Health

One of 5 operations you don't want to get—and what to do instead.

Theres long been a concern, at least among many women, about the high rates of hysterectomy (a procedure to remove the uterus) in the United States. American women undergo twice as many hysterectomies per capita as British women and four times as many as Swedish women.

The surgery—either traditional open (large incision) or laparoscopic (small incision) — is commonly used to treat persistent vaginal bleeding or to remove benign fibroids and painful endometriosis tissue. And if both the uterus and ovaries are removed, it takes away your sources of estrogen and testosterone. Without these hormones, your risk of heart disease and osteoporosis rises markedly. There are also potential side effects, from newfound pelvic problems to lower sexual desire and reduced pleasure. Hysterectomies got more negative press after a landmark 2005 University of California, Los Angeles (UCLA), study revealed that, unless a woman is at very high risk of ovarian cancer, removing her ovaries during hysterectomy actually raised her health risks.

So why are doctors still performing the double-whammy surgery? “Our profession is entrenched in terms of doing hysterectomies,” says Ernst Bartsich, MD, a gynecological surgeon at Weill-Cornell Medical Center in New York. “Im not proud of that. It may be an acceptable procedure, but it isnt necessary in so many cases.” In fact, he adds, of the 617,000 hysterectomies performed annually, “from 76 to 85 percent” may be unnecessary.

Although hysterectomy should be considered for uterine cancer, some 90 percent of procedures in the United States today are performed for reasons other than treating cancer, according to William H. Parker, MD, clinical professor of gynecology at UCLA and author of the 05 study. The bottom line, he says: If a hysterectomy is recommended, get a second opinion and consider the alternatives.

What to do instead
Go knife-free. Endometrial ablation, a nonsurgical procedure that targets the uterine lining, is another fix for persistent vaginal bleeding.

Focus on fibroids. Fibroids are a problem for 20 to 25 percent of women, but there are several specific routes to relief that arent nearly as drastic as hysterectomy. For instance, myomectomy, which removes just the fibroids and not the uterus, is becoming increasingly popular. And there are other less-invasive treatments out there, too.

In France in the early 1990s, a doctor who was prepping women for fibroid surgery—by blocking, or embolizing, the arteries that supplied blood to the fibroids in the uterus—noticed a number of the benign tumors either soon shrank or disappeared, and, voila, Jacques Ravina, MD, had discovered uterine fibroid embolization (UFE). Since then, interventional radiologists in the United States have expanded their use of UFE (typically a one- to three-hour procedure), using injectable pellets that shrink and “starve” fibroids into submission. Based on research from David Siegel, MD, chief of vascular and interventional radiology at Long Island Jewish Medical Center, New Hyde Park, New York, some 15,000 to 18,000 UFEs are performed here each year, and up to 80 percent of women with fibroids are candidates for it.

Another new fibroid treatment is high-intensity focused ultrasound, or HIFU. This even less invasive, more forgiving new procedure treats and shrinks fibroids. Its whats called a no-scalpel surgery that combines MRI (an imaging machine) mapping followed by powerful sound-wave “shaving” of tumor tissue.

We asked the pros who know for their tension tamers. Here in their own words, they share their strategies.

Sole to soul
“The tightness that you feel after sitting in front of a computer for hours can be overwhelming. As a reflexologist, I believe you can manipulate points on the feet to reduce tension. I like to slip off my shoes and give myself a massage, reflexology-style.

“Use your thumb and fingers to gently rotate each toe, applying on-and-off pressure by rocking your thumb from the first joint to its tip. Inching your thumb along, work all surfaces of each toe. Thats called thumb-walking. Do that across the ridge where your toes meet the ball of your foot. When you get to the outside edge of your foot, at the base of your small toe, thumb-walk in a circle. Then stretch your toes, flex and extend your feet, and do a few ankle rotations. Take a moment to enjoy the relief, and youre ready to get back to work.”

– Opal J. Knowles is president of the Reflexology Association of America.

Lighten up
"I'm a recovering idiot, someone who has tried to control others' actions rather than his own reactions and failed miserably—repeatedly. What could be more idiotic than that? After a minor stroke, I realized that instead of changing the world, I could choose to change how everything affected me. Now, when I'm talking to an idiot and feel my face getting hot, I sing a song to myself that I made up just for such occasions, sung to the holiday melody 'Let It Snow! Let It Snow! Let It Snow!' It may sound trivial, but when you're troubled or frustrated, there's nothing trivial about the relief humor can bring. Here's how it goes: "Oh, judging won't make folks like you.
In fact, they might despise you.
Give yourself a chance to grow.
Let it go, let it go, let it go."

– John Hoover, PhD, is a psychologist and humor therapist. His most recent book is How to Live With an Idiot: Clueless Creatures and the People Who Love Them (Career Press).

The Power of everyday objects
“We sometimes forget that everyday things in our lives and our memories can rid us of stress. My book is a collection of comforts from people all over the country. Dena from Grants Pass, Oregon, for example, destresses just by taking a short walk along neighborhood streets lined with fragrant honeysuckle vines. To recreate the essence of Denas ritual, have a scent nearby that triggers tranquil thoughts: a sliver of yummy-smelling soap, a cup of jasmine tea, or your dads old leather wallet. Remember—there are things all around you that can bring comfort when youre overwhelmed.”

– Carol Wiseman, author of A Patchwork of Comforts: Small Pleasures for Peace of Mind (Conari Press).

Getty ImagesIm planning a country getaway one of these weekends soon—maybe to my brother Jakes house in the woods near the beach, or to a pals rustic cabin in the Catskills.

Its not like either place is a days hike from a supermarket or drugstore, but still, I like to be prepared to deal with common country hassles so that my relaxation time isnt cut short. Heres what Ill tuck in my duffle bag:

Bottle of vodka
Its not only an essential ingredient for Sunday morning Bloody Marys; vodka is also an essential preventive treatment for poison ivy or oak. Thats because alcohol is one of the few things that can remove urushiol, the clingy, rash-inducing oil from poison ivy and oak that causes the blistery, itchy, weepy rash.

But you have to act fast: If you wait longer than 10 minutes or so, the oil will do its damage. So as soon as you can after youve touched the three-leaved plant, wipe affected skin with vodka, then rinse well with plenty of plain water. Then, and only then, shower with soap and water (using soap too early in the process only moves the urushiol around).

Finally, don gloves and with vodka wipe off clothes, shoes, or anything else that touched the plant. To remove urushiol, rubbing alcohol works as well as vodka (but not in the Bloody Marys).

Herbal Clear Outdoor Whole Body deodorant
This great-smelling stick deodorant (about $5; drugstore.com) is made with a fragrant blend of essential oils that not only keeps you smelling fresh, but also repels bugs—and thanks to the lavender, eucalyptus, thyme, lemon, bergamot, and ginger oils, it has an herby, citrusy aroma. I not only use the stuff as an effective underarm deodorant, but I also swipe it over my ankles, neck, and arms when Im strolling through the woods—and before bed—to keep mosquitoes from biting.

UV Sun Sense strips
I got a sample of these strips ($6; amazon.com) in the mail and think theyre really cool—especially if you have kids whose sun exposure you want to monitor. Theyre wristbands, and you slather them with sunscreen as you slather yourself. The bands turn blue when exposed to the sun; when the blue fades, its time to reapply sunscreen (to yourself and to the band). If the band turns yellow-orange, thats a warning that its time to cover up or seek shade. Each pack contains seven bands; you use just one per day.

We admit it: We have a love-hate relationship with our breasts. We show em off when they're proud and perky, but freak the second they start to sag. We squeeze them into bras that don't fit, complain if they bob when we jog, and obsess over every little imperfection. But the minute we find a lump or feel a twinge of pain, we realize just how much we want them around—no matter their flaws. That's why we created this A-to-Z Guide to help keep your breasts——and you—healthy.

A: Alcohol

The numbers don't lie: Alcohol is to blame for 11% of all breast cancers, according to data from the United Kingdoms Million Women Study. That's because beer, wine, or cocktails—even just one or two drinks a day—hike your risk, and that risk increases with each additional drink. Scientists are still probing the alcohol-cancer connection but, for now, moderation is a must. “If you don't drink, don't start,” says Susan Love, MD, president of the Dr. Susan Love Research Foundation and clinical professor of surgery at UCLA. “If you do, three drinks a week or less is probably OK.”

B: Breast-feeding

Yes, babies are more likely to attend college if they nurse, but what's really surprising: Breast-feeding may save your life. Women's Health Initiative data suggests that moms who breast-feed 12 months or more throughout their lives have less heart disease than women who don't nurse. And a new study shows that women with a family history of breast cancer cut their risks of getting the disease before menopause if they breast-feed their kids.

C: Caffeine

You've heard theres a link between caffeine and breast cancer? The truth: About 200 to 300 milligrams of the stimulant per day—the amount in two to three cups of coffee or (strong) tea, an energy drink or two, or about five diet sodas—probably wont hurt you, says Liz Applegate, PhD, director of sports nutrition at the University of California, Davis. But to be safe, don't overdo it.

D: Dècolletage

There's a simple reason you see freckles, sun spots, and those dreaded vertical wrinkles on your cleavage—youre not using enough sunscreen on the delicate skin there. Baby your bosom with a high SPF, plus a moisturizer, says Amy Taub, MD, a Chicago-area dermatologist and assistant clinical professor at Northwestern University Feinberg School of Medicine. Try Aveeno Positively Radiant Daily Moisturizer with SPF 30 ($13.99). It offers sun protection and spot-reducing soy.

E: Eat right

Loading up on fruits and veggies and cutting back on fatty meat keep your whole body healthy. But which foods specifically help you fight breast cancer? Recent studies suggest you eat more: Cruciferous vegetables like broccoli, cauliflower, cabbage, and bok choy. They contain potential cancer-fighting compounds called isothiocyanates. Fish like salmon, tuna, and trout. They're rich in omega-3s and are a healthier protein source than meat. Bell peppers and broccoli They're full of flavonoids, a powerful good-for-you antioxidant. Kefir yogurt Its a yummy source of vitamin D and healthy bacteria (probiotics).

F: Fit

If you're like most women, you're wearing a bra that doesn't fit right. Blame the fact that your bust measurements change at least six times in your adult life. To make sure you're getting the right support, talk to a fitter in a department or lingerie store, or do your own sizing. Elisabeth Squires, author of Boobs: A Guide to Your Girls, swears by Size Me Up!, a doctor-designed system that measures the width of each breast to more accurately determine cup size.

G: Genes

Most women who get breast cancer don't carry the harmful gene mutations known as BRCA1 and BRCA2. Women who do (roughly 1 in 500) tend to get cancer under age 50 and may have multiple cases of breast and ovarian cancer in the family. Who should be gene-tested? If relatives (sisters or other women on your moms or dads side) have had breast or ovarian cancer, its most helpful for one of them to be tested before you. Testing costs about $3,000, and most insurers don't cover it. If a mutation doesn't show up, your risk is still higher because of your family history. But if your relative has the BRCA1 or BRCA2 gene mutation, your risk could be elevated even more, and you may want to talk with a genetic counselor about your own test.

Too much jiggling can make you sag: According to one British study, breasts move during exercise up to 8 vertical inches, adding painful pressure on supporting ligaments. Solution: Make sure your sports bra is up to the job. Small-breasted women usually just need a compression, or “uniboob,” bra. If you're large, try encapsulating styles, which surround each breast separately. Champion makes good low-cost running bras, and sportswear companies like Title Nine even offer special rating systems for each bras support level.

K: Know em well

Take a good look in the mirror—is one breast bigger than the other? (That's typical.) Are your nipples inverted? Does anything look or feel different? You need to know your breasts well so you'll notice any changes during your monthly breast self-exam (BSE), which is an important way to catch abnormalities like lumps or swelling.

L: Lumps

The vast majority of breast lumps are benign—and more than 60% of women have fibrocystic, or naturally lumpy, breasts. Still, you should get all lumps and bumps checked, especially if they change. “Women get into trouble when they ignore lumps because they're afraid,” says Joan Bull, MD, director of the Division of Oncology at the University of Texas Medical School in Houston. The doc may recommend an ultrasound, mammogram, or biopsy to figure out what's up.

M: Mammograms

No one likes having her boobs squeezed flat in what feels like a refrigerator door. But its worth it: Early detection from regular mammograms is estimated to reduce the risk of death from breast cancer by at least 15%, according to a recent research review. Are there any downsides to recommended annual screening mammos? A report in the British Medical Journal suggested they could lead to overdiagnosis—detecting tumors that turn out to be harmless—and unnecessary treatment. But experts insist that the benefits far outweigh the potential costs.

N: Nipples

Smooth or bumpy, inverted or standing at attention on a chilly day, nipples seem to have a mind of their own. Together with the surrounding areola, they even change color during and after pregnancy. Here are some of the most common problems and how to, well, nip em in the bud.

O: Ouch!

About 10% of us have breast pain more than five days a month. Usually the ache (also called mastalgia) goes in cycles, since monthly hormone changes can make breasts extra achy. If the pain is unbearable, try tracking when it hurts most. Then talk to your doctor, and, if you're over 35, consider a mammogram. The doc may recommend pain pills, birth control pills (if you're in your 20s), or possibly evening primrose oil, which might bring relief for some women. Talking to your doc may ease your fears, too, since many women worry that breast pain is always a sign of cancer. It isn't.

P: Plastic surgery

Even in a down economy, boob jobs aren't sagging. But a lesser-known surgery is also on the rise: breast reduction. For top-heavy women, the surgery can bring much-needed relief from back, shoulder, and neck pain. If you want breast surgery—to get bigger or smaller—talk to the doc about scarring, healing time, and final appearance, says John Canady, MD, president of the American Society of Plastic Surgeons.

Q: Number-one question to ask your doc: “Are my breasts dense?”

Women with dense breasts are five times more likely to develop breast cancer, Dr. Love of UCLA says, although its unclear why. The only way to find out density is after a mammogram—the info is in the results. Bring it up with your doc after the test or have the report mailed to you.

R: Rest

One more reason to get your sleep: Getting enough zzzs may help protect you from cancer. In a recent study of nearly 24,000 Japanese women, those who slept six hours or less each night were 62% more likely to have breast cancer than the women who slept seven hours. Researchers think that the sleep hormone melatonin seems to regulate the release of estrogen.

S: Soy

Soy contains phytoestrogens, chemicals similar to estrogen. Docs say soy has many benefits, if you get it in natural forms like edamame. But concentrated forms found in supplements may be harmful—especially if youre at high risk for breast cancer, says Applegate, PhD, of UC Davis.

T: Tomosynthesis

Watch for the looming debut of this new digital imaging system, which allows doctors to slice and dice super-clear 3D pictures of the breast, while applying less pressure to your boobs than standard mammos (hooray!). Early research shows the new technique may more accurately spot tumors, especially in very dense breasts.

U: Underwires are dangerous (and other myths)

Relax—, your sexy new number from Victoria's Secret wont give you cancer. Experts say the notion that underwires trap toxins just doesn't hold up. Ditto for antiperspirants, living near power lines, and being hit in the chest. Theres no evidence that any of these things causes breast cancer, Dr. Love of UCLA says.

V: Vaccine

Stimuvax, a vaccine currently in testing, may help women who have inoperable breast cancer live longer. The drug is designed to juice up the immune system so it can kill malignant cells. Its also being eyed for lung, prostate, and colon cancers.

W: Weight

Women who gain 55 pounds or more after age 18 have nearly 1 1/2 times the risk of breast cancer compared with those who keep their weight steady. But losing the weight substantially lowers risk as you age.

X: X-Rays

Radiation can cause cancer. That's why doctors say that younger women and girls should avoid unnecessary X-rays (a typical X-ray administers radiation at a higher dose than a mammogram). If your doctor recommends an X-ray for anything, ask how having it will change your treatment plan. If it won't, reconsider.

Y: Yoga

To keep “the girls” from sagging, Health expert Sara Ivanhoe, creator of the Yoga on the Edge DVD, recommends this Plank Sequence: Start with hands and knees on a mat, hands directly under shoulders and knees below hips. Firm your abs to support your lower back; extend right leg backward, curl toes and place them and on the ground; repeat with left leg. (Your body should be in a straight line from your head to your heels.) Hold for 5 full breaths. On an exhale, slowly lower yourself to the floor, keeping your elbows tucked in. Your chest and belly should touch the floor at the same time. On an inhale, push back to lean on your hands and knees; exhale into plank, hold for a full inhale, then exhale and lower again, then up into plank. Repeat 5 times.

Z: Zero!

That's the number of new breast cancer cases we all hope to see in our lifetimes—, and a project launched by the Dr. Susan Love Research Foundation and Avon Foundation for Women may get us there. The Love and Avon Army of Women's mission: Recruit 1 million women to participate in life-saving research. Sign up online at ArmyOfWomen.org.

A new study found that invasive MRSA infections, the kind that attack the blood or bones, occur more than 94,000 times a year in the United States. While most of those infections occur in hospitals, others are picked up in the outside world. Here, expert tips on how to protect yourself.

1. Wash your hands—a lot.
MRSA passes by touch. Use soap and hot water. And carry a hand sanitizer when you dont have access to a sink.

2. Be on guard at the gym.
Bring your own yoga mat, and wear workout gear that covers your skin.

3. Check it out.
Pay attention to pimples or spots that look like spider bites. If they become painful or red, see a your doc—or visit a drop-in clinic or an ER. And dont be shy about asking about MRSA.