Definition
Endometriosis. It affects 6-10 % of all US women. They suffer from a disease that can in some cases be quite painful. And they are treated by a medical profession that is largely uninformed about endometriosis, a deficit that stems from the acceptance of an unproven theory from the 1920’s and a misinterpretation of clinical results.
What is this thing called endometriosis? One accepted definition: It is aberrant growth of. endometrium outside the uterus. Yet this is really an oxymoron.
Aberrant is defined as “straying from the right or normal way, deviating from the usual or natural type, i.e. atypical.”
But endometriosis not only involves abnormality of location, i.e. putting hormonally responsive tissue in the wrong place, but also an abnormality of the tissue itself. Endometriosis is not, contrary to fashionable thinking, exactly like the endometrium lining the inside of the uterus. It’s not the same thing as taking normal endometrium tissue out of the uterus and planting it say, on an ovary or abdominal wall. For one thing, the tissue’s hormonal receptor population shows far more variation, sometimes having a noticeably lower number of receptors than that found in endometrium. Not surprisingly, the endometriosis response to hormonal stimulation varies, bleeding is unpredictable. This means you then get a difference in visual appearance in endometriosis. Younger patients may present with subtle, often misdiagnosed lesions. A surgeon trying to treat endometriosis by attacking only the classical “black powder burn” lesion will miss out.
A Female Experience.
How is endometriosis likely to present? It doesn’t occur the same way in all patients. Pelvic pain is frequent and may accompany menses. Pain often starts 2-7 days before menses and worsens until flow diminishes. Painful intercourse is another troubling sign.
If endometriosal tissue invades the bowel, the patient may experience rectal pain and bleeding. Bowel cancer frequently presents in this fashion and patients with these symptoms should seek medical advice.
The longer endometriosis persists, the more continuous the pain becomes. The severity of the pain does not necessarily parallel the extant of disease spread in the body.
Inferility and Endometriosis.
Not infrequently endometriosis is identified as the cause of infertility, and patients seek treatment of the disease with the specific objective of achieving pregnancy. Often the pregnancy itself halts the endometriosis.
The impact of endometriosis on fertility often affects the treatment approach to human infertility. Even clinics such as the DePorres Clinic in Chicago, that work to achieve pregnancy by all natural methods requires careful investigation of pelvic pain or other manifestations of endometriosis. Patients often require referral and review of initial imaging studies including ultrasound, MRI and laproscopy. Many physicians advise young women with endometriosis to conceive as early as possible out of a concern that infertility from permanent damage of tubes may result from the disease process.
Treatment
We mentioned that pregnancy may be helpful in stopping the disease. But most patients will turn to drugs or surgery to cure endometriosis. Many excellent discussions of medical treatments of endometriosis may be found on the web. They can be effective in controlling pain in may patients. We mentioned that endometriosis is an important cause of infertility. While medications may control pain there is no evidence that such treatments will increase the likelihood of pregnancy. In general drugs are looked at as a short term solution and it is hoped that ongoing research will produce more acceptable drugs for long term use .(see below for latest developments in endometirial drugs.
Many patients turn to surgery as longterm solution.
One approach is to remove endometrial lesions; These procedures are frequently difficult to perform with success. Those of us who have worked alongside surgeons are familiar with their bewildered look on inspecting the peritoneal cavity in these patient. Faced with the multiple varied lesions that can accompany this disease they often make the hopeless statement: “No matter what I do it will recur.” Consider also what we said about the non classical appearance of endometrial lesions and it’s easy to see why these operations often fail to cure the patient of the disease.
Another surgical alternative is the removal of pelvic organs-a removal of uterus,tube and ovaries. Does it really work? Is it the best strategy for all patients?
Dr David Redwine a gynecologist at St Charles Medical Center in Bend, Oregon has argued against the claim that this organ removal procedure, called TAH, is a definitive treatment of endometriosis- you remove organs but not endometriosis; the disease is still present. The procedure may appear to be clinically successful, but the reasons for the success is not understood. This failure to understand what is happening affects the pain and suffering of the cases where the procedure simply doesn’t work.
According to Dr Redwine, the removal of pelvic organs eliminates all of the disease in only 4% of patients. This startling figure implies that the disease remains in 96% of patients with total hysterectomy. What is the significance of this?
First, if the remaining endometrial sites are superficial then no problems will result. The patient will consider the procedure a success even though the disease is still present. For the unfortunate others, where the disease remaining is not superficial, then symptoms still occur.
Putting this another way, in the 130,000 hysterectomies done each year 9,000 women are left symptomatic. And what of these woman who complain of endometrial pain after organ removal; how are they treated?
Some are advised that nothing can be done for them. After paying thousands of dollars for surgery in the hope that it would end their pain they are now simply told to “live through it.” Some are prescribed drugs that suppress ovulation-but they have no ovaries. What is really sad it that some patients are given psychiatric referral-“it’s impossible to have pain without organs-it’s all in your head.” It’s easy to see why some women simply give up looking for help with endometriosis. For all the talk of feminist empowerment, current society values the clinical problems of women less than the male or senior groups when it comes to responding to diseases like endometriosis.
Despite the acceptance of TAH, there is no scientific proof that hysterectomy is a definitive treatment for endometriosis. When it does work it is because the patient was fortunate to have only benign lesions remaining in the pelvis. There is also the possibility that the source of pain was really a condition in organs themselves and not due to endometriosis.
Endometriosis. It affects 6-10 % of all US women. They suffer from a disease that can in some cases be quite painful. And they are treated by a medical profession that is largely uninformed about endometriosis, a deficit that stems from the acceptance of an unproven theory from the 1920’s and a misinterpretation of clinical results.
What is this thing called endometriosis? One accepted definition: It is aberrant growth of. endometrium outside the uterus. Yet this is really an oxymoron.
Aberrant is defined as “straying from the right or normal way, deviating from the usual or natural type, i.e. atypical.”
But endometriosis not only involves abnormality of location, i.e. putting hormonally responsive tissue in the wrong place, but also an abnormality of the tissue itself. Endometriosis is not, contrary to fashionable thinking, exactly like the endometrium lining the inside of the uterus. It’s not the same thing as taking normal endometrium tissue out of the uterus and planting it say, on an ovary or abdominal wall. For one thing, the tissue’s hormonal receptor population shows far more variation, sometimes having a noticeably lower number of receptors than that found in endometrium. Not surprisingly, the endometriosis response to hormonal stimulation varies, bleeding is unpredictable. This means you then get a difference in visual appearance in endometriosis. Younger patients may present with subtle, often misdiagnosed lesions. A surgeon trying to treat endometriosis by attacking only the classical “black powder burn” lesion will miss out.
A Female Experience.
How is endometriosis likely to present? It doesn’t occur the same way in all patients. Pelvic pain is frequent and may accompany menses. Pain often starts 2-7 days before menses and worsens until flow diminishes. Painful intercourse is another troubling sign.
If endometriosal tissue invades the bowel, the patient may experience rectal pain and bleeding. Bowel cancer frequently presents in this fashion and patients with these symptoms should seek medical advice.
The longer endometriosis persists, the more continuous the pain becomes. The severity of the pain does not necessarily parallel the extant of disease spread in the body.
Inferility and Endometriosis.
Not infrequently endometriosis is identified as the cause of infertility, and patients seek treatment of the disease with the specific objective of achieving pregnancy. Often the pregnancy itself halts the endometriosis.
The impact of endometriosis on fertility often affects the treatment approach to human infertility. Even clinics such as the DePorres Clinic in Chicago, that work to achieve pregnancy by all natural methods requires careful investigation of pelvic pain or other manifestations of endometriosis. Patients often require referral and review of initial imaging studies including ultrasound, MRI and laproscopy. Many physicians advise young women with endometriosis to conceive as early as possible out of a concern that infertility from permanent damage of tubes may result from the disease process.
Treatment
We mentioned that pregnancy may be helpful in stopping the disease. But most patients will turn to drugs or surgery to cure endometriosis. Many excellent discussions of medical treatments of endometriosis may be found on the web. They can be effective in controlling pain in may patients. We mentioned that endometriosis is an important cause of infertility. While medications may control pain there is no evidence that such treatments will increase the likelihood of pregnancy. In general drugs are looked at as a short term solution and it is hoped that ongoing research will produce more acceptable drugs for long term use .(see below for latest developments in endometirial drugs.
Many patients turn to surgery as longterm solution.
One approach is to remove endometrial lesions; These procedures are frequently difficult to perform with success. Those of us who have worked alongside surgeons are familiar with their bewildered look on inspecting the peritoneal cavity in these patient. Faced with the multiple varied lesions that can accompany this disease they often make the hopeless statement: “No matter what I do it will recur.” Consider also what we said about the non classical appearance of endometrial lesions and it’s easy to see why these operations often fail to cure the patient of the disease.
Another surgical alternative is the removal of pelvic organs-a removal of uterus,tube and ovaries. Does it really work? Is it the best strategy for all patients?
Dr David Redwine a gynecologist at St Charles Medical Center in Bend, Oregon has argued against the claim that this organ removal procedure, called TAH, is a definitive treatment of endometriosis- you remove organs but not endometriosis; the disease is still present. The procedure may appear to be clinically successful, but the reasons for the success is not understood. This failure to understand what is happening affects the pain and suffering of the cases where the procedure simply doesn’t work.
According to Dr Redwine, the removal of pelvic organs eliminates all of the disease in only 4% of patients. This startling figure implies that the disease remains in 96% of patients with total hysterectomy. What is the significance of this?
First, if the remaining endometrial sites are superficial then no problems will result. The patient will consider the procedure a success even though the disease is still present. For the unfortunate others, where the disease remaining is not superficial, then symptoms still occur.
Putting this another way, in the 130,000 hysterectomies done each year 9,000 women are left symptomatic. And what of these woman who complain of endometrial pain after organ removal; how are they treated?
Some are advised that nothing can be done for them. After paying thousands of dollars for surgery in the hope that it would end their pain they are now simply told to “live through it.” Some are prescribed drugs that suppress ovulation-but they have no ovaries. What is really sad it that some patients are given psychiatric referral-“it’s impossible to have pain without organs-it’s all in your head.” It’s easy to see why some women simply give up looking for help with endometriosis. For all the talk of feminist empowerment, current society values the clinical problems of women less than the male or senior groups when it comes to responding to diseases like endometriosis.
Despite the acceptance of TAH, there is no scientific proof that hysterectomy is a definitive treatment for endometriosis. When it does work it is because the patient was fortunate to have only benign lesions remaining in the pelvis. There is also the possibility that the source of pain was really a condition in organs themselves and not due to endometriosis.
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