In the last fifteen years or so, there has been greater interest in investigating pain control through behavior modification, self-hypnosis, biofeedback, imaging, arid stress management techniques, for the endometriosis sufferer, especially the woman who has severe and chronic pain, such a program can guide her toward feeling more in charge of her body and her life. A good pain-control program will address the psychological as well as physiological realities of the disease. A number of pain clinics across the country are affiliated with medical centers, such as the Pain Management Center at UCLA in California, which operates an outpatient Pelvic Pain Program. Other clinics may be privately run. Finding a pain-control program is a matter of asking your doctor or inquiring at a large hospital or medical association.

A good measure of satisfaction comes from having some success with these alternate techniques, since many of them depend on your commitment to them in time, energy, and a sense of purpose. Unlike conventional medical therapies, they can be something of a challenge in this regard, but they are fascinating nonetheless. When you learn how to control pain without painkilling drugs, you will understand more about who you arc, while having as well the adventure of mastering a new discipline, such as behavior modification, meditation, or yoga.

Many of what are now considered alternate therapies were once the only source of practical medical treatments. They coexist now with supersophisticated surgical techniques (such as laser) and the nearly perfected drugs for treating endometriosis (such as the gonadotropinreleasing hormones, or GnRH). They remain popular, if not without an aspect of controversy attached to whether or not they work.

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Before a diagnosis of fibroids is confirmed, other possible reasons for a mass in the abdomen should be excluded; for example, pregnancy or cancer of the cervix, endometrium or ovaries. To rule out pregnancy in a premenopausal woman, a sample of blood or urine is tested and a result obtained within minutes. To exclude cancer, several diagnostic procedures may be necessary. These include a Pap smear; a colposcopy, which entails viewing the cervix with a magnifying instrument called a colposcope, with or without removing a small sample of tissue (a biopsy) for subsequent examination; dilatation and curettage, in which the cervix is stretched or dilated and an instrument is inserted to scrape away most of the uterine lining; an ultrasound examination conducted via the vagina which produces an image of the uterus and other internal structures; and laparoscope a pelvic examination using a laparoscope (a tubular instrument with a light at one end and an eyepiece at the other) inserted through a small incision in the abdominal wall. Before committing to a diagnosis a doctor may also want to exclude other situations in which similar symptoms can occur, such as endometriosis, a pregnancy in a Fallopian tube, irregular placement of the uterus, bladder cancer, and ascites, which is an accumulation of fluid in the abdomen.

Doctors do not usually recommend removing fibroids if they are not causing problems, and it is estimated that this is the situation for most women who have them. In these women, fibroids tend to be diagnosed during a routine check-up, usually causing suspicion because the uterus is larger than expected but there is no evidence of pregnancy. If a doctor feels a firm, irregularly shaped mass when conducting an abdominal examination, the likelihood is that one or more fibroids are present.

When suggestions are made about removing fibroids that are not producing symptoms, this may be because of concerns that their further growth could make later removal difficult, or could result in serious complications by pressing on nearby organs. Of course doctors do not have crystal balls and predicting which patients will experience a worsening of their symptoms requires a good deal of guesswork. If this is the reason given for hysterectomy, it should be closely questioned. It is reasonable to remove symptomless fibroids if they are blocking the cervix, protruding into the uterine cavity or closing off the Fallopian tubes. Recent estimates suggest that fibroids are involved in about one in fifty cases of infertility in Australian couples.

The cause or causes of fibroids are uncertain although it is clear that stimulation of the myometrium by oestrogen promotes their growth and development. When oestrogen levels are high, as occurs during the reproductive years in general and pregnancy in particular, fibroids tend to increase in size. When oestrogen levels fall, for example after menopause, fibroids tend to shrink. During the past decade, further valuable insights have emerged. Studies of large population groups show that fibroids are much more common in women from certain racial groups. Black women in the US, for example, are three to nine times more likely to develop fibroids than comparable White women. Suspicion has fallen on genetic factors and pelvic infections, but it has also been suggested that a predisposition to fibroid formation occurs in obese women with above-average levels of blood glucose and growth hormone. Oestrogen and growth hormone are synergistic, meaning that their combined effect is greater than the effect of either hormone acting alone. Women on the Pill and those who smoke cigarettes seem to be less likely to develop fibroids.

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You will probably be in hospital for about five to seven days if you are having a conservative laparotomy, or seven to ten days if you are having a hysterectomy.

You will usually be admitted to the hospital the day before the operation. After you have gone through the formalities of being admitted to the ward someone will probably take your medical history. A nurse will take and record your temperature, pulse, breathing rate and blood pressure. An electrocardiogram and blood and urine tests may be taken, particularly if you are having a hysterectomy. Your pubic hair and the lower part of your abdomen will usually be shaved and you may be given a suppository if you have not opened your bowels that day.

A physiotherapist may visit you and teach you some breathing and foot and leg exercises to do after the operation, especially if you are a smoker, an asthmatic or prone to chest infections.

The anesthetist will visit you to discuss the operation and ask you about any allergies and previous problems that you may have had with a general anesthetic, such as nausea.

Some time before your operation you will be given a consent form to sign so that you can give your permission to undergoing the operation. You may have previously signed the consent form when you discussed the operation with your gynecologist during an earlier visit.

At bedtime you may be offered a sleeping tablet to help you sleep in the unfamiliar hospital ward. It is important to have a good night’s sleep before your operation so it is advisable to take the sleeping tablet if it is offered.

You will not be allowed to have any food or drink for at least six hours before the operation. Shortly before the operation you will be asked to shower and put on a gown and you will be asked to empty your bladder. About an hour before you are due to go to the operating theatre you will probably be given an injection, known as a pre-med or a pre-medication, which will probably make you feel relaxed and sleepy and make your mouth dry.

If you are apprehensive about your surgery you may like to ask if you can have your partner or a friend or a close relative come to stay with you for the hour or two before you go into theatre.

Immediately before the operation you will be taken to the operating theatre. In the operating theatre an intravenous drip will be inserted into your arm and you will be given the general anesthetic. After you have lost consciousness a tube will be placed in your throat and connected to a machine that breathes for you.

A tube known as a catheter may be inserted into your bladder to drain the urine.

A horizontal cut about ten centimeters in length will usually be made across the abdomen along the pubic hairline. Sometimes the cut will be made vertically between the middle of the pubic hairline and the navel, particularly if you have previously had a vertical cut or if bowel surgery is likely.

The gynecologist will then thoroughly inspect the pelvic cavity for any signs of endometriosis, adhesions and other damage so that she or he can plan the operation and decide which procedures need to be carried out.

When the surgery has been completed the gynecologist will stitch up the wound and the tube in your throat will be removed. You will then be taken to the recovery room for about half an hour before being taken back to your bed in the ward.

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