On rare occasions, the bowel may be paralysed for several days after surgery. Eating will stretch the paralysed bowel and cause further delays in recovery of bowel function. So an intravenous drip is needed to supply nutritional needs in the meantime. Another rare occurrence is bowel blockage caused by the formation of adhesions during the operation. The blockage may resolve if the bowel is rested, but if not, further surgery is required. Although this is an unusual and unpleasant complication, the outcome is generally quite satisfactory.

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If you are trying to conceive it is imperative that you start to ovulate. One of the most common drugs used to trigger ovulation is clomiphene citrate. Clomiphene is an anti-oestrogen that tricks the brain into thinking that there is no oestrogen in the blood. Because the oestrogen is blocked, the pituitary gland gets the message to increase the supply of follicle stimulating hormone (FSH).The FSH reaches the ovaries and egg production is stimulated. If the clomiphene is suddenly stopped, the brain recognizes that there is a massive amount of oestrogen and this results in an LH surge that releases the egg from the ovary.

Clomiphene is an effective drug for artificially inducing ovulation but, ironically, it may also increase the chances of a miscarriage by somewhere in the region of 20-30 per cent. It is thought that the clomiphene interferes with the womb lining, preventing the fertilised egg from implanting. Other treatments used to induce ovulation, like gonadotrophin treatment, can also increase the miscarriage rate.

Natural Treatment

Losing weight has been shown to be very effective in treating PCOS and restoring fertility. One study showed that overweight women with PCOS had more fertility problems than lean women with PCOS. However, even though the link between PCOS and excess weight (and between losing weight and reduced symptoms) is well-established, the reasons for it are unclear.

Nevertheless, overweight women seem to have much lower levels of sex hormone binding globulin (SHBG) in their blood which resulted in more testosterone and worse PCOS symptoms, such as an excess of hair.

When these women went on a diet and lost weight their SHBG levels rose, their testosterone levels fell and their PCOS symptoms diminished.

Along with the weight loss, came a remarkable change in ovarian function: 82 per cent of the women who were not previously ovulating showed improvements, with a number of successful pregnancies occurring during the study, even though these women had a long-standing history of infertility.

One reason may be that weight loss lowers insulin levels, which reduces the ovaries’ production of testosterone. No one really knows why PCOS responds to weight loss but it must be linked with the fact that overweight women (without PCOS) can dramatically increase their fertility by losing weight.

One study found that 11 out of 12 women who had been overweight and not ovulating conceived naturally after reducing weight.

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Heat

You will probably have already discovered that heat brings some relief to menstrual pain. The faithful hot water bottle placed on the affected area can diminish your menstrual pain significantly. Other forms of heat relief include electric blankets or heating pads, a hot shower, bath, spa or sauna. The heat works directly on the nerves that transmit the pain and it also relaxes tense muscles.

Transcutaneous electrical nerve stimulation (TENS) therapy

Transcutaneous electrical nerve stimulation, commonly known as TENS, is a treatment developed when it was observed that pain symptoms eased when electricity was applied to the skin at the site of pain.

A TENS unit is a small battery-operated machine (about 10 centimeters by 8 centimetres) that is usually clipped to a belt or placed in a pocket. Two small electrodes that are stuck on to the skin with paste at the site of the pain run from this battery. The small electrical impulses emitted from the battery are transmitted through the electrodes and stimulate the nerves which, in turn, control the pain symptoms. The intensity and rate of the impulses can be regulated by a dial located on the machine.

It is thought that TENS may work in two ways. Firstly, the electrical currents may stimulate the nerves to prevent the pain messages from the area reaching the brain. Secondly, it may increase the production of endorphins – pain-killing chemicals produced by the body.

During the treatment women have said that they experience a tingling or pulsating sensation under the electrodes.

There is no evidence that TENS is addictive and during the day it can be used continuously or intermittently.

It appears that the effect of the TENS may be such that after a time you will be able to decrease the amount of time that you need to use it.

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Women who have had hysterectomies, even when their ovaries are left, often have an earlier menopause, thought perhaps to be due to the disturbance of blood supply to the ovaries, and their consequent atrophy or shrinkage. Menopause, of course, occurs immediately if ovaries are removed surgically, or irradiated for any reason, because ovarian hormone production suddenly stops.

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Does oestrogen cause weight increase?

While oestrogen tends to hold on to the extra kilos say one or two, you cannot blame it for general obesity and overeating. The weight increase associated with oestrogen may be due to retention of fluid, which can be overcome to some extent by reducing the salt intake in your food, which is good for other symptoms in your body as well.

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When can you ignore contraception? After fifty pregnancy is rare, even if you are still having periods. In the United States only one in 24 000 live births are from mothers over the age of fifty.6 In the United Kingdom, there are even fewer.7 A woman over fifty is as likely to become pregnant as she is to be struck down by lightning. Statistically, therefore, contraception at this age is unnecessary.

Could the pill be continued instead of hormone replacement therapy?

The doses are much higher than are necessary to control postmenopausal symptoms, and with increased knowledge of side effects with doses of the present oral contraceptive pills, it is unwise to use this for replacement therapy.

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This was used commonly in the past, but it is rarely used today. The commonest form is three weeks on tablets, one week off. It was thought that the week’s rest prevented build-up in the lining of the uterus, but it has now been found that this is not the case in all instances. Continuous oestrogen therapy, with progestogens, is the method of choice.

Therapy control

The ultimate goal of hormone treatment is complete relief of symptoms. It may be required for a few months, a few years, or for life, or may be necessary at intervals only with recurrent symptoms. We use the relief of symptoms as the indication of effectiveness of treatment.

Vaginal wall smear A vaginal wall smear test gives some indication of oestrogen levels, but is of little use in routine management as any small amount of infection in the vagina alters the appearance of the smear. This test is therefore not routinely used in our clinics.

Implants

If oestrogen is unable to be taken orally, then it may be introduced under the skin in pellets. Testosterone may be added to this if a loss of sex interest and energy is unrelieved by oral oestrogens.

Implants give good results and the procedure is simple. It takes approximately 10 minutes and is done in the office or out-patients department. Using a small amount of local anaesthetic, the pellet is inserted into a small cut in the skin. Implants are particularly useful for young women who have had both uterus and ovaries removed. It is also useful for older women whose loss of sex interest is a problem. If the woman still has her uterus progestogens must also be given, as in oral therapy.

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What can you do about it?

That depends on how much of a problem it is. A small problem can be dealt with by bleaching. Pulling out the hairs is effective if you only have odd ones that worry you. Waxing is successful if the hair growth is too heavy for tweezers. This does not encourage more hairs to grow, in fact the hair will tend to recur less. I would like to stress this, as many believe this ‘old wives’ tale’ i that shaving increases hair growth. Waxing will need to be done periodically. Shaving for heavy growth also does not encourage further growth, but as hair regrows it feels bristly. Some women choose to use chemical products which dissolve the hair close to the skin in preference to shaving, but they have much the same effect. Electrolysis is of two types- the old method where an electric current is passed into the hair root, and the more modern method where the current passes down to the root by means of the hair held by the tweezers. Both are expensive, and although this root will lose its function, others around it, which have not been reached, may not. Oestrogens will help to balance the male hormone production and therefore will assist you in this regard.

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