Herbal Health

Unlike laparoscopy, which is, in a way, exploratory surgery, laparotomy is a much more serious consideration, and should not be thought of as routine. Exploratory laparotomy is a major surgical procedure. The doctor makes a horizontal or vertical incision in the abdomen in order to explore the abdominal cavity for any abnormality or to remove tumors or cysts. This procedure is not used routinely as a diagnostic tool, but if a woman has a large pelvic cyst or mass that needs to be removed, a laparotomy might be indicated and might help treat the patient. Surprisingly, endometriosis often is discovered when something else is suggested, such as pelvic infection or pelvic tumors.

Sharon’s instincts about her condition were right from the start; she would have been better off searching for a specialist in endometriosis. Specialists are a good bet because they have experience in treating endometriosis on a regular basis, frequently are involved in research on the disease, and are more skilled with the laparoscope.

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There are four common reasons for the treatment of moles:

1. Diagnosis of a mole as being of the type that is statistically more likely to become malignant; such a mole would be the large, hairy ‘bathing trunk’ naevus.

2. The presence of changes suspected to be malignant.

3. The occurrence of functional changes within the mole. These may be irritation, trauma, or infection.

4. Cosmetic reasons. In this case removal is only successful if the result improves the appearance of the individual. The choice of surgical technique is therefore important.

There is absolutely no foundation for the widely-held misconception that surgical interference with a mole will cause it to become malignant. This may have arisen from the result of inadequate treatment of what in fact was already an early malignant melanoma, not a simple mole. All doubtful moles should be excised with an adequate margin and submitted for pathological examination. No moles should ever be simply destroyed by cauterization or similar treatment without adequate pathological examination. Removal for cosmetic or functional reasons does not necessarily have to be complete. Elliptical excision and suturing may be avoided and a very satisfactory cosmetic result obtained by a shave excision. This entails shaving the mole off flush with the skin surface, and stopping bleeding with light electro-desiccation.

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Summary of main points.

• Sustainable strategies of eating a low-fat diet and maintaining appropriate activity levels are required for long term management of fat stores.

• Fad diets are not sustainable, exploit the vulnerabilities of the overweight and are counter-productive.

• Criteria can be applied to these diets to assess their validity and sustainability.

Long term management of fat stores requires people to develop sustainable strategies in eating a low-fat diet and maintaining appropriate activity levels. The ad libitum approach to low-fat eating has been shown to be the most effective and easiest to follow over the long term. The rationale and techniques for doing this have been discussed in previous chapters. One disadvantage of this approach, however, is that it takes longer for success—even though this is likely to be more sustainable over the long run. Hence, there is still often a desire by many for a ‘quick fix’. ‘Diets’ offer this. Fad diets offer it even more convincingly. The most popular diets promise faster and seemingly effortless ways of losing ‘weight’, contributing to sporadic, and often counter-productive, efforts in weight management.

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Every woman should be aware that a second opinion is her right and she should never be made to feel guilty about wanting one.

A second opinion will give you peace of mind so it is essential that you get this from a specialist well-versed in the treatment of endometriosis and one who is well up on the latest research and technology. It is important that the doctor giving the second opinion is not in the same practice as the first doctor.

When should I get a second opinion

If you are unable to communicate with your doctor or you are uneasy about your doctor’s attitude, approach and explanations then you should seek a second opinion.

You should also obtain a second opinion if you are unsure about the type of treatment recommended, or if your doctor says there is nothing wrong with you.

If you do not feel that adequate tests and evaluations have been carried out or you wish to consult a doctor who has expertise in one particular aspect of the treatment of endometriosis — such as laser therapy or infertility — then seek a second opinion.

A second opinion is important for women who:

Have been recommended a hysterectomy.

Are told by their doctor that nothing further can be done to treat their disease.

Need reassurance that the treatment suggested by their first doctor is appropriate.

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Primolut N is a hormonal drug occasionally used to treat endometriosis. It is also sometimes used to treat a variety of other conditions including abnormal uterine bleeding, amenorrhoea (absence of periods) and PMS (premenstrual syndrome).

Primolut N is a progestogen (a synthetic progesterone) derived from the male hormone testosterone. Its chemical name is norethisterone. It is manufactured by Schering and sold in the form of white 5 milligram tablets.

How Primolut N works

It is thought that Primolut N eradicates endometrial implants by suppressing ovulation and interfering with the growth of the misplaced endometrial cells, causing them to slowly waste away Most women will stop ovulating and menstruating during their course of Primolut N.

Dosages of Primolut N generally used

Gynaecologists usually recommend 5 to 20 milligrams of Primolut N per day (one to four tablets per day) for four to nine months.

Side effects of Primolut N

The more common side effects are depression, weight gain, malaise, lethargy and tiredness, acne, vaginal bleeding, decreased libido and nausea.

How effective is Primolut N

There are no reliable figures on the effectiveness of Primolut N for the treatment of endometriosis.

Primolut N, pregnancy and breastfeeding

Primolut N should not be used during pregnancy as progestogens derived from testosterone can cause abnormalities in the developing foetus.

The use of Primolut N while breastfeeding is not recommended, as small amounts of progestogens have been found in the milk of mothers taking them and the effect on the child is not known.

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