Endometriosis Fast Treatment

51 Tips for Dealing with Endometriosis

51 Tips for Dealing with Endometriosis

Do you have Endometriosis? Do you think you do, but aren’t sure? Are you having a hard time learning to cope? 51 Tips for Dealing with Endometriosis can help.

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Treating Your Endometriosis

Shelley Ross put it upon herself to help endometriosis sufferers lead the most comfortable, healthy, and normal lives possible. Her efforts began with her e-book Treating Your Endometriosis, and the popularity of that ebook brought about her blog. In her Treating Your Endometriosis eBook Shelly talks about the endometriosis diet that is a key factor in addressing endometriosis pain and symptoms. Endometriosis is not something to be taken lightly. If you suspect that you may have endometriosis you should immediately seek medical advice for a diagnosis. While there is no cure for the disease, it is possible to treat it through a variety of treatments.

Treating Your Endometriosis Overview

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Endometriosis What It Is and Isnt

Endometriosis is a long word derived from Greek, as many medical words are, but what is it In this part, we look at the complicated disease of endometriosis what it is, what the typical symptoms are, and how common it is. We cover some biology to give you a good understanding of how all your inner parts interrelate. And we look at the reasons some women get the disease and others don't.

Finding endometriosis in unexpected places

I have seen some strange cases where pelvic endometriosis causes seemingly unrelated symptoms. A patient had right-side pain at the level of her umbilicus (belly button) and multiple intestinal symptoms, such as nausea, constipation, and pain after eating. She had a previous diagnosis of irritable bowel syndrome (IBS) or some other inflammatory bowel disease, but when she didn't receive any relief from other treatments, she turned to me. After much discussion, she decided on laparoscopy to try and determine the cause for her problems. Very unexpectedly, I found severe endometriosis her intestines were stuck to her uterus and right ovary, and her appendix was literally stuck to the top of her uterus After I cut down the adhesions and removed the appendix, her intestinal symptoms resolved.

Measuring How Endometriosis Affects Your Reproductive and Other Organs

Endometriosis lesions can act and look differently in different areas, but all are detrimental. In addition, the amount of endometriosis isn't always an indicator of the damage or pain it causes a little endometriosis in one location can be much more damaging and painful than a lot of endometriosis somewhere else. In fact, doctors have known for a long time that the amount of visible endometriosis has very little bearing on the symptoms. In this section, we discuss the ways endometriosis can damage different organs. (See Chapter 7 to find out how these changes can affect your fertility.)

Understanding your immune systems role in endometriosis

Most women have the components (such as retrograde menstruation) that would make endometriosis development possible. So why does only a small percentage of women ever develop endometriosis Why do the endometrial cells take root and grow in some women and not in others The answer may lie in the immune system. The study of the immune system and its relation to endometriosis and other immune-related diseases (such as lupus, fibromyalgia, and chronic fatigue syndrome) has rapidly progressed in the last decade. The immune system does seem to play a role in endometriosis. New research sheds more and more light onto the inner workings of the immune system, but at the same time that research makes the waters murky. Endometriosis isn't immune (forgive the play on words) to this confusion. In the next sections, we highlight and try to simplify the immune system's involvement in endometriosis.

Are endometriosis and cancer related

Having endometriosis is bad enough, but the thought that endometriosis may increase your risk of developing certain types of cancer is even worse. Even though studies are inconclusive about a definite link between certain cancers and endometriosis, research indicates that endometriosis doesn't increase the general risk of cancer. However, endometriosis may increase the risk of certain rare cancers. According to a very large (64,000 women) retrospective study (researchers looked at statistics only after the study was complete) in Sweden, the cancers that are more prevalent in women with endometriosis are i Women who had endometriosis and a hysterectomy showed no increase in ovarian cancer over the general population. i Younger women who developed endometriosis between the ages of 20 and 40 had a higher risk of getting ovarian cancer than other age groups. i Women with endometriosis developed cancer at a younger age than the general population. i Women with endometriosis had a lower...

Suspecting Endometriosis Defining the Symptoms

Counting off the common symptoms of endometriosis Identifying the less common symptoms Tracking symptoms and other factors of endometriosis s something wrong with you, something you and your doctors can't put your collective fingers on You may wonder whether endometriosis is causing the symptoms that have been plaguing you. However, your symptoms seem so varied and elusive at times that you aren't quite sure what's wrong. In this chapter, we help you answer the question, Could I have endometriosis by discussing the most common symptoms of the disease. We also identify the less familiar problems of endometriosis so you can get a more complete picture of this complex disease. Finally, we help you get a handle on your specific situation by showing you how to keep a written record of symptoms (when they occur and under what circumstances) and other relevant information. With these facts, you can give your doctor clear and accurate descriptions that will help her help you. Considering the...

Understanding Your Menstrual Cycle And Its Relationship to Endometriosis

Figuring out the connection Your menstrual cycle and endometriosis Taking a closer look at the painful side of cycles Making dysfunctional periods functional Adjusting abnormal bleeding through surgery Bidding a not-so-fond farewell to endometriosis Menopause Endometriosis can disrupt the normal march of your menstrual cycle by interfering with your hormones, your egg's production and release, the fertilization of the egg, and the egg's ability to travel to the uterus. In addition, endometriosis can cause pain throughout your menstrual cycle, especially around your period. This chapter looks more closely at your menstrual cycle and the ways endometriosis can mess it up. We uncover the relationship between your period and endometriosis by first looking at a normal period and then comparing it to a period with endometriosis. We also tell you how to know whether your pain is endometriosis or another gynecologic problem. Next we discuss medical and surgical treatments to regulate your...

Your Period and Endometriosis Why Are They Connected

Fact Endometriosis and your menstrual cycle are closely related. Because endometriosis derives from endometrial tissue, it functions in much the same way it grows like your uterine lining does during the first part of your menstrual cycle and bleeds when your uterine endometrial lining sheds during your period. For this reason, many women experience more pain from endometriosis around the time of menses than any other time. (See Chapter 3 for more background on endometrial tissue.) To understand the symptoms of endometriosis, you need to first understand the inner workings of the menstrual system. In the next sections, we tell you how your menstrual system works when it's in perfect order and then give you the lowdown on how endometriosis can throw your menstrual cycle out of synch.

Understanding how endometriosis affects your period

Endometriosis can interfere with your menstrual cycle in a number of ways. Starting right from Day 1 of your cycle, endometriosis on or around your ovary can interfere with your egg production. If you're not planning on getting pregnant, you may say, So what But the whole purpose of the menstrual cycle is the maturation, release, and implantation of an egg. Disrupting the process in any way impacts your periods. Although the exact reasons aren't clear, endometriosis in and around the ovaries can interfere with your period by Women with short menstrual cycles may also be more likely to develop endometriosis if they don't already have it. This connection may exist because of the retrograde menstruation theory (see Chapter 4 for more about this theory). Bleeding more frequently means that more blood spills into the pelvis, giving endometriosis more chances to grow where it doesn't belong.

Pain by Any Other Name Is Still a Pain But Is It Endometriosis

Do you experience monthly pain with your period Occasional, mild pain isn't unusual. However, for recurrent and or severe pain during your menstrual cycle, you need to see your doctor so he can determine whether you have endometriosis. Although the only way to definitely diagnose endometrio-sis is through surgery, the pattern and type of pain you feel each month may lead your doctor to a presumptive diagnosis of endometriosis. Pain during or around your period is a classic sign of endometriosis. (Check out Chapter 9 for more on how your doctor makes a presumptive diagnosis.)

Speculating on How Endometriosis Develops The Most Common Theories

Retrograde Menstruation

Several prevalent theories exist as to why endometriosis develops in some women and not in others. Some days you may not really care how it got there you just want it to go away But understanding how a disease works is the first step to overcoming the problems it can bring. In this section, we review the most common theories. Retrograde menstruation is one of the oldest theories describing the possible development of endometriosis. In the 1920s, Dr. John Sampson first identified retrograde menstruation as a possible explanation for endometriosis. But this theory can't be the only explanation of how endometriosis develops, because of these problems This theory doesn't explain how endometriosis ends up in places far from the pelvic cavity. This theory doesn't explain why all women don't have endometriosis, because more than 90 percent have retrograde menstruation. The following two sections look more closely at how a woman's body, combined with retrograde menstruation, can lead to...

Hello Menopause Goodbye Endometriosis

For many women with endometriosis, there's an end in sight it's called menopause, the cessation of menstrual periods. Normally women stop having periods between the ages of 45 and 55 because the ovaries produce less estrogen and progesterone. At menopause, all (or almost all) primordial follicles are used up so eggs can't form. With no follicles or eggs, a woman's body doesn't produce estrogen. As a result, the tissues that normally respond to estrogen (like the endometrium and breast) no longer grow. Because hormones are responsible for the symptoms of endometriosis and because artificially induced menopause (with hormone therapy) often reduces the pain of endometriosis, we can expect menopause to end endometriosis. Although the pain of endometriosis continues into menopause for a small percentage of women, the end of menstrual periods is the end of pain for many women. Unfortunately, a few women don't follow the rules. They may be taking estrogen for hormone replacement or making...

Suspecting intestinal endometriosis

Intestinal problems are common in endometriosis at least 30 percent of patients, probably more, have some intestinal symptoms. But endometriosis isn't the first problem doctors think of when they hear patients complain about intestinal issues. In fact, endometriosis may be the last diagnosis they consider. Despite this fact, endometriosis in the intestines, not the pelvic area, is the most common site for post-menopausal women. You don't have to have endometriosis on your intestines to have intestinal symptoms in fact, most people with symptoms don't have endometriosis on their intestines. Most symptoms are due to irritation from endometrial implants in adjacent areas (such as the ligaments) and adhesions from other areas to the intestines. In addition, inflammatory factors can affect intestinal function just as they can affect other organs. Endometriosis can cause the following intestinal issues When patients do have endometriosis on their intestines, the implants are usually...

Differentiating between IBS and intestinal endometriosis

Two diseases that people easily confuse and doctors misdiagnose are intestinal endometriosis and irritable bowel syndrome, or IBS. A lot of people up to one in five have some symptoms of IBS, and one in ten doctor visits relates to its symptoms. IBS can come and go, or it can become a chronic condition. The symptoms bloating, cramping, diarrhea, and constipation are similar to the symptoms of intestinal endometriosis, so you may not realize which problem you have. IBS symptoms are more common in women and are more annoying during menses. Changes in the nerves that control the contractions of the intestinal wall may cause IBS. Endometriosis has these same problems, making the diagnosis between the two conditions difficult. If you don't have a diagnosis of endometriosis but do have symptoms that seem like IBS, your doctor may treat you for IBS through diet, stress reduction, and medications. No rule says you can't have more than one disease. If you already have endometriosis and then...

Diagnosing and treating intestinal endometriosis

.cjMiEfl Because endometriosis may not invade as deep as the mucosa, it's almost impossible to find during diagnostic tests, such as a barium enema or a colonoscopy. As a result, the best way to diagnose intestinal endometriosis is the best way to diagnose any endometriosis surgically. But endometriosis on the intestine may be difficult to see during either laparotomy or laparoscopy. Both types of surgery have their advantages and disadvantages. What are the main differences between the two surgeries in terms of diagnosing endometriosis in the intestines Another advantage is that the scope magnifies the view by 1.5 to 2 times, so your surgeon can find a more subtle disease. But, seeing all the small intestine through the laparoscope is difficult, and feeling anything through the laparoscope is impossible. Another problem is that very few skilled surgeons can remove endometriosis from the intestine via laparoscopy, so a second surgery may be necessary.

Endometriosis and Your Urinary Tract More Than Just Another Infection

Although the bladder is relatively near other organs in the pelvis, endometriosis in the urinary tract itself is fairly rare. (Check out Chapter 3 for a full discussion of these organs.) However, if you or your doctor suspects you have endometriosis in your urinary tract, then this section is for you. In this section, we take a closer look at endometriosis in the urinary tract by identifying some of the common symptoms, figuring out how to diagnose it, and naming the best treatment options.

Endometriosis and your fallopian tubes

Scarred Fallopian

Endometriosis can implant on the outside surface of the fallopian tubes and cause scarring. Just like burn scars can lead to contractures that distort limbs and other body parts, the endometriosis scarring can distort the fallopian tubes so they can't function properly. How endometriosis blocks your tubes Endometriosis inside the fallopian tube can partially or totally block that tube. This blockage may cause infertility or ectopic pregnancy. Unfortunately, even good imaging techniques, such as X-rays or ultrasounds, can't see inside the tubes. Likewise, during surgery, doctors have a difficult time seeing directly in the narrow tubes because the instruments used to view the pelvic cavity are too big to enter the tubes. Even if the fimbriae aren't destroyed, any decrease in their functionality can lead to problems. For example, endometriosis may cause them to stick to the ovary, tube, uterus, intestines, or pelvic wall, so they can't move around to pick up an egg. Inflamed fimbriae...

Endometriosis A Quick Review of Biology

Ureter Rectum Ovary

Understanding how endometriosis affects your reproductive system and other organs This chapter fills in the gaps with knowledge about the female anatomy and physiology. In this chapter, we also explain what endometriosis consists of and how the condition affects different reproductive and surrounding organs. Whoever said It's what's inside that counts was right. How your body functions has very little to do with what you see on the outside it's all about what goes on in the places you can't see. In the case of the female body, you may be familiar with many parts and their names, but maybe you're a little hazy on their exact locations and functions. So, to understand endometriosis, you first need to understand your reproductive system and the organs that surround it. Figure 3-1 is a picture that's worth a thousand words. This section contains a part-by-part description of your reproductive system and nearby organs that endometriosis can affect. 1 The innermost part of the uterus, the...

Endometriosis in the lung tissue parenchyma

Parenchymal endometriosis, an uncommon disease, has a completely different course and probably a different way of spreading than pleural endometriosis. Most patients with parenchymal endometriosis cough up blood during their period but don't have pain or trouble breathing. Also, patients with parenchymal endometriosis often don't have pelvic endometriosis but do have a history of pelvic surgery or vaginal delivery. Note One theory of how endometriosis arrives in the lung tissue is that the endometrial cells spread through the blood vessels as emboli (small clots that travel through the blood stream). (You may have heard about these clots from varicose veins in the legs causing severe problems )

Figuring Out Why Endometriosis Is a Major Cause of Infertility

Many women find out they have endometriosis because they've been unsuccessful at trying to get pregnant. They never mentioned the menstrual cramps, diarrhea, and pain that come with every period to their doctor (probably because their mom told them those symptoms were just part of being a woman). But now, after six months of trying to have a baby, they're beginning to suspect that mom's advice (Just relax and you'll get pregnant ) may not be all that accurate. How big a deal is endometriosis when you're trying to have a baby Endometriosis can be a very big deal, depending on where it is and how much you have. Are there ways to overcome endometriosis and have that bundle of joy you dream of Yes, but it's not always easy or cheap. But, first we give you a quick review of the normal steps to pregnancy so our discussion of endometriosis and infertility is easy to understand. We also look at the number of women with fertility problems due to endometriosis you'll see that you're not alone

Whose fertility is affected by endometriosis

Although you may feel like you're the only one in the world not able to get pregnant, you're not alone. Having trouble getting pregnant is a major concern for women with endometriosis. The following statistics show the widespread effects of this disease on infertility 1 Endometriosis is responsible for around 30 percent of these infertility cases. 1 Thirty percent of laparoscopic surgeries for unexplained infertility result in a diagnosis of endometriosis. 1 About 40 percent of women with endometriosis have some degree of infertility. Most people start trying to get pregnant with the attitude that it will occur quickly, like five minutes after they consider the idea Unfortunately, becoming pregnant isn't easy for many women with endometriosis although, if your endometriosis is mild, you may get pregnant just as fast as the next guy (or girl, in this case). How long you should try before seeing your doctor depends somewhat on your age and circumstances, but the following guidelines may...

Endometriosis in Your Lungs Coughing Chest Pain and Breathing Problems

Endometriosis in your lungs isn't common, and it can be really hard to diagnose because your doctor won't think of it when you come in coughing up blood. You may not even think to tell him you're having your period, and he's unlikely to ask. Diagnosing endometriosis in the lungs, or thoracic endometriosis, requires an inquiring mind. Even if you know you have endometriosis elsewhere, you may think that relating it to your lung problems is too far fetched. Thoracic endometriosis can cause many different symptoms, all seemingly unrelated to your pelvis. But suspecting thoracic endometriosis is the first step to diagnosing it, and you may be more likely to make the connection than your doctor, especially after reading this book. Thoracic endometriosis causes different symptoms, depending on the location of the lesions. Endometriosis can be either in the lung tissue (the parenchymal tissue), or in the lining of the lung (the pleural tissue). Endometriosis is about five times more common...

Endometriosis In Around and On Your Ovaries

Ovaries are one of the most common sites for endometriosis. Endometriosis here can gum up the works, so to speak, and interfere with pregnancy by Ovarian endometriosis was the first endometriosis to be seen microscopically, and it can develop on the surface of the ovary or bury itself deep inside. This section looks more closely at how endometriosis affects the ovaries and causes infertility.

Endometriosis and your pelvic cavity

Male Reproductive System

Endometriosis that implants on the peritoneum in the pelvic cavity (see Figure 3-5) can cause severe inflammation that leads to adhesions or scar tissue. These adhesions can then cause all these organs and tissues the uterus, ovaries, tubes, intestines, and bladder to stick to each other so they don't move in the usual manner. This restriction of movement and the inflammation due to endometriosis cause the pain or discomfort. In addition, these same adhesions can make the intestines, bladder, and reproductive organs malfunction. Endometriosis in the pelvic cavity can cause pain in several ways i Endometriosis may simply irritate these nerves or actually entrap them, causing even more bizarre symptoms, such as back and leg pain, loss of feeling in the legs, vulvar discomfort, and other lower extremity symptoms. (Check out Chapter 2 for more information on the symptoms of endometriosis.) S Pelvic wall endometrial lesions can rupture. The fluid released contains many irritants that lead...

Understanding the link between endometriosis and egg development

Endometriosis has four classifications of severity, from Stage I to Stage IV (see Chapter 9 for more on endometriosis staging), and different stages impact egg development in different ways. Early-stage endometriosis and your ovaries Early-stage disease, Stage I (minimal) and Stage II (mild) endometriosis, seems to cause different problems related to egg production 1 Early-stage endometriosis seems to cause poor embryo quality, which is related to either poor egg quality or poor sperm quality. tf-Sfy Stage I and II endometriosis appear to have a worse effect on egg develop- TpfSfX ment than Stage III and IV disease. But this theory doesn't make sense Why ) are the earlier stages worse on the eggs The following explanations are possible 1 The later stages of endometriosis are mostly burnt out (no longer growing) and are much less metabolically active than the earlier stages. Severe endometriosis and your ovaries Endometriosis is classified as severe depending on the amount of...

Processing how endometriosis destroys ovarian tissue

Researchers and doctors know that endometriosis can hinder egg development, especially in early stages of the disease. But when a woman has the late-stage disease (which is metabolically less active), why is achieving pregnancy still hard How does endometriosis decrease ovarian reserve, causing you to lose eggs In simple terms, the advancing process of endometriosis destroys the ovarian tissue. The following steps indicate this process

Noting the chemical effects of endometriosis

Endometriosis can have serious chemical effects on peritoneal fluid (the fluid that accumulates in the abdominal cavity) and other parts of the reproductive tract. These chemical changes can make fertilization and implantation difficult. Because the peritoneal fluid is in constant contact with the ovaries and fallopian tubes, any toxic chemicals from the fluid can affect the ovaries and tubes, as well as the eggs, sperm, and embryo.

Removing damaged intestine when your deep intestine endometriosis is severe

If you have deep intestinal endometriosis or the intestine is injured while removing superficial disease, the surgeon may have to remove a part of the intestines. This is a fairly routine procedure in a controlled situation, and a bowel prep can make the surgery and your recovery much simpler. (Fortunately, only about 1 to 2 percent of women with endometriosis on the intestines need this type of surgery.) If the endometriosis has caused extensive scarring and or inflammation of the intestinal wall, the best choice may be to remove this piece of intestine because the surgeon may not be able Although the procedure of entering the intestines may sound simple, it's actually very involved, and the surgeon must be very careful. He must repair any compromised areas immediately and expertly. In many cases, he must remove whole sections of the intestine to insure that damaged and weakened areas don't cause future problems, including necrosis (essentially death) of remaining sections due to...

Blaming Mom Is endometriosis hereditary

Research shows that endometriosis has a family link because it tends to cluster in families. If you have a first-degree relative (a mother or sister with endometriosis), your risk of having endometriosis is seven to ten times higher than your friend who has no endometriosis in her family. Not only are you more likely to have endometriosis if it runs in your family, but your disease is also likely to be more severe than endometriosis found in women without a family history of the disease. Aren't genetics grand This section looks more closely at the possible connections between genetics and endometriosis. This section also helps you check out your own family tree to see whether endometriosis is prevalent. So why does endometriosis run in families Today's researchers seek answers to this question. Great leaps in the study of molecular genetics (looking at chromosomes and individual genes) have given researchers new insight into the inheritance of the disease. As with many other diseases,...

Endometriosis in the lining of the lung pleura

More than 90 percent of cases of pleural endometriosis are on the right side. Often small holes are in the diaphragm, the muscular membrane that separates the abdominal and thoracic cavities. Most patients with pleural endometriosis also have pelvic endometriosis. One theory is that endometriosis travels through the small holes in the diaphragm. When endometriosis is in the pleural tissue, the most common symptoms are

Do You Have Endometriosis Your Initial Exam and Diagnosis

Knowing what to expect during the exam Communicating with your doctor Relying on diagnostic tests Taking a close look at endometriosis Classifying the stages of endometriosis M ow do you find out whether you have endometriosis You may suspect it, think that your symptoms match those in every book and on every Internet support board, know that your mom and six sisters all have it but how do you know for sure When you really want a diagnosis, you need to talk with a doctor. But how does a doctor know you have endometriosis In many cases, this disease isn't easy to diagnose. In this chapter, we tell you about preparing for your first diagnostic appointment, what occurs at that exam, and how you can communicate most effectively. We also tell you what's in your doctor's bag of tricks to properly diagnose endometriosis, including lab tests, imaging techniques, and the granddaddy of diagnostic gold standards a biopsy. After you have a diagnosis, we tell you how the doctor analyzes your...

The Mystery of Traveling Endometriosis

You suspect you have endometriosis, or your doctor may have diagnosed you with the disease. However, you're wondering how the endometriosis you have in your pelvic area can end up in your lungs or even your brain. It didn't catch the red-eye from your uterus to your lungs, so how does endometriosis travel to different areas in your body from the pelvic area Animal studies show that when scientists place endometrial tissue into an animal's pelvic cavity, the tissue eventually resembles endometriosis. (The only animals that spontaneously develop endometriosis are rhesus monkeys, as far as we know.) Yet, unlike in humans, this artificially induced disease in the studies doesn't seem to travel anywhere. In this section, we discuss the ways endometriosis may hitch a ride to far-off parts of the body.

Biopsying endometriosis

Physicians refer to surgically removing endometriosis and identifying it microscopically as the gold standard, that is, the best procedure to diagnose endometriosis. Your doctor can make this diagnosis through laparoscopy, a minimally invasive procedure, or by a laparotomy, a larger incision (see Chapter 11 for descriptions of the surgeries). Biopsy of endometriosis is fairly easy, but, like all procedures, it carries some (though small) risk. Also, a biopsy may miss the endometriosis, or the endometriosis may be unrecognizable to the pathologist due to distortion of the tissues. Because endometriosis isn't accessible from outside the body, a surgical procedure must provide the specimen. Two procedures are possible an open procedure (laparotomy) or a less invasive procedure (laparoscopy). Although the laparoscopic approach takes more skill and experience, most surgeons can get a specimen via this route. The easiest way to get a specimen is by peeling or wiping it off the surface of...

Relying on Prescription Drugs to Treat Endometriosis

Figuring out how drug therapy fights endometriosis Looking at your medication options Giving nonhormonal options a try Staying optimistic about the future m Mnfortunately, no medications are available to cure your endometriosis. With so many drawbacks, why do doctors prescribe medications for endometriosis Because the meds do help with symptoms even though the relief may be temporary and the meds can help avoid surgery. Oftentimes the medications can get you through the tough times until you get pregnant or the disease runs its course. In this chapter, we discuss the most commonly prescribed medications and their pluses and minuses. We also tell you what you can do to alleviate side effects.

Understanding Medical Treatment How Drugs Fight Endometriosis

Medication therapy isn't a permanent cure for endometriosis. Although it may help with symptoms for a period of time maybe up to a year or two after treatment stops in the case of the hormonal therapies, dietary changes, and natural substances medication eventually becomes ineffective and the Different classes of medical therapy work in different ways. Some medications relieve pain and decrease inflammation although they don't directly affect the endometriosis. Other therapies suppress the growth of the endometrial tissue and cause the endometrial implants to shrink down and become inactive. None of the medications currently available totally eliminates endometriosis, nor do any of them affect adhesions and anatomic distortions already present. Even after hormonal treatment, endometriosis is still there and gradually reactivates after your ovaries start working again. Active endometriosis returns gradually 12 to 24 months after you stop treatment. When you start considering medication...

Approach to acute pelvic pain with a positive pregnancy test

In a female patient of reproductive age, presenting with acute pelvic pain, the first distinction is whether the pain is pregnancy-related or non-pregnancy-related on the basis of a serum pregnancy test. B. In the patient with acute pelvic pain associated with pregnancy, the next step is localization of the tissue responsible for the hCG production. Transvaginal ultrasound should be performed to identify an intrauterine gestation. Ectopic pregnancy is characterized by a noncystic adnexal mass and fluid in the cul-de-sac.

What a Gas Endometriosis and Your Intestines

If they're not out of order, you probably take your intestines (the interchangeable term for bowels) for granted. When it's working right, intestinal plumbing is fairly predictable, reasonably painless, and only occasionally inconvenient. But for many women with endometriosis, their intestines are truly in an uproar much of the time. If you suspect that endometriosis is affecting your intestines, then this section is for you. This section looks at how endometriosis can affect your intestines, what you can do if you suspect you have endometriosis there, what symptoms you need to look for, how your doctor diagnoses endometriosis at this site, and what your treatment options are.

Endometriosis in Your Brain Rare but Possible

The idea of endometriosis ending up in the place farthest from its initial source may sound impossible, but it's true endometriosis can, in rare cases, end up in your brain. (So no matter what some people think, endometriosis is definitely not just in your head.) Obviously, more than retrograde menstruation must send endometrial tissue all the way up to your head, so endometrial tissue must arrive there via one of the other theories of endometriosis transmission. (See Chapter 4 for the theories on how endometriosis travels all over your body.) Cerebellar endometriosis, or endometriosis in your brain, can cause headaches, seizures, or, in very rare cases, bleeding in the brain. The diagnosis may be aided by CAT scan or MRI. A spinal tap (placing a small needle into your back to get spinal fluid out) may show blood or endometrial cells. Cases of endometriosis in the brain are rare, so standard treatments don't exist. Brain removal usually isn't an option Most of the time, doctors...

Determining What Causes Endometriosis

Figuring out your immune system's role Examining the theories Which one is right Watching the ways endometriosis gets around Steering clear of endometriosis Feasible or not Endometriosis isn't an unknown disease, but it's still a mysterious one. The tissue that behaves normally in the endometrium (the layer of tissue that lines the uterus) causes all kinds of pain and dysfunction when it hits the road and travels through the reproductive tract and beyond. One of the toughest questions is What sets the events into motion that move endometrium from the endometrial cavity into other parts of the body to become endometriosis Researchers have been studying endometriosis, trying to answer this question. This chapter looks at all the most common current theories as well as some other theories that attempt to explain the development of endometriosis.

All Things Teens Diagnosing Treating and Coping with Endometriosis

Recognizing the differences in teenage endometriosis Keeping up on treatment risks Opening the doors of communication Adjusting to the challenges of endometriosis l ot too many years ago, doctors thought teenagers couldn't have endometriosis, and many moms taught their daughters that pain, cramps, and abnormal bleeding were just a normal part of becoming a woman. Now that doctors have diagnosed endometriosis in girls as young as 11 years old, they're more aware of endometriosis as a possible cause for a teen's painful periods.

Coping with Endometriosis and Your Emotions

Figuring out how endometriosis affects your mental health Understanding depression Considering anxiety M *oes anything make you feel more alone than a disease that others can't see People with a chronic disease, such as endometriosis, deal with it in different ways. Some never stop talking about the problems, and others never talk about the disease at all. Neither extreme is good for your emotional health. Trying to find a happy medium is important for your own emotional and psychological well-being. However, no matter how you cope, you may inevitably be depressed or anxious at one time or another. Face it Endometriosis is very painful, and its symptoms are so overwhelming at times that even the strongest people can experience depression and anxiety. In this chapter, we help you to emotionally and psychologically handle the frustration of endometriosis in a way that's healthy for you and the people around you. We look at how endometriosis affects your mental well-being, why women...

Understanding How Endometriosis Can Affect Your Mental Health

Initially you may be scratching your head and wondering how we can even suggest that endometriosis may affect your emotional and psychological well being. Endometriosis is a disease typically located in a woman's reproductive organs that causes physical pain, right How can it affect your mental health In addition to causing severe physical pain (check out the symptoms of endometriosis in Chapter 2), endometriosis can severely affect your mental health. When you're in pain, you may feel alone. As often as other people say, I know how you feel, you can't help but feel that they really don't understand at all. And verbalizing your pain over and over because other people forget about it becomes frustrating. Yet you feel like a hypochondriac when you have to keep turning down invitations and activities you may really want to do. How do you keep the balance between feeling like a martyr when no one understands and being this person whose every waking moment is consumed with endometriosis...

Changing Your Lifestyle When You Have Endometriosis

Living well despite endometriosis Making changes in your work life Lowering the stress in your life Taking in the good, leaving out the bad Getting up and exercising Detoxing your world Adding some spice to your sex life n a perfect world, you wouldn't have the inconvenience of endometriosis but in the real world, you do. However, having endometriosis doesn't have to mean the end of life for you. For the most part, you don't really want to change your life completely. Maybe you're fairly happy with it the way it is. And if you aren't completely happy with your life, you may feel too overwhelmed to make any significant changes. Finding the right job, decreasing your stress, and improving your sex life may not make you forget your endometriosis, but they can add to your life in a way you didn't think was possible. Even little choices like eating right and exercising regularly can change your outlook on life (and even help reduce the pain). In this chapter, we're your cheerleaders,...

Endometriosis may even cause intestinal contractions and hypoglycemia

A study by Baylor University looked at a group of women with endometriosis and found they had increased frequency of contractions within the muscle layer of the intestine, which can be related to the production of prostaglandins and other substances by the endometrial implants. (Prostaglandins are produced in the endometriosis and then released into the surrounding tissues, blood vessels, and lymphatic tissue.) This occurrence may also account for cramping and intestinal symptoms in women who have endometriosis in places besides the intestines. Furthermore, the same study had another odd conclusion Women with endometriosis also had reactive hypoglycemia (a drop in blood sugar) during a glucose tolerance test, even though the women had normal insulin levels. 1 Women with endometriosis may be more sensitive to the actions of insulin than women without endometriosis. Eying where endometriosis attacks the targe intestine Endometriosis is more common in the large intestine and can show up...

Focusing on Life beyond Endometriosis

What's the first step to improving your life when you have a chronic disease Change your focus. Stop putting endometriosis in the center stage of your life. Everything doesn't have to be about endometriosis, even if you're in pain, even if you never know how you're going to feel from day to day.

Ten Myths about Endometriosis

Endometriosis is a minor problem Just certain women get endometriosis The solutions for endometriosis are simple You just can't get pregnant if you have endometriosis ndometriosis is often a misunderstood disease. Ask your friends what they know about endometriosis, and you're likely to hear a list of misconceptions. Even your doctor may not truly understand endometriosis. This chapter examines ten of the most common misconceptions about endometriosis, so feel free to hand it to anyone who tries to misinform you.

Endometriosis Is Just Cramps

Although your significant other may think your endometriosis is just a case of really bad cramps, you know the difference. Endometriosis can affect many parts of your body, and symptoms can occur at any time of the month, not just during your period. Endometriosis can cause permanent damage to your ovaries, fallopian tubes, bowels, bladder, and any other body part it attaches to. Of all the misguided attitudes about endometriosis, this one is the most dangerous because it may lead you to ignore your symptoms until they've done permanent damage. (See Chapter 2 for more on ways to differentiate between endometriosis and other diseases that cause similar symptoms.) As doctors and the public become more educated about the far-reaching consequences of endometriosis, the myth of endometriosis as just cramps will be permanently debunked. If you suffer debilitating cramps, don't wait another minute. Call your gynecologist immediately for an exam to see whether you have endometriosis or some...

Teenagers Dont Get Endometriosis

Girls as young as 11 years old have been diagnosed with endometriosis. Because girls now start menstruating at an earlier age than they did in past decades, their endometriosis is occurring at a younger age too. (See Chapter 14 for more info.) And because endometriosis was considered a career woman's disease up until the 1980s, physicians didn't consider looking for it in teenage girls who had the symptoms. In the past, many doctors thought bad cramps were just part of being a woman. Now, however, more and more doctors are testing teenagers who have symptoms, and the diagnosis is frequently endometriosis. _Chapter 18 Ten Myths about Endometriosis 319

Hysterectomy Cures Endometriosis

A hysterectomy (the removal of your uterus) doesn't cure endometriosis, unless the endometriosis is only in the uterus. Although a hysterectomy stops menstrual bleeding because the blood comes from the uterine lining, the surgery doesn't change the endometriosis on your ovaries, bowel, bladder, or elsewhere in your pelvic cavity. However, hysterectomy with removal of both ovaries will permanently get rid of endometriosis symptoms in most women, because removing the ovaries removes most of the hormonal stimulation that activates endometrial implants, wherever they're found. Unfortunately, the surgical menopause that results has a multitude of additional symptoms to cope with (refer to Chapter 11 for more info).

You Cant Get Pregnant If You Have Endometriosis

Even if you have endometriosis, you can get pregnant. In fact, 60 to 70 percent of women with endometriosis do conceive, but they may have a harder time than a woman without the disease. Although some women with endometriosis get pregnant easily, others need to see a fertility specialist (see Chapter 7 for more on fertility issues). The bottom line If you want to have kids and you have endometriosis, see a specialist and, if at all possible, have babies sooner rather than later in life.

Determining the Source of Endometriosis

Scientists are now challenging many long-accepted theories about endometriosis. The theory that retrograde menstruation (menstrual blood that flows backwards, up, and out of the fallopian tubes see Chapter 4 for more info) causes endometriosis may be true in some cases, or it may be a contributing factor. But most likely retrograde menstruation isn't the only cause of endometriosis. This one theory can't explain the many variations of endometriosis. In fact, many experts feel that endometriosis may be a generic term to describe two or more diseases. That is, the slow-growing, annoying-but-not-life-altering endometriosis may be a whole different disease than the aggressive, painful, debilitating disease some women have. And why do some women's symptoms recur more quickly and other women's symptoms don't Is the difference between the women, or is it within the disease Researchers are working on answering these questions. Looking at what the future holds Picking apart genes for clues to...

Identifying Endometriosis Genes

Endometriosis is likely to involve genetics because a woman has an increased risk of developing endometriosis if a close relative also has it. Studies suggest that the disease involves several different genes, each playing a unique role. But environmental factors may also be necessary to activate the genes that predispose a woman to develop endometriosis (much like some cancers are genetic based and activated by environmental factors). As the ability to find genes and genetic markers evolves, researchers will be able to identify endometriosis genes. Recent studies have shown that many genes in the endometrium of women with endometriosis act abnormally. Scientists can plot hundreds of genes and their activity during the menstrual cycle. In normal women, certain genes are more active at specific times and then decrease at other times. Research has found that this sequence of gene activation and deactivation is different in women with endometriosis. Our ability to identify and measure...

Overcoming Infertility in Endometriosis

Researchers have associated endometriosis with infertility for years a logical connection because 35 to 50 percent of infertile women also have endometriosis. However, new research into the causes of infertility in endometriosis shows that some women with endometriosis lack the molecules that allow embryos to attach to the uterine lining. Obviously, if the embryo can't attach, this problem prevents pregnancy even though fertilization may occur. This study also indicates that some genes in the uterus of endometriosis patients appear to function abnormally. As a result, infertility in endometrio-sis patients appears to be much more complicated than originally thought. Infertility isn't just the result of blocked fallopian tubes or other mechanical factors. The uterine lining may also have an inherent defect that prevents pregnancy. For women with severe infertility problems related to endometriosis, embryo freezing can be a godsend. Eggs can be taken during an egg retrieval cycle and...

Diagnosing Endometriosis Earlier

At one time, scientists thought that teens rarely developed endometriosis and that preteens never did. Researchers have now proven these notions incorrect. The earlier that doctors can diagnose teens and preteens, the earlier treatment can begin and the more damage can be minimized.

Gaining Respect for Endometriosis

Endometriosis is a disease that affects more women than any other disease in the United States. But do you see ads for endometriosis awareness on television or telethons to raise money for research No Why is that The answer is simple In the past, doctors and lay persons alike have treated endometriosis more as an emotional problem than a medical one. Scientists and medical personnel are just beginning to realize how complicated and debilitating endometriosis can be. In the near future, we hope to see more awareness of the problem and a greater emphasis on its research, understanding, and treatment in both the medical profession and the public.

Trying ablation of endometriosis

Facenerve Anatomy

No matter which approach you choose (laparotomy or laparoscopy), dealing with endometriosis lesions through ablation (surgical destruction) or excision (removal) remains controversial. Some surgeons prefer to remove only lesions involving important structures. Other surgeons remove every last bit of disease they can see. Who's right Both and neither. You should discuss these issues and the pros and cons with your doctor. Requires the surgeon to take a margin of normal-looking tissue with the implant because microscopic endometriosis reaches some distance around the main, easily visible lesion. Because the KTP and nd-YAG lasers are effective through fluid and are absorbed by the pigment in endometriosis, they can be good in larger lesions. They're particularly good in the treatment of endometriomas. But because they coagulate and don't vaporize, they have a greater chance of damaging surrounding tissues. The ovary is a special case when treating endometriosis. Surgeons have no standard...

Contemplating Surgery to Improve Your Endometriosis

M doctors often suggest medical therapy as the first treatment for endometriosis symptoms. However, if you don't already have a definite diagnosis or the medication doesn't work for you, your doctor may suggest surgery. Surgery, then, can determine whether you actually have endometriosis or another disease, and in most cases, your surgeon can treat the disease during the surgery. Don't take surgery lightly. Risks are always present, even though small, with anesthesia and surgery. But in many cases, surgery is the best option for decreasing the pain and destruction of endometriosis. Deciding to have surgery is a major decision, but we hope to make that decision a little easier for you. In this chapter, we discuss all the current options, the potential complications, and the benefits of surgically treating endometriosis.

Treating urinary tract endometriosis

Unfortunately, as with so many types of endometriosis, curing the disease in the urinary tract isn't possible. The goal of treatment is to decrease symptoms and prevent worsening of the disease. Your doctor tries to accomplish this with a nonsurgical approach, such as hormonal treatment and other medications, in most cases (see Chapter 10 for more info). In severe cases of endometriosis of the bladder, your doctor can perform surgery to remove part of the bladder (called a partial cystectomy) or other involved areas. But, the implants are usually superficial inside the bladder or on the pelvic surface of it, so this procedure is rare. The endometriosis doesn't affect the bladder nearly as often as the intestines, and medical therapy seems to work well. Differentiating between interstitial cystitis and endometriosis in the bladder Interstitial cystitis (IC) is a complicated disease many doctors feel it may actually be several diseases that can cause symptoms identical to those of...

Endometriosis Only Exists in Industrialized Countries

This statement is a variation of the career woman myth. In the past, experts believed endometriosis was a disease only in industrialized countries where exposure to toxic chemicals was rampant. But researchers haven't proven this theory. Women in third-world countries have endometriosis, but, without the resources to obtain treatment, they're less likely to be diagnosed. These women also tend to have children at a younger age, which helps keep symptoms at bay longer. (See Chapter 4 for more on how and why pregnancy affects your chances of having endometriosis.)

Looking at endometriosis under the scope

You would think that endometriosis always looks the same under the microscope, right Well, no. Even after a biopsy and under the microscope, this disease doesn't always look the same, even in the same woman. t The surgeon doing the biopsy may just miss the real lesion. An area of endometriosis has many tissue variations. The inflammatory process can cause a change in color and distortion of the anatomy. And an area at the edge that looks good to biopsy may just be a reaction to the disease process and not the actual endometrial implant. The actual lesion may be much deeper and not visible. The surgeon doesn't want to cause harm while diagnosing the problem, so he may not biopsy deeply enough to reach the actual active endometriosis. t The surgeon may not recognize the active areas. The textbooks describe classic endometriosis as black, stellate (star-shaped) lesions. But this definition is only for the end stage of the disease, so the biopsy may only contain scar tissue and old...

The Lowdown on Endometriosis A Quick Run Through

Understanding endometriosis basics Educating the public about endometriosis Knowing who's who in endometriosis Counting the real costs of endometriosis Answering the big question A self-test eople generally don't understand endometriosis very well. Until recently, * you didn't even hear about it unless you were at a gynecology convention But new research and better publicity have brought endometriosis to the public's attention, making many women wonder whether this is the nameless disease they've had since puberty. In this chapter, we talk about the little-known disease of endometriosis what it is, who it affects, and why it's received so little attention (despite the fact that it costs millions of dollars a year in lost wages and productivity). We also include a self-test to see whether you may have this disease. Defining Endometriosis If you tell someone you have endometriosis, you probably get a blank look in return. Unfortunately most people are pretty clueless when it comes to...

Endometriosis Is a Career Womans Disease

The concept of endometriosis being a career woman's disease is an old wives' tale based on the premise that only driven, Type-A personalities got endometriosis. This myth is a twisted version of it's all in your head, but it adds the dig, You brought this problem on yourself by being a driven career woman. The attitude probably gained credence when career women started trying to get pregnant at a later age than traditional homemakers. If the older woman had trouble getting pregnant, endometriosis was often the cause. In fact, no relationship has ever been proven women from every socioeconomic and racial group can have endometriosis, whether they're working in the office or at home (check out Chapter 1 for more statistics about who gets endometriosis).

Diagnosing endometriosis visually

An experienced surgeon may also recognize endometriosis visually, and he may not biopsy at all if he sees obvious disease. Visual diagnosis also avoids the rare but serious complications of biopsy. Given the advantages of visual diagnosis, having an experienced surgeon who knows what he's looking at and is comfortable with the procedure is of utmost importance. sNOTjjjp Many times I've seen new patients whose endometriosis was obviously missed during an earlier surgery. The previous surgeon may have not recognized the disease because he was relying on the textbook description a classic powder-burn lesion appearance. We now identify that traditional appearance as end-stage disease (check out Staging Endometriosis later in this chapter for more info). In reality, endometriosis can take on many varied disguises, and surgeons must be trained and experienced to recognize them. When bits of endometrial tissue turn into endometriosis, the resulting lesions don't look like your regular...

Staging Endometriosis

If your doctor diagnoses you with endometriosis, she may use a staging system developed by the American Society for Reproductive Medicine (ASRM) that categorizes endometriosis into four stages based on 1 The amount of endometriosis present 1 The location of the endometriosis 1 The severity of the disease Surgeons further classify endometriosis as superficial or deep 1 Superficial endometriosis lies more on the surface of a structure. 1 Infiltrative or deep endometriosis implants are deeper than 5 to 6 millimeters. Your doctor can only make this classification in your diagnosis during surgery. With endometriosis staging, lower numbers are better. The following classifications determine the points and stages of endometriosis 1 Superficial endometriosis of the peritoneum (1 to 3 centimeters) 2 points 1 Deep endometriosis of the peritoneum (greater than 3 centimeters) 6 points 1 Deep endometriosis of the ovary (less than 1 centimeter) 4 points 1 Deep endometriosis of the ovary (1 to 3...

Asthma allergies and autoimmune issues in endometriosis

There's growing evidence that endometriosis is an autoimmune disease. There's also growing evidence that people who have one autoimmune disease are more likely to have additional autoimmune problems. One large study of more than 3,000 women with endometriosis showed the following

Endometriosis Is All in Your Head

Even doctors used to believe that endometriosis was a psychological disease. The prevailing attitude was that, if you just stopped thinking about yourself all the time, all the pain would disappear. Some doctors actually believed that a woman's positive attitude would make the pain go away. Unfortunately, some professionals still use this rationale today. Although a positive attitude is certainly good to have throughout your life, you probably know that attitude doesn't decrease your endometriosis one bit. Endometriosis isn't just in your head (although it can be endometriosis has been found in the brain See Chapter 6 for more info) it's in your pelvis, and it hurts.

Endometriosis and your cervix and Vagina

Endometriosis of the cervix is quite rare. Why would endometriosis even develop there, because menstrual flow normally passes through these places That question is the great mystery of endometriosis, but possible causes are an altered immune response, metaplasia, or genetic defects of the endometrium (see Chapter 4 for more info on the possible causes). Two symptoms of endometriosis of the cervix are The cervix is often contacted during sex, and endometriosis can make the cervix tender to touch. As a result, women with endometriosis of the cervix often have pain with deep penetration and then bleeding after, or even during, sexual intercourse. These endometriosis lesions on the cervix can also cause irregular spotting or heavy bleeding at any time during the cycle. Even more unusual is endometriosis of the vagina, which occurs mostly in the top third of the vagina. This occurrence may be due to the fact that section of the vagina develops from the same embryologic tissues as the...

High probability of endometriosis

Summary of Recommendations for Treatment of Chronic Pelvic Pain American College of Obstetricians and Gynecologists Endometriosis, irritable bowel syndrome (may be given empirically in women with symptoms consistent with endometriosis) Endometriosis, pelvic congestion syndrome Laparoscopic ablation resection of endometriosis Stage I-III endometriosis

Looking Closer at How Endometriosis Also Affects Other Body Parts

Investigating endometriosis and your intestines Checking out endometriosis and your bladder Considering endometriosis in your lungs Thinking about endometriosis in your brain focusing on endometriosis and its effect on your period and your fertility may not be that difficult. However, you may not realize that endometriosis can affect other body systems as well. In fact, in very rare cases, endometriosis has been found only outside the pelvis. In this chapter, we look at how endometriosis can affect areas outside the reproductive tract, from your intestines and urinary tract to your lungs and even your head.

Endometriosis

Endometriosis is a medical condition where the tissue that lines the inside of your uterus (also called the endometrium) spreads to other areas of your body, usually to your pelvic organs. Endometrial tissue found on your fallopian tubes or ovaries can lead to scarring, adhesions, and blockages within your pelvis. (See Figure 1.2.) Endometriosis is estimated to affect about 7 percent of women of childbearing age. However, endometriosis is found in approximately one-third of infertile women. Therefore, endometriosis is a major factor when considering the causes of female fertility problems. The main symptom of endometriosis is pelvic pain. The pain and cramping occurs most often just before and during your menstrual cycle. The pain sometimes occurs during sexual intercourse, urination, or bowel movements. The amount of pain does not always tell you the severity of your condition. For example, some women with slight pain may have a severe case of endometriosis. However, those with...

Understanding dioxin exposure

Studies show that some women may develop endometriosis after having a tubal ligation (having your tubes tied to prevent pregnancy). But, you ask, if the retrograde menstruation theory is correct (refer to the section, Migrating out the tubes Retrograde menstruation, earlier in this chapter), how can blood back up through the top of blocked tubes One possibility is that some small, unseen islands of endometrial tissue were present before the surgery. These microscopic implants can then eventually grow, cause symptoms, and become endometriosis. No matter what process causes the problem after tubal ligation, studies don't show that the surgery is actually responsible for the disease. In fact, studies haven't ever shown a relationship between a tubal ligation and increased risk of endometriosis. Women who opt for this procedure have most likely had children. In reality, these women may very well have had endometriosis all their lives, but the pregnancy(s) kept it at bay (see the section...

Answering some of the unanswered questions The metaplasia theory

Most theories on endometriosis can't answer some nagging questions. For example, why is endometriosis in girls who haven't gone through puberty yet, and also (though rarely) in men And why does the tissue in endometriosis not exactly resemble that of the endometrium These questions have led to other theories, the current leading one being the metaplasia theory. i Endometrial tissue from the uterus is functionally different and looks different under the microscope from endometriosis tissue. i Girls who haven't reached puberty, women with few and light periods, women with tied tubes, and even men can all have endometriosis, even though none of them can have retrograde menstruation. The metaplasia theory suggests that when the mesodermal cells in the pelvis, abdomen, and lungs are exposed to some stimulus from the menstrual flow or an outside source, the cells morph (change) into endometrial cells. Back in the 1950s, Dr. John Sampson, the first proponent of the retrograde menstruation...

Hitching a ride in the lymphatic and vascular systems

One explanation for endometriosis ending up out of the pelvis is the lymphatic and vascular spread theory. In cancer, malignant cells travel throughout the body via two routes the lymphatic system or the blood. Both of these methods require the malignant cells to lose their attachment to other cells nearby and still survive. This is one of the mysteries of malignancy. But don't worry, endometriosis isn't cancer. But does the forced delivery really occur Scientists have seen apparent endometrial cells microscopically in the lymphatic system of the uterus, but this doesn't mean the cells are viable and able to implant elsewhere. And this theory presents another question How do the cells get out of the lymph channels Though this is an attractive theory to explain the rare incidence of distant endometriosis, it remains unproven. Although the lymphatic and vascular systems theory has some support, the vast majority of scientists and physicians believe this method may be secondary to other...

Watching what you eat

Good nutrition is important, no matter how healthy you are. However, it's especially important if you're trying to keep your immune system and other body systems in tip-top condition to fight off the effects of a chronic disease like endometriosis. Can you eat away endometriosis Probably not. Can you eat in a way that minimizes endometriosis symptoms and strengthens your immune system Probably. 1 Eating more fresh fruits and green vegetables and limiting red meat and ham may reduce your chance of developing endometriosis. 1 People with diets high in polyunsaturated fats have a greater chance for developing endometriosis. i Simple sugars that increase insulin levels may also cause a rise in prostaglandins, increasing the symptoms of endometriosis. i Caffeine can stimulate cramps and contractions of intestinal and uterine muscle (common symptoms of endometriosis). What you eat may be important, but equally important may be how much you eat. Studies on the effect of body mass index, or...

Considering environmental factors

Endometriosis is related to environmental contamination. Dioxin, one of the first pollutants scientists studied, is an example (see the sidebar Understanding dioxin exposure earlier in this chapter) of an environmental effect on endometriosis. Likewise, scientists can link pollutants to multiple sclerosis, lupus, thyroid disease, chronic fatigue syndrome, fibromyalgia, and even cancer. Be aware of your environment and avoid the obvious toxins, such as dioxin and PVCs use the safest products and eat the healthiest foods you can. In this way you can minimize your risks of endometriosis and other environmentally-linked diseases (and you can feel better at the same time). See Chapter 16 for specific ways to decrease your exposure to chemicals in your environment.

Dealing with abnormal uterine bleeding AUB

If endometriosis has damaged your ovary to the point where you're not ovulating regularly, you may have irregular bleeding. Sometimes you bleed too much because the uterine lining grows too thick before being shed, and sometimes you bleed in the middle of your cycle, usually at times when you least expect it. Adenomyosis (endometriosis that infiltrates the uterine wall) can also cause irregular bleeding. Bleeding that doesn't fit the norm either in timing or amount is called abnormal uterine bleeding (AUB). About 20 percent of women with endometriosis have AUB. The primary cause of AUB in women with endometriosis is anovulation (lack of ovulation), although adenomyosis can also cause AUB. Abnormal bleeding has some unpronounceable names Although having periods a few times a year doesn't seem like such a bad thing, it can be harmful. Endometriosis growing on your ovary can cause infrequent periods by destroying part of the ovarian tissue. When this happens, your periods come much less...

Generally classifying menstrual pain

General pain with your period is formally called dysmenorrhea, pronounced dis-men-or-ee-ah. This pain usually lasts for the first two to three days of your period. Painful periods are the number one symptom described by women with endometriosis. i Primary dysmenorrhea is unrelated to any other disease process (such as endometriosis). In other words, women with primary dysmenorrhea don't have endometriosis. i Endometriosis is the most common cause of secondary dysmenorrhea. i A number of other causes for secondary dysmenorrhea are also possible. So having secondary dysmenorrhea doesn't mean you definitely have endometriosis. 1 Inflammation in your pelvis from the toxic chemical produced by endometriosis implants 1 Irritation of nerves due to endometriosis implants 1 Direct effect of endometriosis on the uterus, ovaries, or other organs You can reduce much of the pain related to endometriosis by regulating your menstrual cycle (see Regulating your Menstrual Cycle to Reduce the Pain...

You can empty your bladder as soon as the exam is over

Your doctor may decide to biopsy any suspicious-looking tissue inside the bladder or urethra. This involves removing a small piece of tissue from the bladder wall during the cystoscopy and then examining it under the microscope for evidence of endometriosis or other disease processes, like interstitial cystitis (see the nearby sidebar Differentiating between interstitial cystitis and endometriosis in the bladder in this chapter). The biopsy is relatively painless and can be very useful in the diagnosis. Afterwards, you may have some slight bleeding as with a regular cystoscopy.

Checking out other hormonal problems Luteal phase defect

1 Endometriosis may affect the ovary's ability to produce normal amounts of both estrogen and progesterone, just as it affects the egg's maturation. (See Understanding the link between endometriosis and egg development in this chapter for additional information on egg maturation and endometriosis.) 1 Endometriosis can somehow decrease the corpus luteum's ability to make enough progesterone at the right time.

Messing with Your Fallopian Tubes

A blocked fallopian tube is like a dead-end road your egg isn't going anywhere. Fallopian tubes are, unfortunately, common sites for endometriosis the disease can block the tubes anywhere from the opening at the top to the bottom near the uterus. And blocking an egg from the uterus or the sperm from the egg pretty much prevents a healthy pregnancy. In this section, we focus on the fallopian tubes to see how endometriosis can block the tubes and cause infertility. We also discuss a serious concern that endometriosis can cause the ectopic pregnancy.

Seeing an infertility specialist

Is it absolutely necessary to see a specialist That depends on your age, degree of endometriosis, pregnancy history, and personal preference. (Many women under the age of 45 don't have a GYN, although they should.) Some women want to go right to the big guns the specialist. Even though consulting with a specialist may not be necessary, this decision may help a woman feel like she's doing all she can. If you feel this way, by all means, see a specialist.

Starting with Simple Treatments

The good news Infertility caused by endometriosis is treatable. If you have mild, Stage I or Stage II endometriosis, you may not need to jump right into the big guns of infertility treatment, such as IVF. Most fertility experts recommend treating infertility from mild endometriosis as if it were unexplained. In other words, start with treatments that don't require you to remortgage your house. This section looks at some of the simple treatments available.

Taking the Next Step Surgery to Treat Infertility

1 You've had no success with simple treatments. 1 You've had long-standing, unexplained infertility. 1 You're older than 35, more so if you're older than 40. i Your doctor strongly suspects endometriosis. This section looks at the different surgical options to help you get pregnant. You can also check out Chapter 11, which gives you much more in-depth info about your surgical options and removing your endometriosis.

Fertilization with sperm in a laboratory

How does IVF bypass the problems of endometriosis No one does IVF for fun your doctor will only suggest it if he thinks it will help overcome your fertility problems. IVF bypasses several of the inhibiting factors of endometriosis. For example, it Stimulates the ovaries until the eggs are mature (eliminating the effect of endometriosis on maturation)

Twisting through your intestines

Before you can clearly understand the relationship between endometriosis and your intestines, you need to understand what your intestines entail. (Refer to Chapter 3 for more information on the intestines.) The intestines literally start at your mouth and esophagus and continue to the anus. The small intestine is narrower and more coiled than the large intestine and has three sections The location of endometriosis on the intestines has a lot to do with your symptoms. When the endometriosis is on the serosa, you likely have bloating, nausea, and loose stools during your period. If the endometriosis has grown through the serosa and muscle layers to the mucosa, you may have rectal bleeding during your period. Endometriosis on the intestines is more common on the serosa and muscle layers and less common on the mucosa. (Check out the next section for the different symptoms you may encounter if endometriosis has invaded your intestines.)

Interviewing your doctor

Do you treat many patients with endometriosis (The answer should be Yes.) How many patients with endometriosis do you see in a year (The more the better a few or a dozen or so isn't very many.) ii What kind of testing can you do to diagnose endometriosis (There aren't many tests for endometriosis surgery is the most definitive way to identify it.) i Do you do surgery often for endometriosis (The answer should be Yes, when necessary.) (V NG If the doctor already has his prescription pad out and is writing on it before you even have your coat off, he may not be the doctor for you. Treating a chronic illness, such as endometriosis, is more than suppressing the symptoms, and rarely does a simple prescription cure your ills. Ordering medications isn't wrong, as long as the doctor has heard the whole story first and has a good idea of what he's treating.

Whats with the midcycle pain

Many women spend a day or two a month wondering whether they have appendicitis because mittelschmerz (German for mid-cycle pain) on your right side can mimic the symptoms of appendicitis. But you can experience mittelschmerz without having endometriosis. Mid-cycle pain has characteristics that are unlike other pelvic pain

Its a draw blood that is

Few blood tests help to diagnose endometriosis. In fact, no blood test can prove or disprove the presence of endometriosis. So why is Nurse Ratchet coming at you with a needle and an evil smile on her face Although endometriosis has no specific blood test, one called CA125 can be a diagnostic tool because many women with endometriosis in the pelvic area have an elevated CA125 level. An elevated CA125 level is the result of irritation of the peritoneal surface by the disease. However, other diseases, such as fibroids or ovarian cancer, can also cause an elevated CA125, so the test isn't a reliable way to diagnose endometriosis by itself. In most labs, a normal CA125 level is less than 35 U ml (units per milliliter). Current research is focusing on the diagnosis of endometriosis by cytokines (see Chapter 4 for more on cytokines) that develop in response to the inflammation of endometriosis. Down the road, scientists may identify specific gene markers for endometriosis and then isolate...

Checking your stool for blood

A hemoccult or stool guaiac test checks for blood in your stools. If blood is present, your doctor can order more specific tests to determine the source of the blood. Endometriosis on the intestines can cause blood in your stools during your period, so a positive test may suggest this problem.

Your cup runneth over The urinalysis

Endometriosis on your bladder can cause abnormalities in your urine, so your doctor may want to do a urinalysis, a test of your urine (see Chapter 6 for more on endometriosis in your bladder). Urinating into a cup isn't all that difficult, unless you're klutzy or can't aim. It can also be challenging if you can't urinate on demand. Our advice Always go to your doctor's appointments with a full bladder that way you can minimize your anxiety and happily accommodate the request for a specimen.

Looking at Hormonal Medication Options

Doctors use a number of hormonal medications to treat endometriosis some treatments work better for some people, and others work better for other people. Which medication works better for you often depends on your tolerance to the side effects that each medication causes. Why do hormones decrease the symptoms of endometriosis Because they induce a state similar to either pregnancy or menopause. (See the section Understanding Medical Treatment How Drugs Fight Endometriosis earlier in this chapter for further explanation.) Endometriosis symptoms generally disappear at those two times and may stay away for long periods of time (probably forever in menopause ). Hormonal medications are the most commonly used treatment for endometriosis. Just how effective are hormonal treatments Check out the following statistics I Around 37 percent of women who use hormone therapy for mild endometriosis have pain five years later. I Generally, 66 percent of women who have conservative surgical treatment...

Blocked tubes can cause ectopic pregnancy

The damage that endometriosis does to the fimbriae and the tubes in general greatly increases the risk of ectopic pregnancy. Damage to the fimbriae or tubes can cause the following potentially dangerous scenarios Endometriosis can cause ectopic pregnancies in these possible sites. Endometriosis can cause ectopic pregnancies in these possible sites.

Looking at a healthy cycle

Haematoma Fallopian

A normal menstrual cycle is like a complex work of art (check out Figure 5-1). Okay, you may not think that when you're changing pads or dealing with cramps, but your reproductive system really is amazing. And yet many women understand little of the menstrual cycle. When you understand all the intricate workings, you have a much better grasp of how endometriosis can gum up the works, so to speak.

Looking at GnRH antagonists

Although these drugs aren't specifically approved to treat endometriosis, some doctors do prescribe them to treat the disease. GnRH antagonists are the new kids on the block in hormonal medications to treat endometriosis. They seem to have several real benefits, especially with side effects. Two common GnRH antagonists are Cetrorelix acetate (Cetrotide) and Ganirelix acetate (Antagon). They aren't approved yet for endometriosis, and they're very expensive, much more so than agonists (8 to 20 times more expensive ). Gauging how GnRH antagonists treat endometriosis Serum estradiol remains higher with this therapy (around 50 pg ml), so side effects related to low estrogen are less prevalent. In one study, endometriosis patients undergoing this treatment reported a symptom-free period, with no mood changes, hot flushes, libido loss, vaginal dryness, or other symptoms.

Pursuing antiprogestins

Antiprogestins are promising new drugs for endometriosis because they reduce both estrogen and progesterone receptors. Currently scientists are testing two antiprogestins i Mifepristone (Mifeprex) In one six-month study, mifepristone improved symptoms and reduced endometrial implants without causing menopausal side effects. Long-term use, however, may cause changes in the uterine tissue and cell proliferation. Experience with this drug for endometriosis is limited.

Examining aromatase inhibitors

Aromatase is an enzyme that makes estrogen from other hormones, and it's essential for most estrogen production. Researchers are studying drugs called aromatase inhibitors for effects against endometriosis because they block the production of estrogen. Research also shows that women with endometriosis may have abnormal levels of aromatase in these tissues. Aromatase inhibitors for breast cancer and other disease states include anastrozole, letrozole, exemestane, and vorozole. A 2004 study showed that a combination of letrozole and progestin reduced endometriosis and decreased pelvic pain. More studies are underway.

Eyeing the Two Main Surgical Methods

Choosing to have surgery to treat endometriosis isn't simple. The first questions that come up are, What kind of surgery Minor or major Laparoscopy or laparotomy Which type of surgery you and your doctor decide upon will 1 Radical surgery Don't let the term concern you. With endometriosis, radical surgery simply means that the surgeon removes your uterus, tubes, and ovaries. (We discuss radical surgery in depth in the section Opting for Radical Surgery later in this chapter.) In the vast majority of cases, surgery for endometriosis means choosing an approach for the surgeon to see inside the pelvis and abdominal cavity. Because every surgery requires an incision of some size somewhere, the location and size of that incision dictate the type of surgery. Your surgeon has two choices When endometriosis isn't the problem Finding the real culprit If endometriosis is not your main problem, then surgery may expose the real culprit. Your surgeon may be able to remove that new problem right...

One option Having a laparoscopy

Laparoscopy has become the most common way to diagnose and surgically treat endometriosis. The procedure has come a long way since the 1970s when surgeons used it exclusively for tubal ligations and simple diagnoses. In its early days, the telescope optics and the brightness of the light sources were barely adequate to see fuzzy shapes, and surgeons had only a few crude instruments. These limitations minimized the usefulness of laparoscopy. Treating endometriosis during laparoscopy While your surgeon is looking inside you, what can he do if he finds endometriosis (or any other problem for that matter) The answer depends on what you discussed when you signed the informed consent. People have different pain tolerances, so predicting when you'll be back to normal after laparoscopy isn't easy. Some patients return to work the next day, and other people take weeks. Your recovery also depends on the actual procedures during surgery. Cutting a few adhesions and removing implants and cysts...

Naming the Surgical Tools

Wouldn't it be great if your physician could wave Dr. McCoy's diagnostic tri-corder in Star Trek over your body to make a diagnosis Despite all the technological advances in the past three decades, surgeons still have to rely on today's surgical tools to help them treat endometriosis.

Vaporizing tissues Electrosurgery

Some surgeons use electrocautery to burn away the endometriosis. This method is very effective in getting rid of the disease, but the destructive energy of this device can spread over 1 centimeter (there are approximately 2.5 cm per inch). Using electrocautery is like using a nuclear bomb you destroy the target but you also do extensive collateral damage. Newer devices have been developed to minimize this problem but all have some drawbacks.