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Whether the incidence of endometriosis is on the rise in the United States or whether the disorder is simply attracting more attention is difficult to determine. Victims of endometriosis tend to be women between the ages of 20 and 40. Symptoms include severe cramping during and between menstrual cycles, irregular periods, unusually heavy or light menstrual flow, abdominal bloating, fatigue, painful bowel movements with periods, painful intercourse, constipation, diarrhea, menstrual pain, infertility, and low back pain. What is this disease? What causes it? What are the common methods of treatment?
Although much remains unknown about the causes of endometriosis, we do know that the disease is characterized by the abnormal growth and development of endometrial tissue (the tissue lining the uterus) in regions of the body other than the uterus. Among the most widely accepted theories concerning the causes of endometriosis are the transmission of endometrial tissue to other regions of the body during surgery or through the birthing process; the movement of menstrual fluid backward through the fallopian tubes during menstruation; and abnormal cell migration through body-fluid movement. Women with cycles shorter than 27 days and those with flows lasting over a week are at increased risk. The more aerobic exercise a woman engages in and the earlier she starts it, the less likely she is to develop endometriosis.
Treatment of endometriosis ranges from bed rest and stress reduction to hysterectomy (the removal of the uterus) and/or the removal of one or both ovaries and the fallopian tubes. Recently, physicians have been criticized by some segments of the public for being too quick to select hysterectomy as the treatment of choice. More conservative treatments that involve dilation and curettage, surgically scraping endometrial tissue off the fallopian tubes and other reproductive organs, and combinations of hormone therapy have become more acceptable in most regions of the country. Hormonal treatments include gonadotropin-releasing hormone (GnRH) analogs, various synthetic progesterone-like drugs (Provera), and oral contraceptives
Premenstrual syndrome (PMS), a syndrome describing a series of characteristic symptoms that occur prior to menstruation in some women, has generated a great deal of controversy in recent years. Although the monthly problems experienced by many women have been discussed for decades, they were largely dismissed as insignificant until the 1980s.
So just what is PMS? Premenstrual syndrome is characterized by as many as 150 possible physical and emotional symptoms that vary from person to person and from month to month. These symptoms usually appear a week to 10 days preceding the menstrual period and to some degree affect between 20 and 40 percent of U.S. women of menstruating age to some degree. They include depression, tension, irritability, headaches, tender breasts, bloated abdomen, backache, abdominal cramps, acne, fluid retention, diarrhea, and fatigue. It is believed that women who have PMS develop a predictable pattern of symptoms during the menstrual cycle and that the severity of their symptoms may be influenced by external factors, such as stress.
Women usually experience PMS for the first time after the age of 20, and it may remain a regular part of their reproductive life unless they seek treatment. For many women, the first day of their period brings immediate relief. For others, the depressive symptoms persist all month and are only heightened prior to the menstrual period.
Most authorities believe that the most plausible cause of PMS is a hormonal imbalance related to the rise in estrogen levels preceding the menstrual period. This theory is substantiated by the fact that women with PMS who are given prescriptions for progesterone often experience relief of symptoms. Critics of this theory argue that controlled research has not yet been conducted on the effects of progesterone on PMS.
Common treatments for PMS include hormonal therapy in addition to drugs and behaviors designed to relieve the symptoms. These include aspirin for pain, diuretics for fluid buildup, decreases in caffeine and salt intake, increases in complex carbohydrate intake, stress reduction techniques, and exercise.
Severe abdominal cramps. Incontinence. Infertility. Excessive bleeding. Little can be more frightening to a woman than to know that something is wrong with her cycle or with her reproductive organs. The immediate thoughts turn to cancer – ovarian, uterine, cervical, which is it? Rarely, and understandably, does a woman think first about a benign and relatively common possibility: uterine fibroids.
Uterine fibroids are noncancerous growths that can develop in a woman’s uterus and that occur in 20 percent to 25 percent of all women. Until biopsied, however, the diagnosis of any growth in the body sends fear through everyone. Fibroids are most common in women age 30 to 40, but they can occur at any age. They also tend to occur more frequently and grow more quickly in black women than in white women. Symptoms include the following:
• Changes in menstruation
- Excessive bleeding
- Longer or more frequent periods
- Excessive menstrual cramps
- Vaginal bleeding at times other than menstruation
- In the abdomen or lower back, usually a dull, heavy ache, but may be sharp
- During sex
- Difficulty in urinating or frequent urination
- Constipation, rectal pain, or difficult bowel movements
- Abdominal cramps
• Miscarriage and infertility
Many women develop small fibrous growths in their uterus and experience few problems. They may live their entire lives unaware of these growths. For others, however, the fibroids may grow over a period of time into masses large enough to place pressure on internal organs or interfere with normal functioning. They may even be the cause of infertility in some women. When fibroids interfere with functioning, some form of treatment is usually necessary. The treatment selected depends on a number of factors, including the woman’s child-bearing status (age and desire), the size of the fibroids, and complications due to the fibroids.
The options available to women with fibroids fall into two categories: surgical or nonsurgical. Little is known about what causes fibroids to develop or what causes them to grow so large in some women, although some studies indicate that the hormone estrogen appears to increase their growth. As such, after menopause, fibroids tend to shrink. Therefore, women beyond childbearing age and with tolerable symptoms may opt to let nature take its course. Medication may also help to shrink the fibroids before the onset of menopause. Women who opt for surgery also have a couple of choices: a hysterectomy or a myomectomy. A hysterectomy is the removal of the uterus, the cervix, and surrounding tissue, including the fibroids. A myomectomy is the removal of only the fibroids, with everything else left intact. The decision as to which surgery to have is up to the woman and, again, depends greatly on her desire to have children and on the severity of any problems caused by the fibroids.
Fibroids can be detected during an annual pelvic exam and verified by an ultrasound or other methods, such as a laparoscopy, magnetic resonance imaging (MRI), or computerized tomography (CT) scans when a more detailed image is necessary. Paying attention to changes or unusual events with the menstrual cycle and paying attention to general body health are important components of every woman’s prevention profile. Although little can be done to prevent fibroids, regular checkups are important for early detection and care before they develop into a greater problem.
Each of us responds in our own way to the experience of illness and we all have views about the sorts of treatments we find acceptable. For each there are different circumstances and different priorities. For example, women of all ages would prefer not to have bleeding accidents and may be prepared to undergo extensive investigation and difficult treatments to achieve this end. Other factors that may influence attitudes to treatment include the dollar cost, the risk of adverse effects and complications, the time to recovery, possible effects on body- and self-image and sexuality, and the presence or absence of a family history of gynaecological disease of one sort or another. Weighing up these sorts of considerations, along with input from health advisers, family, friends and other information sources, will influence our views on treatment. The challenge is to find the treatment that is most suitable and has the best outcome given particular individual situations and needs.
Stress can affect both male and female fertility, and not conceiving can in itself become a cause of stress. Many women with fertility problems say that their whole life seems to revolve round their monthly cycle – hoping their period will not come, and, when it does, feeling devastated, and that yet another month has been ‘wasted’. The couple’s relationship may be put under severe strain during the rounds of investigations and IVF treatments. For example, one woman who came to see me, after previous unsuccessful IVF treatments, became pregnant naturally. But then her husband left her, saying he never wanted a baby anyway. He had gone with her for numerous IVF treatments but none of this had been spoken about. In such cases counseling may well be helpful.
If stress is a factor for you, then it is also worth learning some form of relaxation, stress management technique or meditation. Hypnotherapy can also be helpful, in that it can work on the subconscious to address emotional blockages.
When you are desperate to conceive, lovemaking can lose its spontaneity as there is the feeling that intercourse must happen on certain days of the month and those days mustn’t be missed. However, research has shown that the more enjoyable the lovemaking (and especially if the woman has an orgasm), the more likely she is to retain more active sperm. The contractions caused by the orgasm draw in more sperm and it is thought that her arousal may make the vagina less acidic, increasing the chances of the sperm surviving longer. I think the message is: enjoy yourselves!
If you take tranquillizers or sleeping pills, talk to your doctor about gradually coming off them and finding an alternative. Herbs can be very helpful. Valerian is a wonderful herb for helping with insomnia and it is classed as a sedative in herbal medicine. Passionflower (or passiflora) is another good herb for helping you sleep and can be used together with valerian for maximum effect. A cup of hot camomile tea before bed can also be effective.
Aromatherapy oils, such as bergamot, lavender and camomile, can be added to a relaxing warm bath just before going to bed.
Magnesium, known as ‘nature’s tranquillizer’, is a good mineral to use when weaning yourself off conventional medication. One dose of magnesium (100mg) can be taken about an hour before you go to bed.