CHAPTER 2

Preparing for Surgery and Initial Recovery

IN TALKING WITH WOMEN experiencing surgical menopause, I hear two common concerns: Some women wish they had been more prepared for surgery while other women were so afraid of the surgery that they did not educate themselves on what comes after: sudden surgical menopause. I didn’t.

The most important part of preparing for surgery and your initial recovery is you. You are a critical part of the team. Stay empowered by playing an active role in your medical plan. This will help to alleviate some of the fear and anxiety about your surgery and can even speed recovery.

 

Your Personal and Family History

Before surgery, you will be meeting with one or more doctors, gynecologists, oncologists, anesthesiologists, pharmacists, and the like. The one person who can connect them as a team is you.

Wouldn’t it be nice if our entire medical history were all in one place? That’s how it is for Jim at the U.S. Department of Veterans Affairs (aka the VA or DVA) that he’s been with since his West Point days. Despite moving from New York to Georgia to Germany to Chicago to Ohio and back to New York again, the VA and his personal medical history followed him during and after his military career.

In my experience, that is not the case for civilians. Over the years, I have had multiple primary care physicians, gynecologists, gastroenterologists, acupuncturists, dermatologists, and other specialists located all over the country. My medical history and what each doctor knows is only as good as my personal records and what I share.

This is where we must become our own best advocates. Our doctors need to see us as whole people with our complete histories. They need as much information as possible to guide us, especially if we work with Eastern practitioners, such as acupuncturists or naturopaths, who follow the philosophy that everything is connected—no detail is insignificant. This includes a list of any prescriptions or over-the-counter medications, as well as vitamins and herbal remedies we take on a regular basis. Our doctors and pharmacists can advise us on anything we should stop taking before surgery and when it’s safe to resume.

Our family medical histories also provide important clues that help doctors assess risk, schedule tests and screenings, and prevent and diagnose illness and disease. When possible, we should share as much information about our biological parents, siblings, and grandparents as we can gather, including any disease or health problems they may have and the ages and causes of their deaths.

 

Educate Yourself

Educate yourself on all options and alternatives, especially when it comes to surgery, drugs, and lifestyle changes. This book can help. It will be to your benefit to understand the:

~ Natural progression of menopause.

~ Suddenness of surgical menopause.

~ Symptoms of menopause.

~ Options for hormone replacement therapy.

~ Difference between synthetic hormone therapy and BHRT.

 

In addition, understanding the many aspects of wellness and how surgical menopause can interrupt our sense of balance can help to keep things in perspective. These topics are covered in Chapter 3, “Wellness and the Challenges of Menopause.” Having this basic understanding will help you communicate with your medical care team and make the best decisions concerning your health, surgery, and recovery.

 

Ask Questions

Remember, there are no stupid questions. Ask and keep asking. Some women don’t know what questions to ask their doctors. Visit the Appendix for a list of suggestions. Take a written copy with you, so you don’t forget any. The biggest question for me was how long would it take to recover. The answer: As long as it takes.

 

Second Opinion

It is perfectly acceptable to get a second opinion. When we seek guidance from another doctor, we are looking to confirm a diagnosis and/or find possible different treatment options. If our condition is not life threatening, then we have time to pursue less-invasive alternatives. With a cancer diagnosis, however, a hysterectomy can be lifesaving. Second opinions should be done quickly so an educated decision can be made and treatment can begin as soon as possible.

Take Notes and/or Bring a Friend

I admit I am not always the most objective patient. Hormones, diagnosis, and the prospect of surgery can cause me to be emotional and lose my perspective. Other women report going numb, tuning out large parts of conversations with doctors. When we are either emotional or numb, retaining critical information can be a challenge. I have found that when I invite a friend along, my friend provides an objective point of view, along with the opportunity to take notes.

 

Serenity Through Acceptance

Before surgery, I made three major decisions. I:

~ Agreed to undergo surgery to have an ovary and fallopian tube removed.

~ Trusted my doctor and husband to make the decisions that were in my best interest while I was unconscious.

~ Promised to accept whatever outcome I woke up to.

 

Serenity is the state of being calm, peaceful, and untroubled. With serenity comes freedom. There are things that I cannot change: I no longer have a uterus or ovaries. We can’t stuff them back in or do a transplant. I accept that. The uterus I wasn’t using. The ovaries … well, that’s another story, as they are headquarters for producing most hormones that keep a woman in balance.

There are things that I can change: my attitude, my feelings, my thoughts, my words, my habits, and my perspective. It takes courage and hard work, but I can change these things.

Learning to see and knowing the difference between what we cannot change and what we can is where the brilliance of the advice comes in. It is freedom. It is, indeed, serenity.

Every single one of us has adversity and challenges in life. So, the question for each of us becomes not whether we will have struggles, but how we are going to respond to them. As humans, one of our greatest skills is the ability to adapt and transform.

While there was serenity in accepting what I had no control over, I wanted to do everything within my power to go into surgery and initial recovery in the healthiest state possible. This included fortifying my body, choosing the right perspective, managing my expectations, reducing stress, and having a strong support network in place.

 

Fortify the Body

Some women will enjoy their favorite foods of pizza, ice cream, or a burger and fries before surgery. Because I am digestively challenged, I typically choose foods that are nutritionally dense and easy to digest. This was especially true before and after surgery. I drank lots of liquids to stay hydrated and prevent constipation, a common complaint after hysterectomy. I ate smaller, lighter, plant-based meals.

I was able to be active right up until the day of my surgery, but most exercise was off limits for six weeks afterward, so my body could focus all its attention on healing. My doctor told me I could walk as much as possible following surgery to help avoid blood clots and stiffness while promoting healing.

We all face surgery from different levels of health and fitness. If we’ve never run a day in our lives, we probably won’t be running a marathon anytime soon. But we can begin today by making one positive change to our health. We can fortify our bodies to the best of our abilities.

 

Choose the Right Perspective

I believe perspective plays a huge role in how we enter menopause, regardless of whether it is natural or surgically induced, as well as in how quickly we heal.

Think back to when you first got your period. What was your perspective? Did you view it as an honor as you stepped into womanhood, like my friend Susan? Or were you more like my friend Stephanie, who viewed it as terribly embarrassing—always having accidents and not being able to go in the water at the beach for fear of bleeding through? For me, I understood that getting my period made me a woman and enabled me to have children. With my young naïve mind, I thought that the day I got my period I would become pregnant. Silly? Or the power of a child’s brain who takes things literally?

What is your perspective of menopause? Is it a time of distress and discomfort? A signal of aging? Do you fear the best years are behind you? Are you focused completely on your symptoms? Or do you see this transition as a rite of passage and a time to discover or rediscover your power, purpose, passion, and authenticity?

I love that the Chinese refer to menopause as the second spring. They consider it a time to reflect on life and turn our focus inward to nurture ourselves. That rings true for me, as this season of my life already has had an ongoing theme of self-love, self-care, and self-reflection.

Just like surgery may have benefits of alleviating pain or risk of disease, menopause can be a wonderful transition with positive side effects such as:

~ No more periods, cramping, tampons, or pads.

~ We can finally wear white pants again, any time of the month.

~ We can enjoy sex without risk of pregnancy.

~ We may have greater confidence and self-assuredness.

~ We don’t have to schedule our sex lives, athletics, or vacations around our periods.

After my surgery, it took time for my body to heal physically. It took even longer for my mind and emotional health to stabilize. There were times when I felt broken. I had to constantly remind myself that I was in a state of healing and change. Even though I felt broken, I told myself that I was whole, strong, and valuable.

Surgery and surgical menopause can be both frustrating and exhausting. The last thing we need to do is to beat ourselves up. And isn’t that one of our greatest strengths as women? We think we should heal faster, we shouldn’t cry for no reason and we should be able to do it all, even right after surgery. The only thing we need to do is cut ourselves some slack and remind ourselves that this too shall pass. That’s a perspective I can embrace.

 

Managing Expectations

Along with a healthy perspective comes the ability to manage our expectations. This can include talking to our employers about options for time off. I was fortunate to receive short-term disability pay while I was out of work for six weeks. One woman I know took out a small loan to replace her paycheck, so she could take time off to fully heal.

Our expectations regarding the time it takes to feel good again require managing as well. There were times during my recovery from hysterectomy when I started to think that maybe I was imagining things. I wondered if, somehow, the plethora of physical symptoms and emotional fluctuations I felt were all in my head. Maybe, menopause doesn’t really exist. After all, I spoke with other women who went right back to work within days of their surgeries and who appeared to have escaped surgical menopause altogether. Meanwhile, it seemed to take forever for me to feel normal again.

As I contemplated where this thought came from, I started to examine my expectations. Fifteen years prior, I stayed with my parents when my mom had a hysterectomy. The first days after she came home from the hospital, she was in physical pain, but aside from that, she escaped the added symptoms of menopause. Perhaps age played a factor: My mom was fifty-four when she had her surgery; I was forty-three. She had most likely already entered perimenopause, where the decline in hormones manufactured by her ovaries had already taken place gradually, so there wasn’t such a sudden drop and change in her energy levels and emotions.

Being a sports nutritionist and having studied wellness for almost a decade, I also know how much our world has changed. The nutrient and toxicity levels of the foods my mom grew up with are different than the ones I’ve been exposed to. My generation has also been surrounded by more technology and radiation than any other generation in history.

It could simply be that everybody, even women within the same family, is different. My mother was lucky enough not to be affected by premenstrual syndrome, whereas my PMS symptoms had always been quite severe. I had endometriosis, which was not diagnosed until surgery. Add the complication of IBS with the endometriosis and it’s no wonder I had a tougher time than my mom.

For those of us prone to anxiety, we worry and even have tendencies toward negativity and cynicism. In my experience, worry never resulted in anything good. In fact, it elevated my stress levels, made things worse, and slowed healing. I eventually changed my expectation to one of positive optimism, and things began to get better. What I focused on grew. As I focused on the good things in my life with gratitude, I found more in life to appreciate.

Another area of expectation that requires managing is post-surgery intercourse. I remember sitting in the doctor’s office at my six-week checkup, discussing reentry into the world of sex. Jim and the doctor joked a bit as they sang a line of Madonna’s “Like a Virgin.” To warn you and to be frank, that’s not quite accurate.

My first time after surgery felt like my vagina had shortened, shrunk, and dried up. While there is controversy over whether the vagina shrinks due to surgery, the reality is that our vaginas are resilient. They can, after all, bounce back after childbirth. Or so they tell me. They can bounce back after a full hysterectomy as well.

I found that the more relaxed I was, the less pain I had. I made sure I always had lubricant on hand and I used it early on to give my body all the help it required. This became a fun time of exploration as together Jim and I learned what got my juices flowing. Literally. For some women, it is soft music, candlelight, or a sexy movie. Others may enjoy this season of healing as a time to cuddle, talk, and explore other means of mutual pleasure and intimacy.

While we are on the subject of sex, let’s talk about the libido. Sex and intimacy are not only physical. They are emotional. This is where desire comes in, otherwise known as libido. I once heard that when a man and woman fight, the woman needs to resolve the issue before she has sex. A man needs to have sex before he can resolve the issue. I say sex has a similar effect as exercise: If you ask me how my day was before a workout, you’ll get a very different response than you will if you wait to ask me after.

When it comes to menopausal women, we are all over the board on this one. Some women are grateful for the “forced” break from intercourse that surgery provides. Perhaps they didn’t enjoy sex or found it painful. If it’s painful, it is natural to develop a fear of sex, which was my initial reaction. Then, there are others—and you know who you are ladies—who cannot wait to have sex. In their strong desire, they may even rush the process before their bodies are ready. This can cause harm and increases the risk of bleeding, infection, or torn stitches. I highly suggest waiting for the green light from your doctor.

Early on, I complained about a low libido. My doctor and I experimented with the addition of bioidentical testosterone. I fully expected BHRT to fix this, however, I did not notice significant improvement. I’ve known other women who tried testosterone and it made all the difference in improving their sex lives.

I kept an open mind and I recognized that sex brings a level of intimacy, communication, and relaxation to my marriage. I enjoy this closeness with Jim. So, I changed my expectations about BHRT and my mind about my libido. I took responsibility for my thoughts and feelings about my physical and sexual relationship. I embraced spontaneity as a grateful participant. I found that this approach always has a beautiful result: Orgasms bring joy, relaxation, and deeper connection. They also make me forget about my symptoms. And the laundry, the dishes, and anything on my chore list. Heck, sometimes I even forget my name.

As I took a closer look at my attitude and how it was related to my symptoms, I realized that it wasn’t that I’d lost my libido at all. I’d lost my passion. But not for Jim or sex. For life. For my job. In fact, I was pleasantly surprised to discover that my libido was, in fact, strong. I also accepted that in my situation, it wasn’t fair to expect BHRT to fix this. It was up to me.

Finally, remember that during recovery, our partners are going through their own transition, having their own emotions, reactions, frustrations, and expectations. They may attempt to be extra sensitive, not knowing if we are ready to be intimate or how we are feeling. It helps to keep the lines of communication open, especially in the initial recovery stage after surgery.

Physical release is part of a healthy lifestyle and it can certainly be a stress reliever. Men have needs, some more than others. They may choose to “release” on their own. I have heard some women say this makes them feel insecure, while others shame their partners about it. In the spirit of managing my expectations, I decided not to take it personally and to look forward to the time when it was safe and I felt good enough to join in.

 

Reducing Stress

Before surgery, I didn’t recognize that I was stressed. Since then, I’ve discovered that there are two scenarios for stress. In one case, we know we are stressed. We are under a deadline at work, there’s not enough money at the end of our month, the furnace breaks, a loved one is ill, we move, buy a home, get married, divorced, and so forth. Any major life event will cause stress and we usually see it and feel it. And we know it is temporary. The situation passes, and our stress levels drop. Hopefully.

The second scenario is where I found myself: with a cumulative buildup of stress that started with the initial discovery of a mass and a cyst. I was already leading a full and productive life that my body had adapted to. Or so I thought. But add in the stress of multiple surgical procedures, financial stress from a smaller paycheck while on short-term disability, and stress on my body as an athlete. Then add in the stress of constantly looking for a solution, to feel better, to lose weight, and to restore balance emotionally. And then, on top of that, add in the pressure I put on myself to race back to the same life as I knew it to be before surgery, and I was on overload. I was exhausted. I had to learn to relax, rest, and manage my schedule better. I had to remember how to play.

Now, I monitor my days so that I don’t burn the candle at both ends, rising early and staying up late. I examine my vacation schedule to make sure I build in longer breaks and getaways. In between vacations, I take more naps and bubble baths. I enjoy a massage as often as I can. My bike rides are not all workouts; some are joy rides and playtime with friends. Yoga, meditation, spending time in nature, and doing things I love are all healthy ways to relax and calm my anxious mind and heart. These are some of the practices that help to reduce stress in my life. By the same token, I also had to learn to get off my own back. To allow grace and as much time to heal as I needed. The world won’t end if I don’t do the dishes tonight, finish the laundry, or take out the trash. That’s what tomorrow is for.

 

A Strong Support Network

Having a strong support network will help you through surgery and initial recovery until you are back on your feet.

We know that relationships are important. After all, we are women. Our feminine nature is to connect and relate to people. There are studies about the advantages of strong, healthy relationships, and these benefits include living longer, being better able to deal with stress, improved physical health, feeling a richer better quality of life, lower rates of depression, better immunity, and improved blood pressure; things we can all benefit from as we navigate through surgery and surgical menopause.

You don’t have to go through this alone. You may or may not have close family and friends. You may or may not be married or have a partner. Ask your doctors, employers, and health insurance company what resources are available to you for support. If you are on Facebook, there are wonderful groups composed of women just like you and me from around the world that share their experiences and what they have learned. These groups offer a safe place to discuss our fears and symptoms and ask questions. Two such groups are “Hysterectomy & Menopause Support Group” and “Surg Meno.” Ask to join. I did.

I know reaching out to people is not always easy. In the past, I was a private person, to the point where I didn’t share much about my health challenges with my parents or sister before surgery. In hindsight, I might have done this differently. My sister would certainly have wanted to pray for me. My mom would have just wanted to be there, offering support and encouragement while preparing meals, doing laundry, and cleaning my toilets. Some days, that’s just what a girl needs from her mum—particularly right after surgery when your body is using all your energy for healing its tissues.

One way to receive support is to ask for help. My friend Holly knew a woman who had a hysterectomy and felt very alone. This woman needed assistance but did not know how to go about asking for help. Holly suggested she utilize social media. If she wanted a turkey sandwich she could post it on Facebook or tweet it on Twitter and have multiple offers within the hour. I love this idea. You could also ask for recommendations for people’s favorite movie or book and invite some local friends over to watch with you or start a reading, writing, or coloring group.

Not everyone will know how to help us. This is where we need to communicate clearly by inviting friends, family, coworkers, and even neighbors into our lives. Let them bring a meal, do the dishes or a load of laundry, vacuum the floors, clean the kitchen, or pick up a few groceries. They can loan us movies or books, or drive us to the doctor or pharmacy. If we have children, they may help with childcare or transportation to afterschool events and play dates.

Or, they can come for a visit. Some days you’ll want to talk, some days you’ll want just to sit. Ask for what you need and accept what they can give. Release them if they can’t. They will be there for you another time. Remember in the early stages of your recovery to let them know your energy limits so they can plan their time with you accordingly.

In the first weeks after my surgery, my friend Lucy brought me two puzzles while my friend Susan delivered a coloring book and colored pencils. I was amazed how fast time went by as I got lost in puzzle building and coloring. Both provided a healthy distraction from television, social media, and technology in general. They allowed my mind to relax, which resulted in calmness and clarity. Eventually, I was ready to have lunch with friends either at home or close by. When I walked, I invited friends to join me.

Know that your friends are not therapists or counselors and sometimes we require more of a listening ear than they can give. I found talking to a counselor played a large role in reducing my stress levels after surgery. I wish I had done it in the weeks prior to surgery as well.

An important part of the support network for some of us is our partner and/or our children. They get stressed too. During my recovery, Jim would act strangely or not quite like himself. I sensed it, and at times took it personally, until I realized not everything was about me. Laughter and lightheartedness were a great way to ease tension that surfaced.

Our men cannot read our minds. By nature, they have nothing in their lives to compare to hysterectomy or surgical menopause. As we go through surgery and experience the suddenness of symptoms after, we need to use our words to communicate our needs, desires, and fears. It may be as simple as asking for a hug or reassurance that they are with us through sickness, health, and menopause.

Clear communication is crucial with children as well. Include them in discussions about surgery and recovery. If they are old enough, they may be ready to take on more responsibility around the house. Children crave routine and familiarity and this is a time of change for your family. Try to keep their schedule consistent. Again, ask for help from family and friends. Let their teachers know what is going on so they can provide extra support. Above all, know that kids covet our time. Give them as much as you can, even if it is naptime.

 

Final Tips

As you prepare for surgery and your initial recovery, you might:

~ Prepare and store meals (or collect them from family and friends).

~ Make a list of local restaurants that deliver.

~ Hire a house cleaner for the first few weeks after surgery.

~ Schedule a driver to take you home after surgery.

~ Plan childcare support while you are in the hospital and the initial weeks of recovery.

~ Pick up extra books from the local library or order them for your Kindle.

~ Sign up for Netflix.

~ Go to the bank. Sign up for online banking and auto pay for recurring bills.

~ Fill any prescriptions. Ask your pharmacy if they have a delivery service.

~ Consider your home’s layout. Can you avoid stairs or move things for easier access?

~ Stop smoking. Smoking can cause complications with surgery and anesthesia. Talk to your doctor and consider stopping at least two weeks before surgery.

~ Lose weight if necessary. Excess fat can cause complications with surgery and anesthesia and slow the healing process. Talk to your doctor or a nutritionist about the best way to go about losing weight before surgery.

~ If you have other conditions, discuss them with your medical team to make sure they are well controlled. This includes diabetes, high blood pressure, anxiety, and depression. The better managed they are before surgery, the less impact they will have after.

~ Plan to take time off. Discuss all options with your employer as well as your family.