Determining If Anxiety Is Your Problem

One trouble with chronic pain is that it never seems to end. If you have a broken leg, at least you can look forward to the day your cast comes off and you're good as new. Chronic disease, on the other hand, doesn't give you anything to look forward to except more pain. You may not be feeling depressed about your condition, but you may have chronic anxiety. This section looks a little closer at anxiety. Anxiety is a state of apprehension and uneasiness where fear and worry affect your moods and...

Trying Prescription Medications

OTC medications often aren't enough to treat chronic pain. You may also need to take prescription pain medication, at least at certain times of the month. However, you may find that taking pain medication on a schedule is more effective than waiting until the pain builds up. This section looks at the different types of prescription medications that can help you manage your pain. In this section, we cover prescriptions NSAIDs, Ultram, opioids, antidepressants, and antiseizure drugs.

Considering environmental factors

Undoubtedly, pollution is bad for you in a number of ways. Humans produce tens of thousands of chemicals (mostly through manufacturing) that we then dump into the environment as waste or trash. Over the years, nature breaks the chemicals down, and the environment absorbs and accumulates them. In the meantime, your food (plants and animals) and water store these chemicals, and you take them in when you eat. Endometriosis is related to environmental contamination. Dioxin, one of the first...

Managing the Chronic Physical Pain

Figuring out chronic pain Going over the counter Moving to prescription drugs Trying creams Looking to exercise Melting away with heat therapy Chronic pain can drive you to despair. When you suffer from acute pain, say from a bad infection, you know it will eventually end and you'll feel better. But chronic pain gives you no such assurances. You can only hope the pain lessens after treatment or that some medication can keep it at bay. Even with the treatments your doctor gives you, permanently...

Defining Chronic Pain

Chronic pain is difficult to understand. Often the pain continues long after the original injury has healed, leaving other people to wonder why you're not better. For example, Didn't your surgery fix all that is a typical attitude from uneducated family and friends. 1 Pain that may not have a definable cause 1 Pain that continues for longer than six months 1 Pain that may not respond well to conventional medical therapies What's the first step to decreasing pain Know your enemy. (Read Part I to...

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....

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...

Drawing and testing blood

Nobody likes to have blood tests. (But usually men are the ones who turn pale and fall over.) Your family physician or GYN may suggest some blood work early in your treatment. Or, she may defer to a specialist and only do Pap smears and cultures. However, one of your doctors should look for clues in your blood. You doctor may order a blood test that checks for the following 1 Elevated sedimentation rates, which indicate infection or inflammation 1 Ca-125, a protein, which possibly comes from...

Just when everythings looking great nothing happens

The egg stays right where it is, in the ovary. If your doctor doesn't do an ultrasound after you ovulate, he may miss the egg's lack of movement. Because doctors usually monitor estrogen and progesterone, these hormones may still rise appropriately, fooling your doctor into thinking all systems are go. An ultrasound may even show a normal-size follicle, but a follow-up test a few days later still shows that the follicle hasn't shrunk as it should. The reason for LUF is unclear. However, the...

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...

Removing adhesions

A surgeon can remove adhesions caused by endometriosis, but one result of this surgery is you guessed it more adhesions. Between 60 and 90 percent of surgeries create more adhesions. What to do If your surgery is primarily for infertility, your surgeon may need to disregard your other symptoms to maximize your potential for achieving a pregnancy. As a result, he may ignore adhesions that don't directly affect your chance at pregnancy. For example, if your large intestine sticks to your pelvic...

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...

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 One major reason for this problem is the loss of ovarian reserve (the medical term for decreased number of eggs). You only have a finite number of eggs to last your whole reproductive life (check out the sidebar Creating a good egg in this chapter). If that...

Accessing Acupuncture

You may be familiar with acupuncture, the art of inserting fine, sterile needles into different areas of the body for treatment of any number of disorders. Acupuncture, which is part of Traditional Chinese Medicine (TCM), came into use in the United States in the 1970s and is often used for pain relief. Some traditional medical doctors now train in the use of acupuncture. TCM acupuncturists often combine treatments with the use of herbs. This section looks more closely at how acupuncture can...

Pursuing antiprogestins

Antiprogestins are promising new drugs for endometriosis because they reduce both estrogen and progesterone receptors. Currently scientists are testing two antiprogestins i Gestrinone As the most studied antiprogestin, gestrinone (Dimetriose) seems comparable to GnRH agonists in reducing pain but with fewer menopausal symptoms. Gestrinone also seems to have a less negative effect on bone density. In one study, bone density even increased slightly. The side effects are similar to androgens like...

Mimicking menopause

Other hormone treatments work in a way similar to negative feedback (they work on receptors), but these treatments work on the pituitary gland (the gland just below the hypothalamus), tricking the body into thinking that it's in menopause. In natural menopause, the symptoms of endometriosis also decrease for several reasons The hypothalamus and pituitary gland go into overtime trying to make you ovulate. Levels of the hormones FSH and LH soar very high, attempting to stimulate the ovary to...

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...

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...

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 X our menstrual cycle is complex. Hormones and complicated feedback systems orchestrate your reproductive system's march each month toward a single goal the production of a healthy egg that can grow in a properly prepared uterine cavity....

Recovering from hysterectomy

Recovery from a hysterectomy depends on the method. With LH, your recovery is about the same as any other laparoscopy. However, when the surgeon has cut ligaments and other attachments to the uterus, the surgery injures a larger area of tissue. As a result, patients usually have a bit more pain and discomfort with LH than with other laparoscopic procedures. On the other end of the spectrum is the recovery from a laparotomy (see the earlier section Recovering from laparotomy) the removal of the...

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 depend on whether your surgery will be conservative (leaving as much in place as possible) or radical (removing organs such as the uterus). Throughout this chapter we discuss the surgical methods and options and give you the information you need to make an informed decision....

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...

Choosing how to approach a hysterectomy

Most surgical procedures, including a hysterectomy, have more than one approach. Until the advent of laparoscopy, two approaches were common the abdominal incision (laparotomy) or a vaginal removal. All three methods have their advocates. Because no one right choice exists for everyone or every situation, you and your doctor should discuss the route for your surgery. Making an incision The abdominal method In most cases where the surgery involves removing ovaries, the abdominal incision allows...

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...

Diagnosing Infertility Caused by Endometriosis

Infertility for any reason can make the road to pregnancy rocky emotionally, physically, and financially. Before embarking on that road, you want to know all you can about the landmines along the way. Finding the right person to help you is your first step. This section first identifies the importance of seeing a specialist in order to get a correct diagnosis (see Chapter 9 for more on tests used to diagnose endometriosis). This section also looks at the different tests you may undergo in order...

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...

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.

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 About one in six couples suffers from infertility. That's a lot of people about 6 million people (2 to 3 million couples) in the United States alone. 1 Endometriosis is responsible for around 30 percent of these infertility...

Persevering Through Infertility Treatments Together

We've both spent years working with infertile patients and found that this area can really make or break a relationship. Because so many women with endometriosis suffer from some form of infertility, you and your loved one may face this problem as well. Please believe us when we say that your life (and relationship) can be easier if you face the challenges together. Finding out that you may have trouble conceiving can be devastating. Most people assume that having children is an inalienable...

Fertilization with sperm in a laboratory

Implantation of embryos into your uterus through the cervix, bypassing the fallopian tubes altogether. IVF also involves ovarian hyperstimulation, that is, you take drugs (primarily through an injection) that stimulate your body to produce more eggs than normal. 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...

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...

Checking out other hormonal problems Luteal phase defect

Your menstrual period usually arrives 14 days after ovulation, unless you're pregnant. A condition called luteal phase defect (LPD, luteal referring to the time after ovulation) can cause your period to arrive sooner than 14 days. This shortened luteal phase means the embryo doesn't have time to implant well and results in an early miscarriage. A shortage of progesterone can cause LPD. Ideally, the leftover follicle shell (the corpus luteum) from the developed egg generates progesterone after...

Starting with Simple Treatments

After conducting the appropriate diagnostic tests (see the preceding section), you doctor can determine what is causing your infertility. 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...

Refining Medication Treatments

Research into new medications for treatment of endometriosis is exciting. Much research centers on targeting specific causes of endometriosis rather than using medications that may sometimes have harmful systemic effects on body systems outside the reproductive system. In the future, scientists may find additional uses for selective estrogen receptor modulators (SERMs). The SERMs can affect the way estrogen interacts with the cell receptors in endometriosis lesions. Aromatase inhibitors (AI)...

When ovarian tissue stops functioning it disrupts the normal hormonal environment of the ovary which can then affect

K had a young patient with problems of infertility but no other complaints. On examination, he discovered huge endometriomas on each ovary. These cysts were so large that this 28-year-old woman had only a thin layer of ovary with virtually no ovarian tissue. She never did get pregnant. Losing ovarian tissue during surgery Ovarian tissue can also be lost as a result of surgery. Any time a surgeon tries to remove endometriosis or the consequences of the disease (adhesions and other scarring),...

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. Dysmenorrhea can be primary or secondary. Primary dysmenorrhea has the following characteristics i Primary dysmenorrhea is unrelated to any other disease process (such as endometriosis). In other words, women with primary dysmenorrhea don't have...

Seeing an infertility specialist

If you haven't become pregnant within a reasonable time (see the sidebar, How long should I try to get pregnant on my own in this chapter to find out what a reasonable time is), you need to make an appointment with a doctor. Most people start with their gynecologist (GYN) or their family doctor. A hydrosalpinx can affect your ability to become pregnant. Is it absolutely necessary to see a specialist That depends on your age, degree of endometriosis, pregnancy history, and personal preference....

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...

Finding a Gynecologist

When I (coauthor Sharon) first started working in an infertility clinic, I was amazed at how many women didn't have a regular gynecologist (or GYN a specialist in women's health issues). Some GYNs are also obstetricians, or OBs doctors who deliver babies. (See the sidebar Gynecologist or obstetrician What's the difference in this chapter.) Some women had their family practice doctor do Pap smears and breast exams, which can be just fine, but many women weren't having any screenings. They didn't...

Progesterone supplements

Progesterone therapy is another simple treatment that may help you achieve pregnancy. Because a lack of adequate progesterone can cause infertility in several ways, including luteal phase defect, your doctor may recommend additional progesterone after ovulation to be sure your levels are sufficiently high. Your doctor may give you progesterone after you ovulate on an OI or IUI cycle. Though exact dosage depends on the situation, too much progesterone doesn't seem to cause problems. You may take...

Taking the Next Step Surgery to Treat Infertility

If patience or medical therapy hasn't helped to get you pregnant and if male problems have been eliminated, you may want to consider surgery. Fortunately, surgery is much easier and safer today than it was a couple of decades ago, even safer than a few years ago because of advances in anesthesia and tremendous development in technology and instrumentation for minimally invasive surgery. Your doctor may suggest surgery to help you get pregnant because 1 You've had no success with simple...

Having a hysterectomy

If you're reading your doctor's notes as he writes, you may be stymied by the initials TAH-BSO. This is shorthand for removal of uterus, fallopian tubes, and ovaries. (TAH-BSO stands for total abdominal hysterectomy and bilateral salp-ingo-oophorectomy.) Most of the time surgery removes the whole uterus, the cervix, and fundus. Some physicians advocate leaving the cervix to enhance pelvic support and improve sexual response after surgery. This is called a partial (or supracervical)...

Understanding dioxin exposure

Dioxins are chemical-compound byproducts from burning fuels (such as wood, coal, and oil) or from waste incineration. Dioxins can form from the bleaching of pulp and paper during paper manufacturing and from other types of chemical manufacturing. Small amounts of dioxins are in cigarette smoke, and they occur naturally in forest fires. Environmental Protection Agency (EPA) standards have become much more rigid in the past few decades and dioxin levels have been decreasing. Industrial levels of...

Stretching with Yoga and Tai

People have practiced yoga and T'ai Chi for centuries. Although their original purpose was to improve the mind-body-spirit connection, yoga and T'ai Chi are most popular in the United States for their combination of gentle and controlled movements that provide a no- or low-impact workout for people in almost any physical condition. These exercises can ease tense muscles, reduce pain, improve flexibility, and enhance a person's strength, balance, and endurance. This section uncovers where you...

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 Even with in vitro fertilization (IVF), implantation rates are lower than normal. 1 Early-stage endometriosis seems to cause poor...

Gesundheit and gnight The multiple responses to allergies

Some cells in the immune system cause the release of histamines, chemicals that cause the sneezing, runny nose, hives, itching, fatigue, and other symptoms of allergies. Histamines can also cause constriction of the bronchials (tubes that feed air into the lungs) that lead to the wheezing in asthma. In severe reactions, this tightening of the breathing tubes can be life-threatening. Fatigue (chronic tiredness and loss of energy) is one of the most common signs of histamine release and all...

Switching to SSRIs and other new antidepressants

Selective serotonin reuptake inhibitors (SSRIs) are a newer class of antidepressants. They're effective in approximately the same number of people who find relief from TCAs, but, because they react only with one neurotrans-mitter (serotonin), they have fewer side effects. Well-known SSRIs that doctors frequently prescribe are escitalopram (Lexapro), citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and iBE f sertraline (Zoloft). Despite their popularity and fewer side effects, these...

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...

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...

Considering Alternative Therapies and Remedies to Relieve the Pain

Avoiding the pitfalls of alternative medicine Considering acupuncture Trying a chiropractor Melting under massage Mastering meditation techniques Decreasing pain with exercise or yoga Going herbal Using aromatherapy ever before have so many people looked for alternatives to traditional W Western medicine herbs, acupuncture, Eastern medicine, and other alternatives are all getting a close look. But you may be asking Why the popularity of alternative treatments After all, traditional medicine...

Finding out more about yoga and Tai

Yoga and T'ai Chi are gentle enough for almost everyone, and they're adaptable to your physical level. Nearly every college, gym, hospital, YMCA, and neighborhood recreation center offers some type of yoga or T'ai Chi instruction. Most classes are relatively inexpensive and may be covered under your health plan if your doctor prescribes them. If you want to find a program, check out www.yogafinder.com or www. taichinetwork.org. You can take group classes or have individual instruction...

Considering opioids

Opioids are a powerful prescription-only class of pain relievers related to the granddaddy of all pain relievers, morphine. Also called narcotics, opioids include the natural opium alkaloids, the semisynthetic opioids derived from them, and the fully synthetic opioids. They all bind to opioid receptors found principally in the brain and gastrointestinal tract. The following includes some common prescription opioids, with their brand name in parentheses 1 Codeine (Tylenol 3) 1 Hydrocodone...

Finding a competent practitioner

Be sure the practitioner you choose is licensed if the treatment has a licensing procedure. Many alternative treatments, such as acupuncture and chiropractic, have strict criteria for licensure. Finding a practitioner that uses techniques outside mainstream medicine can be more challenging than finding a traditional medical doctor. One of the drawbacks to alternative therapies is that licensing of practitioners isn't as stringent as the licensing of medical doctors, so you may not know whether...

Intrauterine Insemination IUI

Intrauterine Insemination (IUI) may help you get pregnant more easily by putting the sperm a little closer to the egg. The journey for sperm is long and arduous, and sperm aren't particularly bright. Only 50 percent of a good sperm sample knows how to swim forward. Most sperm in any sample are imperfect and have serious problems they may Not ask for directions (typical male trait ) IUI may offer an advantage in infertility because it weeds out the poorer sperm and, ideally, puts only the best...

Exercising for Health and Other Benefits

You probably know you should exercise, but exercise is easy to put off until tomorrow. After all, getting up early to go to the gym or going after work (when all you want to do is collapse on the couch in front of the television) is hard work. Many people are often too tired to exercise, but the irony is that daily exercise can energize and rejuvenate you. Don't believe it Many studies show that exercise has benefits beyond the physical. This section looks at how exercise can help you feel...

Cutting away adhesions

The simplest conservative treatment for endometriosis is the removal of adhesions (scar tissue) around the ovaries, tubes, and uterus. The risks of this treatment are minimal (unless the scar tissue is very dense and around vital structures), but the results can be dramatic. Surgery is via a laparoscopy or a laparotomy, using scissors, electrosurgery, laser, harmonic scalpel, or a blunt instrument to simply break down thin, filmy adhesions. If adhesions are causing your pain, you should feel...

Glossary

M s your Latin a little rusty Figuring out the meaning of medical terms is a lousy way to spend an afternoon, so we've made it easier to understand this book by including the definitions for some of the terms we use that you don't see every day (Latin and otherwise). abnormal uterine bleeding (AUB) Also called dysfunctional uterine bleeding (DUB) uterine bleeding that's heavier than normal, or occurs at irregular times, or lasts too long. acupuncture Oriental system of puncturing the skin with...

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...

Partially blocking tubes are bad too

Sometimes endometriosis doesn't block the tube altogether it may create a hydrosalpinx (a chronically dilated, swollen tube). See Figure 7-2. The hydrosalpinx can fill with fluid that is toxic to embryos. (The fluid is a result of endometriosis's inflammatory process and is full of endotoxins, that is, inflammatory proteins, white blood cells, and other harmful substances.) If the end of the tube that connects with the uterus is open, even a little, the fluid from the tubes can drip down into...

Removing your ovaries

In some cases, you and your doctor may elect to remove one or both ovaries (an oophorectomy) and not the uterus. This decision is unusual but has some good reasons. Sometimes one ovary keeps forming chocolate cysts and adhesions that cause pain and hormonal changes. When more conservative treatment has failed or the disease has recurred quickly, removing the bad ovary may be beneficial. Usually this radical surgery isn't for young women who may want to become pregnant. However, if one of the...

Considering progestins alone

Pregnancy often significantly reduces the symptoms of endometriosis because progesterone levels are high. Therefore, medication that raises these hormone levels and tricks the body into thinking that it's pregnant can also reduce the symptoms of endometriosis. One of the progestins, norethindrone acetate, is also used in BCPs and other hormonal contraceptive combinations, and the other, medroxyprogesterone acetate, isn't. Understanding how progestins treat endometriosis Pseudopregnancy with...

After ovulation the uterine lining changes again under the influence of progesterone from the corpus luteum the

If anything interferes with, blocks, or prevents one of these steps, pregnancy can't occur or early miscarriage may occur. And if no embryo arrives, hormone levels drop, and the lining begins to shed again as in Day 1 of the cycle. Unfortunately, endometriosis can interfere with the perfect progression of these steps in many ways. Each stage of endometriosis (usually noted as Stage I through IV, with IV the most severe) can affect different aspects of fertility. These variables make it very...

Naming the main symptoms

Endometriosis is more likely to appear in the bladder than in the ureters (the tubes that take urine from the kidney to the bladder) or the kidneys, and the lower ureters are a more common site than the upper ureters. Symptoms for endometriosis in the urinary tract can include any of the following Pain with urination isn't unique to endometriosis many problems, including bladder infection and interstitial cystitis (chronic bladder inflammation) can cause bladder pain. Furthermore, all bladder...

Breathing Your Way to Feeling Better Aromatherapy

Aromatherapy may sound like it belongs on the perfume counter, but this approach isn't just about sniffing different odors. Aromatherapy utilizes the essential oils of plants both for their scent and for their medicinal properties. These aromatic oils can be extracted from the seeds, bark, leaves, flowers, wood, roots, or resin of a plant. Experts don't see aromatherapy as a cure for endometriosis but as an aid to strengthening the body's immune system to heal itself. Some of the oils for...

Breathing Slow and Easy

Pain may feel like a never-ending cycle. The pain makes you tense, the tension makes you breathe harder, and the hard breathing makes you more tense. To alleviate some of your pain, concentrate on breathing slow and easy. Have you ever had a child If so, do you remember the breathing techniques for the pain during childbirth All right, so they don't work 100 percent, but they can help you relax. Never been to a childbirth class The technique is simple Breathe in and out slowly, emptying your...

Trying Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) categorizes endometriosis as a blood stasis disease with formation of lumps. The Chinese name for endometriosis is actually neiyi, meaning internal lump. TCM relates blood stasis in the lower abdomen to back and pelvic pain. In addition, qi stagnation (restricted blood flow due to emotional distress) and coldness (decreased metabolism and circulation sometimes called kidney yang deficiency) cause the blood stasis. Since 1979, Chinese researchers have studied...

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 1 Irregular bleeding, especially after sex The cervix is often contacted during sex, and...

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...

Exploring the autoimmune connection

As the previous section explains, the immune system is very complex errors can occur. One error is when the body fails to recognize itself so it attacks its own proteins as if they were the invaders. This is called an autoimmune disease, and some evidence shows that endometriosis may be an autoimmune disease. Autoimmune diseases have the following characteristics 1 Hormonal element Because autoimmune diseases are more common in women than in men, a hormonal component is likely. 1 Numbers of...

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 I Sixty-one percent had allergies compared to 18 percent of the U.S. general population. 1 Twelve percent had asthma compared to 5 percent of the general population. 1 Chronic fatigue syndrome was more than a hundred...

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...

Trying GnRH agonists

GnRH agonists are injected or implanted medications that have found wide use as a treatment for endometriosis. They work by causing a medical menopause with extremely low levels of estrogen (much like natural menopause). Although they're an effective treatment for endometriosis, they aren't without significant side effects. To understand how GnRH agonists work, you first need to understand gonadotropin-releasing hormones (GnRH). GnRH is a vital part of the menstrual cycle. The hypothalamus...

The destructive process literally eats away the area of the ovary that houses the primordial follicles leaving you with

Encountering endometriomas (chocolate cysts) Scar tissue that covers the surface of endometrial implants on the ovary is tough and fibrous. As this endometriosis spreads across the ovary, it takes the path of least resistance by growing into the softer stroma (the inside) of the ovary. As a result, chocolate cysts, or endometriomas, form from the surface of the ovary inwards. (The term chocolate refers to the brown-colored liquid made of old blood and tissue that's inside the cyst.) These cysts...

Inserting an IUD for pain relief

If you had an intrauterine device (IUD) in the past, the thought of using it for pain relief may seem a little foreign to you. After all, most IUDs are pretty uncomfortable at first, so how can one decrease pain IUDs are primarily a birth control device, so if you're planning on getting pregnant, an IUD isn't the method to use to decrease endometriosis However, unlike Depo-Provera (whose effects can last for months after your last injection), an IUD has no effects after you remove it, so you...

Endometriosis

Former Director of Endoscopic Surgery at Cooper Institute for Reproductive Hormonal Disorders Coauthor of Osteoporosis For Dummies 111 River St. Hoboken, NJ 07030-5774 Copyright 2007 by Wiley Publishing, Inc., Indianapolis, Indiana Published by Wiley Publishing, Inc., Indianapolis, Indiana Published simultaneously in Canada No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording,...

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. Many offices now tout their MRIs as being open and less likely to cause claustrophobia, but their definition of open and yours may...

Popping the Pill Oral contraceptives

You're probably familiar with oral contraceptives (OCs), more commonly called birth control pills (BCPs) or just the Pill. But you may not know how versatile they are. Preventing pregnancy is just one of their uses (although that use has certainly changed society ). Breaking down the Pill Biochemistry 101 The estrogen compound in most oral contraceptives in the United States is a form of estradiol, the hormone your ovaries make. However, the progestin element offers some variety (five related...

Comparing the types of OTC painkillers

When you're walking the aisles of your neighborhood pharmacy, you basically can choose from two types of OTC pain medicines, or analgesics. You have acetaminophen, better known as Tylenol, which relieves pain but doesn't decrease inflammation, and nonsteroidal anti-inflammatories (NSAIDs), which include aspirin and newer NSAIDS, such as ibuprofen, which relieve both pain and inflammation. We discuss all the options in the next sections. Acetaminophen, sold as Tylenol, is the most common OTC...

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,...

Just for Friends and Family Help and Support

Understanding the other pains of endometriosis Swimming together through infertility issues Being a good parent Getting the help you need Slaving a chronic illness isn't fun. No one can argue that. But it's no fun sometimes to be the significant other of someone who has a chronic disease, such as endometriosis. Living with endometriosis day to day can be stressful, not only for the patient, but also for her family and friends. If you're a significant other, a parent, a friend, or a family...

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...

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. To diagnose this disease, the endometrial tissue, glands, and stroma must be present in the wrong place. But, in 30 to 50 percent of cases, the biopsy fails these criteria. How can this be Several reasons may be possible. t The surgeon doing the biopsy may just miss the real lesion. An area...

Naming the two main treatment options

Immune therapy is successful with other types of autoimmune disease, and because of the link of endometriosis to autoimmune diseases, researchers suggest that immune therapy may work against endometriosis. Because the FDA hasn't approved any of these more aggressive treatments for endometrio-sis, we include them in this chapter. The two main treatments include 1 Intravenous immunoglobulin (TVIG) IVIG is a sterile protein preparation derived from human blood, given intravenously. IVIG is being...

Changing Your Bad Habits

Everyone has a bad habit or two behaviors you probably know aren't good for you, like eating the wrong foods, smoking, or overindulging in alcohol. Although the occasional indulgence probably won't hurt you, regular doses of things that aren't good for you can harm your health. When you have a chronic disease like endometriosis, anything that harms your health can worsen your symptoms. No matter what your bad habit is, this section can help. We provide plenty of information to help you change...

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...

Considering Immunotherapy

Many doctors already use immune therapy in cancer patients as well as patients with autoimmune disease, a category it seems endometriosis may fall into. (See Chapter 4 for more on the immune system and endometriosis.) The link between the immune system and endometriosis Can immune therapy help decrease endometriosis The following three areas of research may support the idea of immune treatment for endometriosis I Implants of endometriosis cause increased peritoneal fluid, which contains...

Finding the right job for you

Find a job that has a flexible schedule. However, landing a flexible job is easier said than done. And how many jobs are really flexible Even traditionally flexible jobs, such as per diem nursing or substitute teaching, aren't totally flexible because you work when they need you, not when you want to. A job where you can work when you're well and stay home when you're not is difficult to find. But some jobs may work better for you than others. Obviously, the more flexible a job, the better it...

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)...

Another option Choosing laparotomy

Laparotomy means to enter the abdominal cavity via a large, or relatively large, incision. With the advent of mini-laparotomy techniques, the incision may be as small as 4 centimeters (about an inch and three-fourths), which is still bigger than the 1-centimeter incision for laparoscopy but far smaller (and easier to heal) than the common 12-inch wounds a few years ago. Before the boom of laparoscopic technology and training, a laparotomy was the only way to really treat endometriosis. Even...

Testing testing Ultrasounds Xrays CT scans MRIs and more

Have you ever wished you could just look inside your body and see what's giving you trouble Although Superman's X-ray vision was great, today's ultrasounds, X-rays, computed tomography-scan tests (CTs), and Magnetic Resonance Imaging (MRIs) are the next best thing. Ultrasound can help your doctor diagnose distorted or swollen fallopian tubes, endometriosis, other pelvic problems, and uterine anomalies. Ultrasound bounces sound waves off internal organs or tissues, detecting differences in the...

Contemplating Surgery to Improve Your Endometriosis

Knowing your surgical options Introducing the surgeon's tools Beginning conservatively Undergoing radical surgery Choosing what kind of surgery to have 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...

Debating danazol Danocrine

Danazol (brand-name Danocrine) is an oral drug that was extensively used in the past to treat endometriosis. Although it was proven to be effective, its numerous side effects (see Facing the side effects of danazol later in this chapter) have resulted in its replacement by more modern medical treatments. However, for some women with endometriosis, it remains an optional medical treatment. Danazol acts like two kinds of sex hormones, estrogen and testosterone. Its structure is very similar to...

Taking antidepressants

At first glance, you may think this section is in the wrong chapter. How can taking prescription antidepressants help with pain Actually, antidepressants can help decrease chronic pain in several ways. The two most obvious ways are i Decreased depression, which is a common side effect of chronic pain (Check out Chapter 15 for more information about depression and your emotions.) However, there's much more to this story. Many studies have shown that some classes of antidepressants have analgesic...

Whats the downside of IVF

So, you're thinking IVF is the perfect way to get pregnant, right Unfortunately, IVF isn't a bed of roses leading you to dirty diapers, empty bottles, and bundles of joy. You do need to consider the following cons before deciding if IVF is right for you 1 Cost IVF is very expensive, and not all insurance companies cover the cost. 1 No guarantee of success Your chances of pregnancy may be 50 percent or less. 1 Emotional strain Undergoing IVF can be stressful and frustrating, particularly if you...

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. Your doctor may use any or all of the instruments in the section, Naming...

Going for the Big Guns Is In Vitro Fertilization IVF Necessary

If your fallopian tubes are completely blocked, in vitro fertilization (IVF the removal of eggs from your ovaries by a surgical procedure and fertilizing them with sperm in a Petri dish and then putting the embryos into the uterus) is not only the best way to become pregnant, it's the only way. (For much more information on getting pregnant with IVF, check out Fertility For Dummies by Jackie Meyers-Thompson and Sharon Perkins Wiley .) And if the tubes have partial closure, the risk of ectopic...

Being honest with your potential boss

Is it better to tell a potential boss that you have a chronic disease, or is it wiser to keep quiet Several schools of thought exist about disclosing an invisible illness when you're applying for a new job. You certainly won't be the only one having this inner debate as many as 40 percent of American workers have a chronic illness, and employees justifiably worry about increased health costs and decreased productivity for this 40 percent. If endometriosis is just an inconvenience in your life...

Keeping a positive attitude

As with any chronic disease process, a positive attitude can't cure endometriosis, but it can make the disease much more tolerable for you and your family and friends. Staying positive may be an easy concept, but when you have to walk the walk not just talk the talk , the concept isn't that easy. However, you can express a positive attitude simply through an optimistic rather than pessimistic attitude toward life. We're not the only people in the world to say that a positive attitude can...

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...

Determining What Causes Endometriosis

Considering the more common theories Contemplating other theories 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...