It is important to develop a healthy muscle tone before (if possible) and during the pregnancy. Supple and elastic abdominal muscles can stretch more easily and support the pregnancy better, assist in an easier birth and contract back into shape more quickly after the baby is born.Healthy muscle tone, as we have seen, is dependent on overall use. In the Alexander Technique we never think of one set of muscles working in isolation from the rest, and the way your abdominal muscles work is dependent on the way the whole body is used. The way that you are taught to use yourself in Alexander lessons – to keep the neck free and allow the back to lengthen and move as a whole, and using movements such as monkey, squatting and lunging for your everyday activities – promotes good tone in these muscles.However, our normal everyday activities may not include the whole range of movements required to tone up the abdominals, particularly if we lead a sedentary lifestyle, with all its activity-saving conveniences. Therefore, we recommend that you practise some abdominal exercises during this time when extra demand is being put on them.Details of commonly taught exercises can be found in a number of general books on pregnancy and childbirth. However, there are some exercises that we strongly advise you against. These include all kinds of ‘sit-ups’ with straight legs, and straight leg raises with both legs extended, both of which can cause back strain and unnatural ligament and nerve elongation, weakening the lower back.Some exercises are safe, however, and these can usually be practised throughout pregnancy. A note of caution: if any of the exercises cause pain or discomfort you should consult your midwife or doctor. Remember that in the later stages of pregnancy, exercises done lying on your back may cause restrictions in the blood flow to both you and your baby as the weight of the uterus falls on to the main blood supply. If there are any signs of dizziness, shortness of breath or discomfort, stop and change position. These exercises can also be used for getting back into shape after the baby is born.The exercises should not be practised as a quick routine but with direction and conscious control. Breathing is a very important consideration in any kind of activity. Move slowly and gently enough to allow smooth and continuous breathing. Do only a few of each at one go, and always finish with an Alexander resting position. It is not how many times, how quickly or how strenuously you do them that counts – it is how well you do them that makes them really effective. We also advise you, if possible, to ask your Alexander teacher to take you through these exercises to help you maintain your directions while doing them and to make sure that you are not harming yourself.Two beneficial abdominal exercises that we recommend are both done in semi-supine. The first is to lie and gently rock the legs from side to side; in the second, one leg at a time is gently extended in a sliding motion and then returned to the bent-knee position. Hip-hitches or tail-wagging on all fours is another well known and safe exercise.*43\346\2*

Laser laparoscopy for endometriosis is surgery which attempts to remove and destroy endometrial implants, cysts and adhesions using a laser beam.

Lasers are fine, highly concentrated beams of light that can be precisely aimed and controlled. They have been used in some branches of medicine for many years. Opthamologists use lasers to treat a variety of eye diseases and dermatologists use them to remove skin cancers and other skin growths.

There are several different types of lasers used in laser laparoscopy and each one has its own particular characteristics and uses. The three types of lasers that are most commonly used in the treatment of endometriosis are the carbon dioxide laser, the argon laser and the Nd:YAG laser. The type of laser used by your gynaecologist will usually depend on which type is available.

Who is suitable for laser laparoscopy

Laser laparoscopy is most suitable for women with minimal to moderate endometriosis. It is not usually suitable for women with severe endometriosis.

Things to discuss before laser laparoscopy

At some stage before the operation you and your gynaecologist should discuss what procedures are proposed and what should be done if a laparotomy is needed.

What happens with laser laparoscopy

A laser laparoscopy involves the same basic routine as that which is used for a diagnostic laparoscopy except that a laser instrument is inserted through a channel in the laparoscope. The laser beam then travels through special fibres known as fibre-optics before being directed onto the relevant tissue in the pelvic cavity.

The laser beam can be used to remove or destroy superficial endometrial implants and endometriomas, and to remove adhesions. The implants, endometriomas and adhesions are removed or destroyed by directing and focussing the laser on to them and using the intense energy of the laser beam to ‘vaporise’ or break up their cells.

Effectiveness of laser laparoscopy

Laser laparoscopy has several advantages over other surgery. It involves less risk of accidentally damaging underlying organs because the gynaecologist is able to precisely control the depth and amount of tissue being destroyed. Similarly, because the laser destroys only the target tissue and leaves the surrounding tissue undamaged, there is likely to be less pain and discomfort and faster healing of the affected area. It is thought that the main advantage of laser laparoscopy is that it may produce less scarring and fewer adhesions than other types of surgery. In addition, because laser surgery usually involves a laparoscopy it has all the advantages associated with having laparoscopic surgery rather than a laparotomy.

The main disadvantage of laser laparoscopy as opposed to conventional laparoscopic surgery is that some women have taken significantly longer to recover from the operation because they were under the general anaesthetic for a greater period of time as laser laparoscopy takes longer to perform.

So far, there are few statistics on the effectiveness of laser laparoscopy. At present there is no evidence to suggest that laser laparoscopy is any more effective than other surgeries in terms of eradicating the disease or relieving the symptoms. Rather, in the hands of an experienced operator, the results of laser laparoscopy appear to be similar to those of other surgical treatments.

Risks and complications of laser laparoscopy

The risks and complications of laser laparoscopy are the same as those associated with a diagnostic laparoscopy.

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The menstrual cycle involves a series of hormonal events which occur at fairly regular intervals. The average menstrual cycle is approximately 28 days, although this may vary considerably between women. The menstrual cycle involves four distinct phases:

Day 1-5: menstruation (the menstrual period);

Day 3-13: the proliferative or follicular phase;

Day 14: ovulation;

Day 15-28: the luteal or secretory phase.

Although the first day of menstruation is usually referred to as the start of the menstrual cycle, the menstrual period (days 1-5) is actually the culmination of the hormonal changes which make up the menstrual cycle. Therefore, in our explanation of the menstrual cycle we will start by looking at the proliferative phase (days 3-13) and we will use a 28-day cycle to explain the process.

Proliferative or follicular phase-The proliferative phase extends from the time of menstruation to ovulation. It is known as the proliferative phase because it is the phase during which the endometrium begins to thicken or proliferate in readiness for implantation of the fertilised ovum. It is sometimes also known as the follicular phase.

During the proliferative phase the pituitary gland releases the follicle stimulating hormone (FSH) which stimulates the growth and development of several ovarian follicles in the ovary. These follicles enlarge and move towards die surface of the ovary. However, usually only one follicle continues to grow and undergo the full cycle of growth and development.

During the proliferative phase the oestrogen levels in the bloodstream rise progressively until just prior to ovulation. The rising oestrogen levels stimulate the endometrium to proliferate so that it is ready to nourish a fertilised ovum.

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•     Learn about PMT. Become aware of your body. Keep a diary of any symptoms you have at any time in the month for at least three or four months so that you understand what is related to your menstrual cycle and what is not.

•     Find a PMT club or group to join -other women’s experiences can be very reassuring and even curative.

•     Keep a note on the family’s calendar so that the rest of the family knows why you are behaving strangely and can make allowances.

•     Having learned by self-observation when to expect symptoms, do the following from ten days before their onset until the day you start bleeding:

1. Stop eating added sugar, sweet foods, refined-flour products and between-meals sugary snacks.

2. Stop adding salt to your cooking or to your food at the table. This will help reduce the amount of fluid you retain and could make you feel a lot better.

3. Stop drinking coffee and cola drinks. Drink only weak tea or other non-caffeine-containing drinks.

4. Reduce or cut out alcohol and smoking.

5. Start eating six small, high-protein meals a day rather than two or three big meals-don’t eat more over the day; simply spread it out evenly so you don’t go for long periods without eating.

6. Increase your intake of foods rich in magnesium. These include millet, corn, brown rice, potato, cashew nuts, peanuts and tomatoes. Reduce your intake of dairy foods because, being rich in calcium, they interfere with magnesium absorption.

7. Take brewers’ yeast tablets (two a day) to improve your sugar metabolism.

8. Take six capsules of evening primrose oil a day. This is especially useful for women whose main complaint is breast swelling.

9. Reduce your intake of fats, avoiding particularly animal fats and hydrogenated margarines. Consume only high quality margarines, high in polyunsaturates.

10. Take daily exercise, preferably out-of-doors. Walking and running are ideal, as are aerobic exercises and swimming.

11. If you are a PMT-H type restrict your fluid intake and beware of hidden salt in your diet as well as obvious salt. Pickled foods, preserved foods, cured meats, spinach and celery all contain large amounts of salt, so be careful. PMT-A women seem to improve with the addition of vitamin B6.

12. If this preventive regime doesn’t work then progesterone (a natural hormone made from inedible yams) can be given by a doctor. Progestogens, the synthetic versions of progesterone used in the contraceptive pill, tend to make PMT worse. Natural progesterone is best, given as a vaginal pessary or as a suppository. For some women even quite a short course of progesterone can stimulate their hormone production to normal levels.

Try to cut down on the stress in your life – this will help your PMT symptoms.

It is my own personal clinical experience, and that of several others who work in this field, that many women who suffer from PMT have emotional or marital problems that are the cause and not the result of their PMT. I find that there is often a substantial psychosexual element with many of these women and that they often give a history of troubled sexual or interpersonal relationships. I have cured many women of their PMT by psychotherapy alone and a lot of women have told me that they can date the onset of their PMT to a particular psychological, emotional or sexually-linked event in their lives. Prevention in these women involves sorting out their underlying psycho-sexual problems.

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