Women's Bodies, Women's Wisdom (47 page)

It has been commonly thought that ovaries become essentially non-functional after a woman stops having periods, but the role of the ovary in the second half of life is now being reevaluated. We now know that the normal ovary should not be surgically removed because it maintains its ability to produce steroid hormones for several decades after menopause.
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Parts of the ovaries do start to decrease in size when a woman is in her thirties, and they do lose mass more rapidly after age forty-five on average, but they are
not
the inert fibrous tissue masses they’ve been thought to be.

As women age, only part of our ovaries regresses, the part known as the
theca
. The theca is the outermost covering of the ovary where the eggs grow and develop and where physiological cysts form. In midlife the theca regresses, but the innermost part of the ovary, known as the inner stroma, becomes quite active for the first time in our lives.
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In other words, as one function is winding down, another one is starting up. This process deserves much more study than it has heretofore received. In the second half of life, women’s ovaries still produce significant amounts of a hormone known as androstenedione, a type of androgen. This substance is often converted to estrone (a type of estrogen) in our body fat deposits. Studies have shown that our ovaries can produce progesterone and estradiol even after menopause. These hormones are significant in preventing osteoporosis and heart disease and also in maintaining energy and libido.
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Up until fairly recently, menopause has been studied mostly as a “deficiency disease.” Because of this cultural attitude toward meno pause, scientists have studied this natural process only to find what is lacking. If we were to design studies of postmenopausal women in which the ovary was viewed as active and useful, we would find out more and more about the ovary’s role in maintaining normal balance in our bodies as time goes on. The truth is that our ovaries are dynamic organs that are part of our body’s wisdom throughout life, not something useless or potentially harmful to us when we are over forty.

Some ancient traditions have supported this view. In Taoist cultures the ovaries are thought to contain large amounts of the life force that constantly produces sexual energy. Special “ovarian breathing” exercises can be learned to release the life force energy produced by the ovaries and “store” it to revitalize other organs of the body, while the person achieves a higher state of consciousness. Ovarian sexual energy is thus transformed into
chi
(life-force energy) and
shen
(sheer spiritual energy).
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In the fascinating book
The Sexual
Teachings of the White Tigress
(Destiny Books, 2005), author Hsi Lai presents teachings from Japan that suggest that women can maintain their sexual attractiveness far into old age by consciously working with this energy. (See also chapter 8, “Reclaiming the Erotic.”)

When a woman does not heed her innermost creative wisdom because of her fears or insecurities about the world outside herself, ovar ian problems can arise. They may arise in situations in which she perceives herself as being controlled by or criticized by forces outside herself. Financial or physical threats in the outer world affect the ovaries, particularly if a woman believes that she has no way to alleviate the threats. Thus, a woman who is abandoned by her mate or feels stressed on the job may develop ovarian problems if she feels that she has no means of escape from her situation and that the outer world (usually in the form of limited finances) is preventing her from changing. Just as life stresses may cause uterine problems, they may also cause ovarian problems. Uterine and ovarian problems are often intimately related, but there are also differences. The primary energy involved in uterine problems is a woman’s perception in her innermost self that she can’t or shouldn’t or doesn’t deserve to free herself from a limiting situation or create solutions that can sup port her. The uterus is very intimately linked with the third chakra and self-esteem. Uterine problems result when a woman’s personal and emotional insecurities keep her from expressing her creativity fully. In these cases, she believes that she herself lacks the inner resources to do so; in other words, she is doing it to herself.

Ovarian problems, on the other hand, result from a woman’s per ception that people and circumstances
outside of herself
are preventing her from being true to herself and living from her center: They are doing it to her. An additional energy affects only the ovaries and not the uterus—the energy of vengeance and resentment, or the desire to get even. The second-chakra area is the part of the body where we traditionally wear weapons, such as guns, knives, and wallets. When a woman uses her emotional weaponry to indulge in being highly critical or wanting to get even, it is her ovaries that are at risk, not her uterus.

Benign ovarian growths differ from cancer only in the degree of emotional energy involved. Cancer in a woman’s ovarian area is also related to an extreme need for male authority or approval, as she gives her own emotional needs last priority.

Note: This so-called male approval may come not from an outside source but from a critical “male” thought pattern she has internalized and which causes her to drive herself relentlessly. I once saw an outstanding example of this. I was exercising in a hotel gym where the woman beside me on another elliptical trainer was talking incessantly on her cell phone. This went on for thirty minutes, rendering her unable to use her arms or her breath to get the full benefit of the workout. When she was finally finished, she limped—yes, limped—out of the gym, still on the phone. She hadn’t bothered to stretch or cool down. And her limp (on her right leg; the right represents the male side) suggested that she had perfected the art of ignoring her body and need for balance completely. Though I had no way of knowing what the health of this woman’s ovaries was like, it was very clear to me that if her behavior in the gym was any indication of the overall balance of her life, she was heading for a health crisis (or at least an orthopedic injury that would force her to get off her feet).

A woman at risk for ovarian cancer may feel that she doesn’t have enough power, financial or otherwise, to move or to change even an abusive situation. In contrast to cervical cancer, which may incubate for years, ovarian cancer usually develops rather quickly due to a precipitating psychosocial trauma, such as a mate announcing that he or she is leaving.
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A friend of mind developed an ovarian cyst when she began to realize that her job was not good for her and that her relationship with her husband was not mutually supportive. During the same period, her husband began having an affair. Dealing with her cyst helped her to realize that there were real problems in her day-to-day life that she had to deal with. Her body was concretizing her emotional dissatisfactions and, in its wisdom, drawing her attention to her need to care for herself.

One of my patients, Beverly, had a long history of endometriosis, and her right ovary had been removed because of a benign growth four years before I met her. When she first came to see me, she was com plaining of intermittent pain associated with her left ovary. She was worried that she might have to have this ovary removed as well, but she did not want to do this. She was only thirty-two and didn’t want to be on hormones to replace her body’s own supply. She was ready to work toward the deepest level of inner healing. On ultrasound, her remaining ovary had some small cysts in it consistent with endometriosis of the ovary. Medical intuitive Caroline Myss did a reading that revealed that Beverly had a lifelong history of truncating her own creative needs in order to meet the demands of her family, who lived close by. She also hated her high-powered executive job, which took up about seventy hours of her time per week.

Caroline told Beverly that she would not get well until she allowed herself at least one hour a day of creative time just for her. During this time, she was to release all expectations of productivity. She should simply allow her creativity to flow in whatever way it needed to. Beverly had always enjoyed working with fabric and was accom plished at needlecraft. She began to sit each day and create small, very magical-appearing dolls that, she said, “seemed to have a life of their own.” She told me that the dolls themselves dictated to her how they would look and what they would wear. When she first brought a few into my office, I was enchanted by them and purchased two for my daughters for Christmas. As she allowed herself this creative time, her pelvic pain eventually disappeared. It returned intermittently when she got caught up in the demands of the external world at the expense of her own creative work. Her ovary, through its persistent voice, became a personal barometer for her of how well she was allowing her innate creativity to flow. As she changed her entire “male” approach to life, the dolls that birthed through her continued to change and evolve as well.

OVARIAN CYSTS

We women are meant to express our creative natures throughout our lives. Our creations will change and evolve as we ourselves grow and develop. Our ovaries, too, are always changing, forming, and reabsorbing those small physiological cysts. As long as we express the creative flow deep within us, our ovaries remain normal. When our creative energy is blocked in some way, abnormally large cysts may occur and persist. Energy blockages that create ovarian cysts may result from stress. Such stress is not necessarily negative; for example, a woman may have a job that she loves but may sometimes simply neglect her need for rest. A cyst may be the result.

The left side of the body represents the female, receptive, yin side, while the right side is the more analytic, action-oriented yang, male side. And amazingly, these differences are reflected in the differing con nections of each ovary in the brain.
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Most of the ovarian cysts I’ve seen are on the left side— symbolic, I feel, of the wounded feminine in this culture. Many women try to imitate male ways of being in the world that don’t always fit their inner needs. When I had my first intuitive medical reading with Caroline Myss, she told me that if I had stayed in my former medical group, I would have developed a pathological ovarian cyst within the next year that probably would have required surgery. It had already been forming in my body’s energy field! When I heard this, I realized that my inner guidance and decision to leave that practice proactively had averted a health crisis.

In premenopausal women in general, cysts that are less than four centimeters in diameter are considered normal. An ovarian cyst is called a
functional
cyst
when it arises as part of the ovulation process. A cyst larger than four centimeters may be watched for a few months to see if it goes away. An abnormal cyst may contain fluid, blood, and cellular debris under the surface covering the ovary or within the body of the ovary itself.

Symptomatic Functional Ovarian Cysts

Follicular Cysts

Many ovarian cysts that grow bigger than four cen timeters and persist after two or three menstrual cycles are actually functional. Such cysts form when the follicle, the physiological cyst in which the egg develops, fails to grow and discharge the egg in the normal way. When this happens, the ovarian follicle may continue to grow beyond the time when ovulation should have taken place. It sometimes grows as big as seven or eight centimeters in diameter and can be painful. These cysts are described on ultrasound as unilocular and thin-walled, meaning that they consist of just a single collection of fluid con tained within a thin membrane. They usually go away on their own, but some persist and require surgery. Although some physicians prescribe birth control pills to stop the ovulation process and allow the cyst to regress, the newer low-dose-estrogen birth control pills do not contain enough hormone to shut down the ovary and influence the cyst.

Luteal Cysts

Another type of functional cyst is known as the corpus lu teum. A corpus luteum, or luteal cyst, forms when the mature egg is discharged from its follicle at ovulation. This process is sometimes accompanied by a small amount of bleeding into the ovulation site on the capsule of the ovary—and sometimes into the pelvic cavity as well—at the time when the egg erupts from the ovary.

Some ovarian cysts are completely asymptomatic, while others cause pain. The pain can be sharp and knife-like if, for example, the cyst bursts and spills its contents into the pelvic cavity. Or the pain can be dull and aching if the condition is more chronic, as in many cases of endometriosis of the ovary. A small pain sometimes accompanies ovula tion, caused by the release of blood into the pelvic cavity. It is known as
mittelschmerz
(middle pain). Bleeding into a cyst cavity or the pelvic cavity often causes pain because it stretches the ovarian capsule (the tis sue on the surface of the ovary). This pain can last from a few minutes to a few days. If the bleeding continues into the cyst wall for longer than a few hours, the corpus luteum becomes known as a
corpus hemorrhagicum,
which simply means “a body that bleeds.” Bleeding from a corpus hemorrhagicum can last for several hours or even days and sometimes mimics an ectopic (tubal) pregnancy. It may be accompanied by vaginal bleeding. Hemorrhagic cysts usually go away on their own, but they can cause several days of pain. Very occasionally, the bleeding doesn’t stop and surgical intervention, usually through the laparoscope, becomes necessary. Most often, this procedure stops the bleeding and removal of the ovary isn’t necessary.

Most functional ovarian cysts are diagnosed by a pelvic examination, followed by an ultrasound evaluation. Both ovaries are examined and compared to be sure that it is an ovarian cyst and not something else, such as a fibroid, that is being felt.