The Uterine Connection
Part 1: It Should Be Saved
Sometimes I come home a little down because a female patient isn’t responding to treatment as she should. I don’t like to discuss cases too much too openly, but my wife always asks the same old question: “Does she still have her uterus?”
“Give me a break,” I would think. Why is she stuck on that one? Does she think that is the only consideration in a woman’s health? But more times than not I would hear myself saying: “No, she’s had a hysterectomy.” “There I told you,” she would say and walk away as if she’s solved the problem. End of story, — finished. I bristled against that all too linear conclusion for a long time. But, the correlation has become too obvious to ignore any longer and I have started looking deeper.
Fix the Core Problem Instead
No, I’m not a gynecologist myself, I’m a Doctor of Traditional Chinese Medicine. But it didn’t take much research to reach the obvious conclusion. Any hysterectomy that was done other than that directly related to cancer, was a mistake. This would be almost a full 90 % of all hysterectomies. There is no doubt that in Chinese medicine we would have to agree. We find almost everything outside of absolute cancer treatable. Moreover, the flow of energies in the “whole body” picture of things, which is a disruption to such a vital part of the energetic system, is certainly a disaster.
The Body's Mutual Support Cycle
As in all things in Chinese Medicine, we simply can’t alter the nature of things by simply removing it. Only under the most duressed situation would the castration of such a necessary part of the body continuum be considered. The Bao Gong or uterus, is the intermediary of all transactions between the kidneys, the wellsprings of all the dynamic energies of the body, and the heart which governs the blood and is the center of the spirit or Shen. Without this connection, it was known that the spirit could not be cooled or replenished by the kidney essence. In return, the blood would not adequately support the kidneys. The result would be dry symptoms of the skin and the hair, brittleness of the bones, and a spirit that is anything but cool and collected.
There is a growing body of evidence that certainly belies western medicine’s idea that once the procreative years have finished, the uterus no longer serves a purpose. Recent studies show that endometrial tissue releases estrogen just as the ovaries do. Also as a receptor site for estrogen, it is a feedback mechanism necessary to proper estrogen secreting signals from the pituitary gland. Prostaglandins are produced in the uterus to create contraction and relaxation (for menstruation). They also work on the joints of the body increasing and decreasing inflammation. It has been produced synthetically for the treatment of Rheumatoid arthritis. Does it surprise you that the incidence of arthritis goes up in post-hysterectomy women?
Ovaries That Don't Work?
Some women will be given the assurance that their ovaries will be left intact. However, the ovaries left behind will fail in 30-50% of post-hysterectomy patients. This would amount to the fact that almost 60% of the hysterectomies result in ovaries that eventually do not function. which leaves those women without the benefit of a gradual easing of menopausal symptoms. Within the first 24 hours of a hysterectomy, the sudden lack of estrogen secretion abilities leads to hot flashes and night sweats that come on like a rock. In naturally developing healthy women, it will come on slowly over a period of a dozen or so years and perhaps never seem more than mildly uncomfortable. (In ensuing issues we will be discussing the dilemmas and complications involved in depending on hormone replacement therapy.)
Who Gets Hysterectomies?
Somehow we have the notion that mainly only older women who are increasingly likely to get cancerous symptoms are the victims of hysterectomy. Not so. In fact, in the over age 50 group only 23%have hysterectomies. The other 77% are mainly l9-49, most of those in the 30-49 group. I don’t think it would surprise anyone to find out that the most common victims are the minorities and the less-well educated. In a study done in the Pittsburgh area 38% of women with only a high school degree had hysterectomies; 20% if they graduated from college; l3% if possessing a post-graduate degree. Black women, there were twice as likely to have one as whites.
New Breed of Gynecologists
Dr. Vicki Hufnagel, one of a new breed of Gynecologists, complains that even though it is the number two most common surgery behind Cesarean sections, almost 90% of them are or should be elective surgeries and are not absolutely necessary.
Hysterectomies are driven by the combination of a rationales. Number one, it is just what is done when complications arise. The establishment of the world of gynecology would proclaim that no one needs a uterus once they’re not producing babies anymore? Number two, it is the bread and butter of the gynecological field. Without doing a minimum annual number of such operations, no ob/gyn office is going to make it.
Moreover, in a socialized system like ours, hysterectomies became the solve-all-problems-catch-all protocol. Just try asking for something like Female Reconstructive Surgery (FRS). Actually, Dr. Hufnagel reports that there is one more very important reason that this has become the mainstream solution. She says it is the 'misery loves company’ syndrome. It is created when those who have undergone it want succeeding generations to do the same as a sort of reticent validation ritual. “ It was good enough for me, ... it should be good enough for you too. Get on with it!”
I am a husband and a male who enjoys sexual congress in my relationship. So, it saddens me that this particular form of feminine castration absolutely destroys the libido of more than 40 percent of the females that undergo it. Not only is the desire for sex destroyed in these individuals, but benignly tolerating participation in the act can become a very painful ordeal to subject themselves to. Vaginal areas can become dry. Often in the absence of space created by the loss of the uterus, uterine prolapse occurs or worsens. This may result in excruciating pain upon sexual thrusts. Bladders too are often encumbered by the weight. This may cause incontinence, prolapse and a variety of other complaints.
The Hite report gave full credit to the clitoris for sexual satisfaction. It has also been found that for every woman orgasm is a different experience. Many women have uterine contractions, still others more so in the vaginal canal and upper area of the vagina.
The Doctor's Job is Done
When the surgeon finishes the hysterectomy that doctor’s relationship with that patient is usually ended. A rather simple equation: no uterus, no complications to be taken care of. They’ve done their job and as far as they’re concerned solved all the problems.The new caretakers of what the hysterectomy leaves behind are the ones who take care of psychological problems, urinary infections, and menopausal symptoms.
Coping with such a loss of self is difficult enough when forced upon you by something as onerous as cancer. But those who have undergone hysterectomies in the absence of pelvic disease, were twice as often admitted to psychiatric care. If they were ever under psychiatric care prior to the operation, they were ten times more likely to need such care afterward. Also, problems concerning marriage relationship issues before the operation are six times more likely to be a problem after the loss of the uterus.
Begins With Stomach Prolapse?
We are very successful at treating various forms of prolapse resultant of hysterectomies. However, I would rather preempt the need for such surgery at all. I believe that raising the prolapse of the stomach, could prevent so many problems that lead to hysterectomies. Not only prolapse, but the pain of cramping, bleeding problems, and irregular menstruation are all treatable. To my mind, we have a very high success rate without any direct intervention on the female reproductive system itself. Beyond this, a better class of surgeons are now able to remove benign tumors and fibroids with little fuss.
Part 2: Problem Approaches and Solutions
Hopefully we have established that very few hysterectomies should be done for reasons other than those related to cancer. Also, unnecessary removal of the uterus and of course the ovaries could have disastrous consequences. Unfortunately, however, of the hysterectomies done, only 10% are due to cancer. The other 90% is mainly due to more solvable problems. In this section, we would like to describe some of these problems and their root causes. We will also introduce some solutions offered by Oriental medicine.
Prolapse of the Uterus
Uterine prolapse is almost always the result of the accompanying factor of stomach prolapse. It may seem logical that all the organs are suspended by ligaments or internal fascia. However, it is really the strength of the internal Qi (energy) that determines whether other organs will fall in succession. One of the most common complaints of women who suffered from uterine prolapse had been an ongoing feeling of lower abdominal heaviness and gastric complaints. Women who we’ve treated for severe prolapse of the stomach and gastric complaints say that sex became less painful as the stomach prolapse was lifted. Many of the women who suffered from such complaints were heading for problems of uterine prolapse. In far too many cases had already undergone a hysterectomy.
Furthermore, we find in those who actually had a hysterectomy often had prolapses of the bladder as well. Many times they had much more severe stomach prolapse than those found in other women. This leads to more common complications of eventual urinary incontinence, or the inability to completely evacuate the bladder. These can be some of the most socially restricting of life’s problems.
There are three main causes of either an extremely heavy flow in a period. One is called menorrhagia, or bleeding, heavily at times and for a prolonged time. Metrorrhagia is frequent bleeding at irregular intervals. Then there is menometrorrhagia which is both. Actually, this is an area filled with grey areas and terminological mis-evaluations. Nevertheless, the three main causative syndromes are heat, blood stasis or Qi deficiency.
Internal heat causes the blood vessels to burn and lets the blood to “run wild.” A person suffering from this condition can also be irritable and thirsty and despises hot weather. It can also be combined with dampness called 'Damp Heat,' which would cause obstruction and pain as well.
Blood stasis in its early stages or in certain people can cause a blockage of menstrual flow called amenorrhea. This can mean loss of the period altogether. It can also force blood to flow out of its normal pathways. This can lead to periods that not only can eventually bleed profusely. It may also show lots of clotting and have a characteristic sharp pain as well.
Weak Qi (Chi)
When the Qi is weak it may lack the energy to guide the blood as it normally does. So this blood, lacking normal dynamism, may leak out in quantities enough to be profuse. The patient would probably already be showing signs of listlessness, and the blood would probably be thinner and paler than normal. This takes longer to treat as building up a person's energies takes quite a bit more determination and patience than merely clearing a blockage. Usually, however, it is much less severe and acute than either of the aforementioned conditions.
Dysmenorrhea or Painful periods
Where there is pain there is almost always a measure of stagnation or blockage. While uteruses are rarely removed for reasons of pain alone, it can be a symptom of things like endometriosis, cysts or fibroids etc. this may be true even in their pre-development stages, before they are observable by the doctor. When we clear up the stagnation, we clear up the problem. In most cases, this even reverses the growths that have already taken place.
There are various forms of these blocking syndromes. These include stagnation of energy, stasis of blood, internal coldness, internal heat, dampness stagnation or damp turned to heat called damp heat. Once diagnosed we use a two-pronged approach of treatments to create movement. We use Acupuncture or Nesshi Therapy to move the energies. We also use herbs to alter the aberrant energetics and reinstate harmony. This leads to an amelioration of the pain and its physical deformations.
Hot or Cold For Instance
For instance, if cold is the key problem, warming the patient internally and moving the blood is the primary approach. For heat conditions, we would cool and liquefy the internal environment. I think you are getting the picture. Of course, there are dietary concerns as well as treatment. In any case, the immediacy of the approach can be determined by the seriousness of the pain, the onset of the next period and more often than not the deadline for hysterectomy established by the gynecologist.
Rather large benign fibroids can form without much pain. But patients become frightened by the rapid growth of such growths. They can feel abnormal and uncomfortable. Once the patient passes through menopause, these growths usually naturally decline. Again we feel that they are the result of the obstruction of the normal flow of energy and blood, often due to some past or present emotional forces. Restoring the flow will most often reduce the swelling fairly rapidly.
Seemingly crisis-like problems that aren’t solvable by western methods have been treated for thousands of years by Chinese medicine. It is frustrating to hear the stories I am told by women who ended up with hysterectomies. In most cases they were likely the result of the root syndromes that I am presently treating them for.
Part 3: Hormone Replacement or Not
Of all of the parts of the uterine connection I have so far delved into, this has been by far the most difficult to resolve. There are lots of debates around this issue. When my patients ask me whether they should take HRT or not, the answer is always that it depends!
A Big Choice
I was always pretty well convinced that the best road is the one that nature has provided for us. But, the real 'depends' part of this huge life choice lies in the wants, fears and actual physical and psychological health of the woman doing the asking. I can help the patient assess the physical and psychological factors well enough. But the picture that that patient has for their future health has to be respected.
Estrogen May Be Anabolic
Recently, I had a patient come to me to lose weight. She was already postmenopausal, but vibrant and quite concerned with her appearance. Her weight problem was not because of lacking the willpower to avoid the wrong food or follow a dietary regimen. However, her fat cells held their place in her body structure, enhanced by the estrogen she was taking to ensure certain feminine qualities. There was also the slowing of metabolism as we age.
It seemed like we tried everything possible to break the cycle. We tried to get her body to shake some of that dampness and increase the yang energy to match the overabundance of yin. I suggested she give up the HRT for awhile until she got a handle on the weight. Here is where we came to an assessment of what she wanted and what she feared. While she detested the weight gain, she was most afraid of losing the feminine qualities that HRT, mainly estrogen, insured.
Menopause, a Loss of Yin
In Chinese Medicine, we regard this loss of yin, the liquefying, cooling night force that also calms us, as a natural consequence of aging. In China, women will regularly start taking yin nourishing herbs in anticipation of the change. This allows them to be well supplemented by the time it starts to become a problem. Luckily, this is an option for many women who want to avoid HRT. In those cases, the patient may fear the increased risks of breast and uterine cancer over fears of osteoporosis and heart disease.
Bioidentical, The Yin Factor?
When we say Bioidentical Hormones, what are we talking about? Originally, it was plant based substitutes like Chinese Yam and Black Cohosh etc. These would replicate many of the needs that were being employed only by those refined from pregnant mares urine, Premarin, until then. Today it is pharmaceuticaly synthesized to replicate natural estrogens and progesterones. The difference, I would maintain, is that one is nutrition and the other is a trigger that induces wanted symptoms and reactions. These may not still produce the enduring yin factors that we see as necessary in Chinese Medicine.
Largely, this is a decision time for women that is by and large fear based. In the case of choosing to use western pharmaceutical’s system of HRT or not, there is a lot of logic that can be invoked. Take osteoporosis for instance. Let's say you are a person who has never liked exercise and is rather small boned, with health risks like smoking and an abundance of coffee consumption. You may have very little choice but to pursue HRT. On the other hand, if you are strong boned and healthy, you would probably find a regimen of herbs and supplements with exercise as all you may need.
The same would be true for heart disease concerns. In fact, we would suspect that if a person is larger, HRT may actually add to dampness factors in the body which often shows stress on the heart.
There is one other factor that may influence the necessity or amount taken. You may exacerbate risk factors if you eat any significant amount of hormone-fed meats and poultry (the normal store-bought variety). We must question whether this isn’t one of the most significant factors in the increase of uterine hyperplasias. Further, research shows that this combo increases the incidence of cancer on many levels.
I usually don’t even begin to discuss the choice of HRT or not with patients who have already made the decision. But I do try to factor it into the choice of herbs or course of treatment. What alarms me is that most often women are given “unopposed estrogen,” or estrogen without progesterone. I ask them whether their doctor is giving them regular exams and biopsies on the endometrium. The answer is usually “no.” Why would this be? Probably because this is the uncomfortable side of HRT; the side that leads to drastic mood swings. But this should also be the complete picture of HRT and unopposed estrogen users have a much higher rate of cancer. One more thing is that normally a woman should only stay on HRT for a period of about six years. But this is often exceeded in spite of a steady increase of obvious risk factors.
If you carry a bit of extra weight in a healthy sort of fashion, your body should already be manufacturing some level of estrogen. In this case. using HRT may actually increase your risks of internal stagnation and thereby increase your risk of breast or uterine cancer. There is one sad case of a patient of mine who had had a complete hysterectomy at the age of 48. This was just for a small fibroid that the doctor suspected may have been causing a hip pain. When she came to us she still had the hip pain. We were able to relieve it by raising her prolapsed stomach. However, by being forced to take HRT, blood stagnation in her very strong legs became a serious and painful problem. Because of her surgical menopause, her hot flushes could never quite be controlled with herbal remedies. She was made to choose between increasing the pain and burning up.
What is most important to be remembered here is that there are many choices to be made around the menopause issue. It doesn’t necessarily have to be the same choice for everyone. When it is time to make that choice, talk to your western medical practitioners. But you might also give us a call and come to your own choices around your wants and fears. The choice you make may not be just around comfort or fashion, but the direction the latter stages of your life may take.