Endometriosis: A common disease in which the tissue from inside of the womb implants on the surface of the ovaries, tubes, and uterus. It causes internal scarring, pelvic pain, painful periods, painful intercourse, and infertility.
The Story of Endometriosis: A costly medical mistake...
A few years ago doctors learned a very important lesson about painful periods. At the time many women were forced to postpone childbearing to advance their careers. A large number of these women decided to start their families in their mid-thirties. After a few years of unsuccessfully trying to get pregnant they sought help from infertility specialists. When laparoscopies were performed to find out why they weren't getting pregnant, the doctors often found that a disease called endometriosis had caused scarring of their reproductive organs and destroyed their chance of ever having children. When these women were asked if they had painful periods, one of the classic symptoms of endometriosis, many replied, no, but when I was younger I had terrible pain with my periods. In fact, my doctor treated me for pelvic infections many times. The doctors then realized that the pain of endometriosis had been mis-diagnosed as infection and the women suffered from irreversible infertility because of this mistake.
Laparoscopy: A minor surgical procedure in which a small scope is inserted through the belly button in order to see the ovaries, tubes, and uterus.
A strange paradox...
The paradox of endometriosis is that the pain associated with it is worse in its earlier stages. As the disease progresses, and destroys the ovaries and tubes, the pain gradually gets better. Today gynecologists are aware of this phenomenon and are no longer fooled by this disease. Early diagnosis and treatment is essential to eliminate the pain, protect fertility, and avoid the future need for major surgery such as hysterectomies. However, not all women with painful periods have endometriosis. Doctors suspect this disease in young women only if they have had painful periods for six months or more and it is not relieved by taking oral contraceptive pills and/or non-steroidal anti-inflammatory medications like Motrin, Advil, or Anaprox.
A curious mystery...
For some reason endometriosis is becoming more common, it is attacking younger and younger women, and it is becoming more difficult to treat. The most common symptom associated with endometriosis is chronic pelvic pain, including painful periods and pain with intercourse. Although there are several theories to explain this, no one knows for sure why this disease is on the rise.
Two theories to explain the rise of endometriosis...
There are two interesting theories being discussed among gynecologists as to why they are seeing so many new cases of endometriosis. The first theory links tampon use with the disease. The second theory suggests that estrogen added to the meat supply (chicken and beef) may be to blame. Although there is no proof to either of these theories, it is understandable why they both would be considered.
Tissue that doesn't die...
Once a month an adult woman sheds the inner lining of the womb as a period. The inner lining of the womb is known as endometrial tissue and it is kept alive by the female hormones, estrogen and progesterone. Unfortunately, if endometrial tissue finds its way into a woman=s pelvis it can implant on her internal organs, such as the ovaries, tubes, and bladder, and continue to grow. When this happens it is called endometriosis. Over the years, endometriosis has become much more common and is now inflicting younger and younger women. One reason for this epidemic may be tampon use.
The shocking history of tampons...
Tampons have markedly improved the quality of life for women. Before the development of tampons, women were prevented from enjoying many of their favorite activities such as swimming for an entire fourth of their adult lives (one week every month). When tampons were first marketed many years ago, they were made with a super absorbent material. This material acted like a wick and actively drew the menstrual blood and tissue from the inner cavity of the womb. Within a few months of their debut, however, several women developed a life-threatening disease called Toxic Shock Syndrome. The tampons were then taken off of the market and studied. It was discovered that the super absorbent material that had been originally used was responsible for harboring a dangerous strain of bacteria that resulted in Toxic Shock.
Since the tampons were so popular among women they were quickly re-marketed with a safer but much less absorbent material. The new tampons no longer acted as a wick, but rather as a plug, preventing the endometrial tissue from escaping into the vagina during the period. As the womb contracted, trying to overcome the plugging effect of the tampon and expel the menstrual blood and tissue, it forced the endometrial tissue out of the fallopian tubes and into the pelvis of the woman. Once there, the hormonal-responsive endometrial tissue implanted on the internal organs and continued to grow. From then on, every time the woman had a period and was bleeding from the vagina, she was also experiencing a small amount of internal bleeding as well. This internal bleeding caused scarring of the female organs, painful periods, and eventually infertility.
An interesting coincidence...
The wide-spread use of tampons may therefore explain the growing number of endometriosis cases that gynecologists are seeing throughout the world. It may also explain why the disease is effecting younger women. When tampons were first marketed they were only supposed to be used by women who had already had children. Over time it became acceptable for any woman who was sexually active to use them. Eventually, even non-sexually active women began using them. Today it is not uncommon for a girl to start using tampons with her very first period. This use of tampons by younger and younger women over the past few decades parallels exactly the increasing incidence of endometriosis in teenagers and young women. Now some gynecologists advise young women to minimize their use of tampons if possible, especially if they have been found to have endometriosis.
Another common practice among gynecologists is to prescribe the oral contraceptive pill to help alleviate the pains associated with a period.
How does the pill help endometriosis?...
In review, endometriosis is a disease in which the tissue from the inner lining of the womb finds its way into the pelvis where it implants on the surface of the internal organs, including the bladder, bowel, ovaries, tubes, and womb. Once there, the cyclic hormone production of the ovaries keeps the tissue alive where it wreaks havoc on the female reproductive system. Scientists long ago realized that if the ovaries are shut off by pregnancy or menopause, the cyclic hormones are no longer available to sustain the aberrant endometrial tissue and endometriosis will be put into remission.
One kid at a time...
There is a very good reason for the ovaries to be shut off during pregnancy. If the ovaries continued to work during pregnancy, most women would be carrying multiple babies of different gestational ages. Since most couples remain sexually active throughout a pregnancy, it would be possible for a woman to be carrying a full term baby, along with a six month-old fetus and a three month-old fetus! The reason this doesn't happen is that, the moment a woman becomes pregnant, hormones are produced that tell the brain to shut off the ovaries and stop making eggs. When the ovaries temporarily stop working during a pregnancy, their cyclic production of hormones is disrupted and any endometriosis tissue loses its life support system. Pregnancy is a natural treatment for endometriosis.
Sex and the brain...
Like everything else in the human body, the female reproductive system is controlled by the brain.
Each month the brain pumps out a substance called Follicle Stimulating Hormone (FSH) into the blood stream where it is carried to the ovaries. Once FSH reaches an ovary it drives it to develop an egg. The ovary, in turn, increases its estrogen production during the 10 to 14 days it is maturing the egg. This estrogen is also pumped out into the blood stream where it is carried back to the brain as a feedback hormone. The brain monitors the level of estrogen.
Once the estrogen has reached a certain peak, the brain stops producing FSH and releases a second substance called Luteinizing Hormone (LH). This sudden surge of LH prompts the ovary to release the matured egg. This event is known as ovulation. LH also stimulates the ovary to increase its production of progesterone and decrease its production of estrogen. The brain now monitors the blood levels of progesterone. After about eight days the ovary can no longer sustain the progesterone production and the levels begin to drop. The brain senses this drop in progesterone, realizes that no pregnancy has occurred, and starts to pump out FSH again to restart the whole cycle.
If pregnancy ensues, however, large amounts of estrogen and progesterone are initially produced by the developing pregnancy tissue. The brain receives this feedback message through the blood and does not resume pumping out FSH. Without FSH, no more eggs are produced by the ovary. Therefore, once pregnant, a woman can not get pregnant again until after she delivers the child she is carrying. Without the ovaries going through their monthly cycle, no hormones stimulate the endometriotic tissue in the inner lining of the womb to make a period. Also, there is no more hormonal stimulation of any aberrant endometriotic tissue in the pelvis and endometriosis is put into remission.
Scientists correctly concluded that if they could fake a pregnancy with medication than this would also cause a remission of endometriosis. The oral contraceptive pill contains both estrogen and progesterone. While a woman is on the pill the brain senses the presence of these two hormones in the blood and assumes that they are coming from a developing pregnancy. Consequently the brain shuts off all FSH production. Now the woman can have sex without getting pregnant because her body has been fooled into thinking that she is already pregnant.
Many women who take the pill get some of the symptoms of pregnancy. These symptoms include weight gain, breast tenderness, breast growth, morning sickness, cravings, vaginal dryness, decreased sex drive, and the cessation of periods. All of these disturbing side-effects are a result of the pill fooling the brain into thinking that the woman is already pregnant!
When a woman reaches a certain age her ovaries naturally stop working. This event is called the menopause. Once a woman reaches the menopause, the ovaries no longer produce the hormones that are needed to produce a period and to promote endometriosis. Her period stops and her endometriosis improves. Scientists discovered a medicine called Lupron which turns off the ovaries and fools the body into thinking that the menopause has occurred. Consequently, Lupron can be used to treat endometriosis.
Medical treatment for endometriosis...
In medicine its always best to try the least expensive, least dangerous treatment for any disease. If that doesn't work more expensive and more dangerous treatments can always be tried later. When it comes to endometriosis, the oral contraceptive pill, along with a non-steroidal anti-inflammatory medicine such as Advil, Motrin, Anaprox, etc., is the least expensive and least dangerous treatment option. Lupron is an injection that is more expensive and has more side effect potential than the pill. If medicines don't work than a laparoscopy with laser surgery can be considered. In most cases, this procedure can now be performed in The Women's Surgery Center on the same day as your initial visit without the need to be hospitalized!
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