trials, which are available only at participating cancer programs, you can receive the same treatment at each place, and your decision may be based on other factors.

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Adenomyosis may also be present without symptoms, but if it does cause problems it can be treated. Unfortunately, the drug treatments do not work as well for adenomyosis as for endometriosis. Often removal of the uterus (hysterectomy), with or without removal of the ovaries (oophorectomy), is the effective treatment. If a woman is approaching menopause she may choose not to have surgery, because the cessation of her periods should bring relief from the majority of her symptoms.

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