Endometriosis

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Doctor suspicions of endometriosis	Making the diagnosis
Causes of endo	Getting rid of endometriosis
Continous bcp	Endometriosis look like what
When my HRT isn't working	General endometriosis resources

Endometriosis: what it is
Endometriosis is where the lining of the uterus (endometrium) attaches to other parts of the body (for example, bowel and ovaries) where it isn't supposed to be. Deeper explanations can be found at Shetrust.

How to tell if you have it or think you have it?
Since this is endometrial tissue that responds to the monthly hormonal surges and flucuations, it tries to shed itself during your period. Of course, it can't exactly do that, so you get pain during your periods. On top of this, scar tissue is left at the sites if you have been operated on, called adhesions, which can cause pain. If having your period bothers you so badly that NSAID's (non steroidal pain medications) don't work, that is a clue. Painful sex is another hallmark of endometriosis (the missionary position is reported to be the easiest position to have sex in). Sometimes pain during bowel movements, ovulation, and back pain indicate that you have endometriosis. Heavy cramping becomes a problem if the endometriosis is in the cul-de-sac area. Problems with inserting or removing a tampon, like pain, can indicate endometriosis on the bowel walls also, as can bleeding, cramping, constipation or diarrhea during your period.
It isn't just the uterus or ovaries that are involved. Endometriosis can appear on the bowel, cul-de-sac (of the uterus), bladder, intestines, even the lungs and heart can be affected. The Family Practioners website has information on the diagnosis and treatment of endometriosis. Adhesions.org and She trust.org has further explanations.

Doctor suspicions of endometriosis:
Have your doctor review "Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease, Fertility and Sterility Vol 2, No 2, August 1999, David Byron Redwine, MD", or they should be able to 'feel' it during a pelvic exam. According to the Women's Surgery Group, "During pelvic examination, the astute gyncologist suspects endometriosis when any of the following are discovered: -tenderness or nodularity in the posterior cul-de-sac, especially on the uterosacral ligaments, -anterior cul-de-sac nodularity, -adnexal masses, -reduced mobility or fixation of the uterus or ovaries, -unusual pain associated with the examination", However, it goes on to say that the finding of cul de sac nodularity on pelvic examination points to "more advanced endometriosis".

Making the diagnosis:
Only by a laparoscopy, a surgical procedure where a doctor actually goes in to view any implants. Surgical treatments at OBGYN.net Broadcasting - Surgical Treatments for Endometriosis- transcript.

Causes of endo:
No one knows, but some theories are environmental toxins, soy, genetics/heredity and retrograde menstruation. Retrograde menstruation is a theory whereby parts of the endometrium (or lining) 'back up' through the fallopian tubes, instead of going out the cervix, and attach to where ever in the body it gets to.

Getting rid of endometriosis:
Hysterectomies and having babies will not for 100% sure get rid of endo, no matter what someone might tell you, including doctors. For starters, a simple hysterectomy only gets rid of the uterus. It doesn't mean the doctor got rid of all the implants. A TAH-BSO or Total Abdominal Hysterectomy with Bilateral Salpingo-Oopherectomy (removing ovaries, tubes, uterus) helps better, but you will be on some form of estrogen for the rest of your life. Again, if the implants haven't been removed, this estrogen will stimulate those growths. Also, surgery can cause adhesions to form, multiple surgeries even more so. Those adhesions, in and of themselves, can cause pain. Synechion has a place to learn about surgical adhesions and their prevention. You might be interested in non-surgical endo treatment options.

Continous bcp:
Dr. Leon Speroff in his book, "Clinical Gynecologic Endocrinology and Infertility" states (914) that there is NO reason to recommend free time away from the pill.

Endometriosis look like what?:
It is my understanding that endo looks like different colors, and isn't always the black and blue powder burns you see in most doctors offices' pictures. Actually Dr. Leon Speroff in his book, "Clinical Gynecological Endocrinology and Infertility (1060) says that implants and lesions can be red, white, black, blue or nonpigmented. This is generally why it is best to get someone who has done a lot of surgery, especially with tough cases.

When my HRT isn't working:
Prempro and Tibulone is all I have right now. Zeneca has a new SERM undergoing European trials (10/99) that avoids endometrial stimulation, yet provides symptomatic relief.

General endometriosis resources: