Although no conclusive data exists yet, many doctors and nutritionists feel they are going in the right direction by recommending limited intake of arachidonic add and supplements of gamma-linolenic add, or GLA, to women with endometriosis.

Arachidonic add is an essential fatty acid that is linked to inflammatory conditions, as is the case with endometriosis. What does this mean to you? Inflammation is often mediated by prostaglandins. Knowing this, many doctors are suggesting to patients that they eliminate foods containing this add, which is found in dietary sources of saturated fat, such as butter, animal and organ meats, and lard. It is also possible to alter the balance of arachidonic add by taking another oil to counteract its effect. This is where linolenic acid comes in.

Found in sources as diverse as mother’s milk and cold-pressed safflower oil, gamma-linolenic add, or GLA, is one of the body’s more essential fatty adds. It is most important for the woman with endometriosis, both as a possible pain inhibitor and as an immune system strengthener.

GLA is made in the body from a conversion of vitamin F, or linolenic add, which is the basis of prostaglandins. Prostaglandins E2 and F2 Alpha have been linked to uterine contractions producing menstrual cramps, while GLA, called prostaglandin El, may offset some of the worse symptoms of the opposing prostaglandins. In a number of studies, it was also found to oppose the constriction of blood vessels, prevent blood dots, and prevent cholesterol buildup in the arteries. It has also been tried experimentally to help alcoholics over their addiction and to reduce some of the irritation of eczema.

Suggestions for daily intake: Take one to two tablespoons of safflower, walnut, or nutritional linseed oil (not the commercial variety used for varnishes) a day, preferably on a fresh tossed salad, flavored with herbs. Follow with a tablet of vitamin E to help absorption. GLA is also available as evening primrose oil—cither the essence of oil or in 500-mg tablets. You should be aware that this oil is very costly (approximately thirty dollars tor 180 tablets) and may not be much more effective than a daily salad with the above-mentioned oils.

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The susceptibility to sun-induced damage also depends on one’s skin type. This is largely governed by the amount of pigment in the skin, and one’s ancestry. Those individuals with a darker skin have more protection than those with a fair skin. Similarly, those with skins that tan easily are more protected than those who burn rather than tan. Races with a black or brown akin are much less likely to suffer from sunlight-induced problems than the Caucasians, with their light-coloured skin; they are certainly not exempt, however, from the deleterious effects of prolonged sun exposure.

Ones ethnic origins therefore are most important in assessing the skin’s response to prolonged sun exposure. People of Celtic origin are statistically much more prone to irreversible sun damage. These tight-complexioned people, who are descendants of the Celtic natives of Britain. Scotland. Ireland and northern France, appear to have some biological defect which interferes with normal pigment production and the repair of sun-induced damage. Even amongst Celts, though, those who are blue-eyed and have a lighter complexion, red or blond hair and freckled skin, are more susceptible to sun damage than darker individuals of the same race.

*95\44\4*

If you still have your ovaries, you will continue to produce oestrogen. Without a uterus, however, you will have no periods, so you won’t be aware of the irregular and unpredictable winding down of periods that heralds the natural menopause. Eventually, your ovaries will start to produce less oestrogen, and you will begin to notice the typical menopausal signs, such as hot flushes. This will probably happen up to two years earlier than it might have done if you hadn’t had a hysterectomy because it is thought that the uterus may release certain hormones which control levels of oestrogen, and without a uterus these oestrogen-controlling hormones are no longer produced. Many quite young women stop producing oestrogen within two or three years of a hysterectomy, even though they still have their ovaries.

If you had just one ovary removed (a unilateral oophorectomy) you may continue to produce some oestrogen. If you had both ovaries removed (a bi-lateral oophorectomy) you will no longer produce any oestrogen; this operation produces an instant menopause. For this reason, ask the surgeon who performs your hysterectomy to discuss with you beforehand whether he will remove the ovaries, and if so, why. Many surgeons remove them at the time of the hysterectomy to ensure that they won’t become cancerous in later years. This is a valid medical point, but to remove otherwise healthy functioning ovaries can cause severe menopausal symptoms after the operation. If you have this operation before the normal menopausal age, the loss of oestrogen can produce a striking and rapid appearance of menopausal symptoms. These symptoms are so severe that it is almost certain that you will be prescribed hormone replacement therapy (HRT) straight away. If you are not, ask for it, and be prepared to keep taking it until about five years or more past what would have been your normal menopausal age, that is until you are about 55, or longer if you get on well with it. The sudden fall in oestrogen also increases the risk of developing the serious bone disease osteoporosis.

A premature menopause – whether natural or surgical -is one which occurs before about the age of 45; some doctors say before 40. If you have a premature menopause you have a greatly increased risk of developing osteoporosis and also arterial diseases that could lead to heart attacks and strokes, and you should seriously consider taking HRT from the time your premature menopause or hysterectomy or oophorectomy occurs, and be prepared to take it until you are about 55. The National Osteoporosis Society reports that of women aged 60-65 who have osteoporosis, a disproportionately high number had a premature menopause.

*5\42\4*

Infections and surgical procedures are common causes of adhesions, which are filmy or thick strands of scar tissue that bind organs together. Adhesions can develop between the uterus, ovaries, bowel, bladder and rectum because of their proximity in the abdomen. Pain can occur any time that adhesions are stretched, for example during movement, a pelvic examination, sexual intercourse, passing urine or a bowel motion. If adhesions are constricting the ovary, pain may occur only, or mainly, during ovulation; if constricting the bladder, the pain may be intense when the bladder is full, easing as the bladder empties. Adhesions can also result in infertility by constricting the Fallopian tubes, covering or displacing the ovaries, or impeding the movement of sperm and egg or interfering with the growth of embryos. Ironically, while hysterectomy is sometimes successful in overcoming pain caused by adhesions, hysterectomy itself may be responsible for severe adhesions that result in long-term pain and intestinal obstruction.

The diagnosis of pelvic adhesions in a woman relies mainly on her history of infections or surgery and the nature of her pain. The diagnosis is usually confirmed by laparoscope although ultrasound can be useful in revealing adhesions surrounding the ovaries or bowel. If laparoscopy is performed in the presence of extensive adhesions it can result in puncture of the bowel, so great care must be taken with this technique and alternative methods (such as a mini-laparotomy) may have to be considered. (A mini-laparotomy entails a small incision through the abdominal wall to allow inspection of the internal organs. It is like a mini-Caesarean section.)

It is possible to remove adhesions without going to the lengths of hysterectomy in most women, and one of the most useful techniques is laparoscopic surgery. The laparoscope or viewing tube (for inspecting the internal organs) is used in conjunction with fine forceps which can hold the adhesions steady or break them with a blunt action, scissors to cut the adhesions, lasers to vaporise them, or high frequency electrical currents that produce heat and destroy them. In order to minimise adhesion formation, it is important that your surgeon is gentle and careful in his or her handling of the tissues, that techniques are used to prevent bleeding, and that solutions or

special membranes to reduce adhesion formation and other complications are used in the abdomen.

*20\198\4*

In 1963 Kleitman postulated that the rhythmic recurrence of REM sleep is only a part of a biological rhythm which is continuous in both sleep and wakefulness. He called this the basic rest activity cycle (BRAC). In 1967 Franz Halberg, a scientist working in the USA, named such cycles the ultradian rhythm, which is also known as the 90 minute cycle or the REM/NREM cycle.

The hypothesis concerning the 90 minute cycle is as follows. We know that each sleep cycle consists of REM and NREM stages and that each sleep cycle lasts about 90 minutes. This is believed to be a basic biological rhythm innate in our state of awareness. The 90 minute cycles go right round the 24 hour clock. Every 90 minutes there is a window of a few minutes duration during which a person feels sleepy and can fall asleep. This is why some insomniacs, if they miss the sleep window, may find it hard to fall asleep until the arrival of the next window 90 minutes later. This 90 minute cycle appears to be REM-stage related, and, during the window, other REM-related phenomena may be noted, such as day dreaming, penile erection, or just poor concentration.

Much research was conducted to demonstrate the existence of the ultradian rhythm. Extensive work was carried out on cats and monkeys to chart the activities of these animals in relation to their EEG recordings. It was found that, during the awake state, fluctuations in their activities correspond with the stage in the REM/NREM cycle.

However, the most convincing experiments were carried out by La vie and Scheson in 1981. They tested human subjects in the sleep laboratory. The subjects were instructed to close their eyes and to fall asleep if they could during a 5 minute period of darkness occurring every 15 minutes over 12 hours. It was demonstrated that EEG recordings of stage 1 sleep were evident every 90 minutes but not at other times during the experiments. It was also demonstrated that, when these subjects were sleep-deprived and were very sleepy, their ultradian rhythm disappeared. In other words, when one is very sleepy, one- can fall asleep at any time irrespective of the 90 minute window of the ultradian rhythm. It is also now apparent that this 90 minute cycle is not exactly 90 minutes but can vary from 60 minutes to 130 minutes, with a mean of 90 minutes.

The present controversy over this 90 minute cycle is, when a person falls asleep, how are the cycles relating with each other between the awake state and the sleeping state? Most researchers favour the suggestion that, when a person falls asleep, the first period of NREM sleep or the first sleep cycle appears to reset the 90 minute cycle for the rest of the 24 hours. Also there seems to be a phase reversal after this first NREM sleep. After falling asleep, the brain activity of each REM stage is highly aroused with dream experience. However, during the awake state the 90 minute windows which are REM-related are of low arousal.

*20\174\4*