Endometriosis ~ Abdominal Pain ~ Endo ~ Scar Tissue ~ Adhesions ~ Infertility ~ Hysterectomy

Thursday, February 08, 2007

Endometriosis Awareness Throughout the Month of March

March is the month for Endo sufferers to be heard! In the United States, Congress formally recognizes the entire month of March as "Endometriosis Awareness Month," and in Europe and Australia, the week-long recognition takes place from March 5-11, 2007. See http://www.endocenter.org and http://www.endometriosis.org to learn what others are doing.Some easy ways to get involved, either with your organization of choice or on your own:
Host or participate in a fundraiser for Endo;
Submit articles to your local media outlets and request that they do an Endo feature (or two!);
"Adopt a Doc" (see http://www.endocenter.org/adoptadoctor.htm for details);
Pass out brochures everywhere you go (readily available from all the Endo organizations);
Wear your yellow ribbon jewelry or other Endo accessory with pride (see http://www.cafepress.com/erc for details);
Hand out additional yellow ribbons and/or EndoAngel cards (with details about Endo);
Ask the local high school/middle school nurse(s) if you can present on Endo in young women to the older students;
Ask your local hospital or health center if you can host an educational event on Endo;
Be an advocate to a local Endosister - take her to the doctor or surgery, lend her your support, etc.;
Donate an Endo book to your local library;
Get involved in the legislative awareness campaign (see http://www.endocenter.org/awarenessprogram.htm for details);
Volunteer at a local Endo organization (volunteerism can be done online, too!);
Join a support group for Endo (see http://www.endometriosis.org/support.html for details);
And so much more. No initiative, regardless of how small, is unimportant. Only by working together towards greater awareness can we achieve it!

Hershey puts fertility drugs to the testFinds most popular might not be best

Susan E. Lindt, StaffIntelligencer Journal
Published: Feb 08, 2007 1:21 AM EST
A new study suggests the drug most often prescribed to treat a cause of female infertility isn't the best one for the job.
The good news is a more effective drug already is on the market, researchers say.
Hershey Medical Center researchers studied two medications used to treat women unable to conceive because of polycystic ovary syndrome. The four-year study simply attempted to determine which drug works better, or if a combination of both is most effective.
The answer is revealed in an article published today in The New England Journal of Medicine: metformin, the drug most often prescribed, was less effective, with only 15 of 208 women in the study, or 7.2 percent, conceiving and giving birth.
Another drug, clomiphene, was more effective, with 22.5 percent, or 47 of 209 women, giving birth.
A combination of both drugs was most effective, with 26.8 percent giving birth, but the slight difference between the combination and clomiphene-only groups was considered statistically insignificant.
The study's outcome surprised researchers, who say the health care industry has accepted metformin as the more effective of the two drugs.
"I was shocked to see the data," said Hershey Medical Center physician and researcher Richard S. Legro, who directed the study and is primary author of the New England Journal article. "We definitely know (clomiphene) works. This was a down-and-out group of women who had tried everything.
"I think (clomiphene) is as good as it gets. It's a rousing success."
Click below to

Examine the Role Angiogenesis Inhibitors Have in Cancer, Dermatology, Ophthalmology & Rheumatology

DUBLIN, Ireland--(BUSINESS WIRE)--Feb 7, 2007 - Research and Markets (http://www.researchandmarkets.com/reports/c49924) has announced the addition of Angiogenesis Modulators - A Market Insight Report to their offering.
This market insight report on Angiogenesis Modulators studies the impact of Inhibitors and Stimulators on various diseases. The study focuses on major angiogenesis inhibitors and their role in diseases such as cancer, dermatology, ophthalmology, rheumatology and other angiogenesis based diseases including endometriosis and inflammatory diseases. The emphasis is also given on major angiogenesis stimulators and their role in diseases such as cardiovascular disorders including ischemia, congestive heart failure, coronary artery disease, myocardial infarction and peripheral vascular disease and chronic wound care. The study provides global market analysis for angiogenesis therapeutic products by the above angiogenesis modulators and also by the disease areas such as cancer, cardiovascular disorders and other angiogenesis based diseases. The study includes estimates and projections for the total global angiogenesis therapeutic products market. Projections and estimates are also illustrated by geographic regions encompassing United States, Europe, Asia-Pacific and Rest of World. Business profiles of 34 major companies are discussed in the report. The report serves as a guide to global angiogenesis industry covering 334 companies engaged in angiogenesis research, testing and supply of products and services. Major Contract Research Organizations and Universities serving angiogenesis industry are also covered in the Corporate Directory section of this report. Information related product developments, partnerships, collaborations, and mergers and acquisitions are also covered in the report featuring 92 graphically represented exclusive exhibits. -0-

Wednesday, February 07, 2007

Newest trend in birth control

By Kemberly Richardson
(New York - WABC, February 5, 2007) - The market is now inundated with several new drugs that promise to reduce or eliminate your menstrual cycle. For most women that sounds like a dream. But is it a risky choice for women?
While nursing her second child, Gina Garrison was thrilled to discover she stopped getting her period.
"It was great ... didn't have to worry about anything, especially with them running around ... one less thing to worry about," she said.
She did start taking the pill and got her period. But instead of 12 each year, she now gets only four. Like a growing number of women, she discovered a way to manipulate her cycle.
Dr. Mindy Wiser-Estin, gynecologist: "You can just skip the placebo week and go to the next pill rack."
Dr. Wiser-Estin is talking about a whole new army of birth control pills specifically geared for women who want to, for the sake of convienence, have fewer periods.
"I'm seeing teens in high school who may be athletes ... and them I'm seeing perimenipausal who are just tired of the whole thing," she said.
In fact, one survey showed 71 percent of women didn't like getting their period each month. Another survey found 49 percent want to learn more about stopping or delaying their cycle. But is it safe?
"The answer is yes, as long as you're on pill with progesterone in pills which keeps lining thin, so no reason medically you have to have a period every month," Dr. Wiser-Estin said.
NYU Professor Linda Gordon sits somewhere in the middle. She's written about birth control and warns women to proceed with caution, pointing to the past as a reason why.
"It happened to my generation about hormone replacement therapy for menopause, they pushed hard and it turned out to be destructive with the same issues it was suppose to be helping you," Gordon said.
But experts counter they've been doing the same thing with no complications for decades with women suffering from endometriosis and extremely difficult periods. What lies ahead?
"If you ask me, five years from now, women are going to do long that 12 weeks," Dr. Wiser-Estin said.

Serum dioxin concentrations and age at menopause.

Environ Health Perspect. 2005 Jul ;113 (7):858-62 16002373
Serum dioxin concentrations and age at menopause.
[My paper] Brenda Eskenazi , Marcella Warner , Amy R Marks , Steven Samuels , Pier Mario Gerthoux , Paolo Vercellini , David L Olive , Larry Needham , Donald Patterson Jr , Paolo Mocarelli
2,3,7,8-Tetrachlorobenzo-p-dioxin (TCDD), a halogenated compound that binds the aryl hydrocarbon receptor, is a by-product of numerous industrial processes including waste incineration. Studies in rats and monkeys suggest that TCDD may affect ovarian function. We examined the relationship of TCDD and age at menopause in a population of women residing near Seveso, Italy, in 1976, at the time of a chemical plant explosion. We included 616 of the women who participated 20 years later in the Seveso Women's Health Study. All women were premenopausal at the time of the explosion, had TCDD levels measured in serum collected soon after the explosion, and were > or = 35 years of age at interview. Using proportional hazards modeling, we found a 6% nonsignificant increase in risk of early menopause with a 10-fold increase in serum TCDD. When TCDD levels were categorized, compared with women in the lowest quintile (< p =" 0.77)," p =" 0.14)," p =" 0.10),"> 118 ppt) had an HR of 1.1 (p = 0.82) for risk of earlier menopause. The trend toward earlier menopause across the first four quintiles is statistically significant (p = 0.04). These results suggest a nonmonotonic dose-related association with increasing risk of earlier menopause up to about 100 ppt TCDD, but not above.
Mesh-terms: Adolescent; Adult; Age Factors; Chemical Industry; Child; Child, Preschool; Dose-Response Relationship, Drug; Environmental Pollutants, blood; Explosions; Female; Humans; Infant; Italy, epidemiology; Menopause, Premature, blood; Middle Aged; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.; Retrospective Studies; Tetrachlorodibenzodioxin, blood;


Isolated infiltrative endometriosis of the sciatic nerve: a report of three patients.

Possover M,
Chiantera V.
Department of Obstetrics and Gynecology, St. Elisabeth Hospital, Cologne, Germany. MarcPossover@aol.com
OBJECTIVE: To report that isolated endometriosis of the sciatic nerve without further manifestation of endometriosis does exist. DESIGN: We describe our technique of laparoscopic neurolysis of the sciatic nerve and the sacral plexus. SETTING: Department of Gynecology and Obstetrics, St. Elisabeth Hospital, affiliated with the University of Cologne, Cologne, Germany. PATIENT(S): Three female patients with isolated endometriotic infiltration of the endopelvic portion of the sciatic nerve. INTERVENTION(S): Elective laparoscopic neurolysis of the sciatic nerve with removal of endometriosis. MAIN OUTCOME MEASURE(S): Disparition of pain in the patients and histologic information of the endometriosis. RESULT(S): Isolated endometriosis of the sciatic nerve and/or the sacral plexus does exist without any further endometriosis genitalis externa manifestations. CONCLUSION(S): In young patients with sciatica of an unknown genesis, an endometriosis of the sciatic nerve must be evoked, and a laparoscopic exploration of the sciatic nerve must be discussed.
PMID: 17276152 [PubMed - in process]

Tuesday, February 06, 2007

Is excision of endometriosis necessary to treat pain?

Anyone asking this question has little experience with extensive disease. Extensive endometriosis usually results in severe pain that can be relieved by excision of the endometriosis. Most women with extensive cul-de-sac endometriosis have some degree of nodularity and/or tenderness of their uterosacral ligaments, anterior rectum, and posterior vagina-cervix during rectovaginal exam. The object of the surgery is to remove the painful, tender nodule. Postoperative examination after excision of the previously known lesion should confirm the absence of nodularity and tenderness, documenting that excision of the area of maximum tenderness and nodularity caused by endometriosis is the best treatment for pelvic pain caused by this condition. Unfortunately, many gynecologists fail to do an adequate rectovaginal examination to discover the lesion in the first place.
How can you remove the tender nodule without excision? I don’t know! When areas thought to be endometriosis by laparoscopic examination are subjected to treatment with laser or electrosurgery for ablation, only the "tip of the iceberg" is usually treated. The deeper components of the lesion go untreated as the surgeon under treats because of fear of late complications to the rectum and or ureter. This type of treatment can't possibly work. It usually stimulates the endometriosis lesion with resultant increase in the inflammation both inside the lesion and surrounding it. The end point of laparoscopic (and laparotomy) surgical procedures to excise endometriosis should be a normal rectovaginal exam with a mobile distensible vagina, a free rectum, and the absence of nodularity as palpated with a rectovaginal exam while probing the area visualized with the laparoscope.
Endometriosis is a discreet lesion: Endometrial glands and stroma surrounded by fibromuscular tissue, making the white and fibrotic. Symptomatic black-brown lesions are always surrounded by white fibromuscular scar.
Most endometriosis treated in the United States is not endometriosis; rather, it is old blood from retrograde menstruation or discharge from a corpus luteum (“coffee grounds or tobacco stained” tissue). The pathologist sees hemosiderin laddened macrophages. Without excisional biopsy, we have no accurate idea of the number of people with “real” endometriosis that have been treated in the past. Thus, present data regarding treatment are meaningless as they usually report on the “destructive” treatment of degenerating blood cells instead of endometriosis glands.
I ask you, if a suspected area of endometriosis is ablated without specimen taking, how can we ever know if that patient really had endometriosis to start with? We know that many things can cause pelvic pain including retrograde menstruation, physiological cysts, uterine contractions, and that some certainly are psychosomatic. Women that are told that the old blood from retrograde menstruation is endometriosis may forever feel that they are victims of this condition, no matter what future treatment is applied. This just does not represent good medicine.
I will describe the examination to diagnose endometriosis & the techniques to excise it:
The most common presentations produced by endometriosis are pelvic pain, infertility, and adnexal mass. The ovaries, the posterior leaf of the broad ligament, and the cul-de-sac of Douglas behind the uterus are the most frequent locations, and the left side is more frequently affected than the right.
Extensive endometriosis usually involves the posterior cul-de-sac of Douglas, the area surrounded posteriorly by the anterior rectum, anteriorly by the posterior vagina and cervix, and laterally by the uterosacral ligaments. These lesions can often obliterate the normal anatomy of the cul-de-sac with the rectum stuck to the posterior vagina, cervix, and uterine fundus. One or both pelvic sidewalls overlying the ureters and the rectosigmoid are often affected. In addition, less commonly involved areas include the anterior cul-de-sac (the area above the bladder and the anterior uterus), the appendix and the small bowel. Extensive bulky endometriosis may also be present in the uterine muscle itself where it is called ‘adenomyosis’.
Extensive endometriosis means bulky deep fibrotic endometriosis deposits that can often be palpated preoperatively as tender pelvic nodules. These nodules consist of endometriosis glands and stroma surrounded by fibromuscular tissue that has accumulated over many years in response to cyclic monthly activation of the endometriosis. They represent a longstanding chronic inflammatory response.
TeLinde and Scott defined the objectives of surgical treatment of endometriosis in 1952: “one should excise or fulgurate all evident endometriosis.” The surgical objectives of laparoscopic treatment are similar, i.e., to remove all evident endometriosis by excising large superficial and deep lesions and vaporising smaller deposits.(2) Hystopathological examination to document endometriosis glands and stroma is necessary to substantiate a diagnosis of the endometriosis in any suspect lesion.
Clinical Symptoms and Dignosis
The most common symptom for extensive endometriosis diagnosis is pelvic pain, and the most common sign is pelvic tenderness. This pain is usually more severe on one side and often radiates to the back and legs. The pain may be present throughout the menstrual cycle but especially during the menses (severe dysmenorrhea). Dyspareunia is common. Pain during bowel movements (dyschezia) may also be present. Pelvic pain can be severe enough that the patient is refractory to conventional medical therapy.
Deep full thickness vaginal endometriosis may present with irregular vaginal bleeding. Deep rectal endometriosis is rarely accompanied by rectal bleeding. Most rectal bleeding associated with endometriosis is from hemorrhoids caused by straining during bowel movements, which may result in some cases from a fibrotic endometriosis-related rectosigmoid stricture.
In contrast to mild endometriosis, laparoscopy may not be necessary to diagnose extensive endometriosis of the deep cul-de-sac. It is usually strongly suspected by clinical examination. Laparoscopy is then used to treat it. Yet, histopathological examination of the excised tissue is necessary to confirm the diagnosis of endometriosis: no typical endometriosis glands with surrounding stroma usually means no endometriosis. Ablation of suspected lesions with no pathological specimen always leaves doubt as to whether the lesion treated was endometriosis, fibrosis (old scar tissue), or ‘old blood’ (hemosiderin-ladened macrophages).
The rectum and vagina are readily accessible, and their examination should be the mainstay of clinical diagnosis. If the patient accepts a recto-vaginal examination, this may reveal nodularity or tenderness in the uterosacral ligaments. Cul-de-sac nodularity is pathognomonic of endometriosis. This nodularity is caused by the fibromuscular tissue surrounding endometriosis glands and stroma inside the uterosacral ligaments near their insertion into the cervix and in the angle made by anterior rectum and posterior vagina or by posterior vagina and cervix. Rectovaginal exam is diagnostic when deep cul-de-sac or recto-vaginal septum nodularity are palpated and specific tenderness in these nodules elicited. Unfortunately, most gynaecologists routinely “defer” rectal examination.
Despite the discomfort involved, a rectovaginal examination should be done routinely in patients with pelvic pain and/or a past history of endometriosis. Prior explanation does much to allay the patient’s fears, especially the fear of losing fecal control. The cervix is put on upward tension using the index finger in the vagina and the middle finger in the rectum palpates the uterosacral ligaments including their insertion and the junction of vagina with cervix and rectum. If nodules are discovered, their tenderness and mobility from the surrounding tissues is assessed as is the degree to which the rectum is tented to the lesion. The withdrawn finger is inspected for blood.
During the rectovaginal examination, a good clinician can often pinpoint the tender endometriosis nodules to be excised during surgery. These patients should not be subjected to a diagnostic laparoscopy, but should be referred to a surgeon with experience in excising cul-de-sac and rectal endometriosis.
Clinicians must be aware that a line of evidence exists suggesting that there is no relationship between extent of disease and severity of pain, and no correlation between the location of pain compared with the location of endometriosis implants. (3) This is not the case with extensive endometriosis!
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Monday, February 05, 2007

Synthetic chemicals can affect offspring

Scientists believe effects can extend to two generations
By Douglas Fischer, STAFF WRITER

SAN FRANCISCO — Your ability to reproduce — and the health of your child and even your grandchildren — hinges on an exquisitely timed series of chemical reactions controlled by infinitesimally tiny amounts of hormones.
You scramble those reactions at your peril, in other words, and last week hundreds of researchers gathered at the University of California, San Francisco, warned society may be doing exactly that with synthetic chemicals.
The chemicals, known as endocrine disrupters, are found everywhere in our environment: our food, lotions, shampoos, baby bottles, toys, appliances, even the casings encapsulating our medicines. They mimic hormones at levels scientists only recently have been able to measure, and some are active at concentrations of a part-per-trillion or less — a speck of dirt sullying 55tons of clean laundry.
Most worrisome to scientists: In many cases the effect of such pollution on our bodies remains as mysterious as the processes they potentially disrupt.
"In the absence of concrete data for many of these chemicals, the precautionary principle should be exercised," said Dr. Linda Guidice,chairwoman of obstetrics, gynecology and reproductive sciences at UCSF and the organizer of the reproductive health conference that brought 500 scientists, clinicians and community activists together last week.
The list of potential effects, scientists concluded, stretches across every aspect of reproductive and sexual development — preconception, conception, pregnancy, puberty, menstruation, menopause.
Every key developmental stage is driven by a tightly choreographed fluctuation in hormones. A flood of endocrine disrupters, scientists fear, obviates that dance.
For those suffering from endometriosis, there's no need to imagine.
Wendy Botwin of Oakland was 18 when she felt the first signs: mysterious sickness, massive abdominal pain, irregular periods, crushing headaches, painful sex. Two-and-a-half years passed before a doctor diagnosed endometriosis, a debilitating disease where the tissue lining the uterus appears outside the womb in other parts of the body.
Today, at 37, Botwin has been on every type of birth control pill, been advised to get pregnant (she may be infertile) and to have a hysterectomy. One drug sent her into menopause, at age 21.
Nothing has worked.
She feels certain something in the environment has triggered this. Her father died at 62 of stomach cancer. Her younger sister last year was diagnosed with thyroid cancer. She feels, she said, very much like a canary in a coal mine.
"I know we've polluted our bodies and the Earth," she said. "The environment is really inside of our bodies. It's not just outside."
The science of endocrine disrupters is still controversial. The effects in humans are uncertain. Government panels assessing the weight of the evidence for many of these compounds repeatedly have found no need for concern. But scientists say disturbing gaps remain in our knowledge.
- Several studies have shown pesticides suppress fetal testosterone in laboratory animals. But scientists can't fully explain the consequence. They don't even know the role testosterone plays in a baby boy's brain development.
- The womb was once thought of as a gatekeeper, shielding the developing baby from harm. No more. A number of contaminants readily traverse the placenta, and others — synthetic fragrances, for one — are thought to hold the door open, so to speak.
- Female mice exposed in utero to bisphenol-A, a estrogenic additive used to line food cans and make plastic shatterproof, among other things, saw a 40percent increase in chromosomally abnormal eggs, according to one research team.
But this is where the science gets murky. In November a European panel investigating the effects of bisphenol-A concluded levels found in the environment pose no threat to our health, despite findings such as Hunt's.
Why? Mice and humans process bisphenol-A differently, the panel said.
Mice recirculate the compound and appear to be particularly sensitive to such weak estrogens. Humans, in contrast, rapidly transform bisphenol-A in the gut into a compound devoid of hormonal activity, then pass it via urine.
Such differences, according to the European Food Safety Administration, "raise considerable doubts about the relevance of any low-dose observations in rodents for humans."
There's another example out there, however: DES, or diethylstilbestrol, a wonder drug given with the best of intentions from the 1940s to the 1970s to pregnant women prone to miscarriage.
The mothers did fine, but DES ravaged the reproductive tracts of their children.
DES did its damage, scientists now know, because it turned hormones on at a time during fetal development when they would normally be silent. That, researchers say, is exactly what bisphenol-A and a soup of other endocrine-disrupting compounds do.
Sandra Steingraber, a noted ecologist, author and cancer survivor, echoed Botwin's thoughts on the environment and endometriosis as she told scientists of her experience being pregnant with her daughter, Faith.
"We need to start thinking of our reproductive lives as a live musical performance. Our bodies are the piano, but the hands are the environment," she said. "We are nothing less than the receivers of environmental messages. As that message changes, we are changing ourselves."

Fertility Fact or Fiction? Chicago Reproductive Endocrinologist Sheds Some Light on Outrageous Fertility Myths and Facts You Need to Know

Download this press release as an Adobe PDF document.
Dr. Randy Morris, the Medical Director of IVF1 and a board certified Chicago IVF specialist and reproductive endocrinologist, sheds some light on some outrageous misconceptions and gives us some important facts all couples should know.
Chicago, IL (PRWeb) February 1, 2007 -- It is certainly a FACT, myths abound when it comes to the topic of fertility and conception. Some myths may be harmless, but others may actually work against couples as they try to conceive. It helps to be knowledgeable. Dr. Randy Morris, the Medical Director of IVF1 and a board certified Chicago IVF specialist and reproductive endocrinologist, sheds some light on some outrageous misconceptions and gives us some important facts all couples should know.Birth Control Pills Reduce Fertility (Fiction)No evidence shows that the use of birth control pills affects future fertility. In fact, birth control pills are very short acting. Therefore, birth control pills never make much of an impact on the body's ability to reproduce. If anything, using the pill or one of its hormonal counterparts such as the patch or the ring may actually help fertility in some women. Birth control pills have been used to treat and reduce symptoms of disorders such as endometriosis and ovarian cysts. Stress Causes Infertility (Fiction)The fact is, that while it is possible, although rare, for stress to cause infertility, it is far more common for infertility to cause stress. The role stress plays in a person's fertility is complicated. Evidence indicating stress as a cause of infertility is minimal. There are rare occasions when extreme stress can interfere with normal ovulation in women and may reduce sperm production in men. Stress can also affect a relationship by keeping a couple from the intimacy of intercourse.IVF is associated with the greatest risk for multiple pregnancies Use of fertility medications, especially injectable medications, with intercourse or intrauterine insemination carries the greatest risks of multiple pregnancy. Neither the physician nor patient has control over how many developing eggs will become fertilized and implant. With in-vitro fertilization, the risk for multiple pregnancy is determined by how many embryos are placed in the uterus and therefore is much more easily controlled. Younger women can maximize pregnancy rates with transfer of one or two embryos. Older women, over 40, may use as many as three or four embryos but still have a very low risk for a multiple pregnancy. Taking sugar or anything "white" out of your diet can improve ovulation (Fiction)Obese women or those with polycystic ovarian syndrome or PCOS, may have bodies that are resistant to the hormone insulin. Insulin resistance has been linked to ovulation problems. Weight loss is associated with a reduction in insulin resistance and has been successful at inducing ovulation. There is no data to indicate that one type of diet, whether low fat or low carb is better than another at reducing insulin resistance. The key is a reduction in calories and an increase in calories burned through exercise.Wearing briefs as opposed to boxer shorts lowers sperm counts (Fiction)It has been believed that briefs increase the scrotal temperature and thus impair sperm production. However, using sophisticated temperature monitoring techniques, doctors have shown there is no significant difference in scrotal temperature regardless of the underwear type. Robitussin (guaifenesin) will improve the chances for pregnancy if a woman has "thick" cervical mucus (Fiction)Around the time of ovulation, a woman's cervical mucous becomes clear and watery to allow the passage of sperm. Some suspect that insufficient "thinning" of the cervical mucous is a cause for infertility. This is controversial in itself. Use of Robitussin has been rumored for decades to improve the chance for pregnancy. However, there has never been a single study to indicate any positive effect of Robitussin on achieving pregnancy. Obesity plays a role in infertility (Fact)Excess weight and obesity can affect fertility in a number of different ways by causing hormonal imbalances that have an impact on ovulation and menstruation. Additionally, obese patients have a poorer chance for success with fertility treatments. They tend to have a worse response to fertility medications and as a result may need higher doses. Pregnancy rates are uniformly lower for obese women. This is true even for high tech treatments such as in vitro fertilization. Some IVF studies show a delivery rate for obese women that is one half what it is for thinner women.Smoking contributes to infertility (Fact)Research indicates that smoking is harmful to women's ovaries and the degree of harm is dependent upon the amount and period of time a woman smokes. Smoking accelerates the loss of eggs and reproductive function and may advance menopause by several years.For more information regarding fertility myths and facts or to set-up an interview with Dr. Randy Morris, contact Jaime Alyn PR at 212-213-2003 or via e-mail.###

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Endometriosis in Teens:A Guide for Parents and Guardians

The following information was created to help you as a parent or guardian, learn about endometriosis. As you become familiar with the symptoms and treatment options that accompany endometriosis, you will be able to help support your daughter as she seeks medical treatment.
The most useful thing you can do to understand your daughter's diagnosis is to learn all you can about endometriosis. There is certainly a lot of information on line; however, if you do an Internet search for endometriosis information, make sure the information comes from a reliable source. For helpful tips for evaluating endometriosis websites, books, and magazine articles check our website guide: Evaluating Health Information. Your daughter's health care provider is also another resource for educational materials. Be sure to maintain a list of questions for your daughter's medical treatment team. The doctors, nurses and social workers will assist you and your daughter in understanding her diagnosis and the treatment options.

What is endometriosis?
Endometriosis is a condition that occurs when tissue similar to the lining of the uterus is found outside its normal location. Common locations of endometrial implants include the ovaries, fallopian tubes, and ligaments that support the uterus and tissue covering the bladder and rectum. The location of the endometrial implants and the way in which the lesions affect the pelvic organs contribute to the symptoms adolescent and adult women may have. Some teens have a lot of endometriosis and have very little pain, while others who have a small amount of endometriosis have severe pain.

What are the symptoms of endometriosis?
Endometriosis causes different symptoms in young women. Occasional or constant pelvic pain and/or severe period cramps are definitely the most common symptoms. There can be pain before, during, or after a period. The pain may occur at regular times in the menstrual cycle or the pain may occur at any time during the month. It is often referred to as "chronic" pelvic pain. Some teens may have pain with exercise, and/or after a pelvic exam. For those who are sexually active, there may be pain associated with intercourse. Painful or frequent urination, diarrhea or constipation may accompany the pelvic pain.
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Adenomyosis - An Internal Uterine Endometriosis

Frederick R. Jelovsek MD
"I am 46 and every month before I start my period, I have really painful cramps. They are so painful that I can barely function. What could be the cause of this?" Carolyn
The new occurrence of cyclic menstrual pain in the decade of the 40's could be due to endometriosis, uterine fibroids, partial cervical stenosis or adenomyosis. By far the most likely cause of these painful menstrual cramps at this time is adenomyosis. This is sometimes called endometriosis interna or internal endometriosis.
Since this is the most likely problem that your doctor will want to rule in or rule out with diagnositic tests, let us focus on adenomyosis. What is adenomyosis?
Adenomyosis is defined as the presence of endometrial glands and supporting tissues in the muscle of the uterus where it normally would not occur. When that gland tissue undergoes growth during the menstrual cycle and then subsequent sloughing, the old tissue and blood cannot get out of the muscle and flow out of the cervix as part of normal menses. This trapping of the blood and tissue causes uterine pain in the form of menstrual cramps. It also produces abnormal uterine bleeding as some of the blood finally escapes the muscle and results in prolonged spotting. For a picture of what adenomyosis schematically looks like, see the (images) at one gynecologist's site.
Adenomyosis occurs more often in the decade of the 40's, perimenopausally. In hysterectomy specimens, adenomyosis can be found from 15% to 25% of the time (1, 2). The glandular change of the endometrial cells in adenomyosis are often incomplete in the second half of the menstrual cycle (luteal phase) and as a result, adenomyosis may not be very responsive to suppression by progesterone. About 50% of adenomyosis is asymptomatic although as it goes deeper into the uterine muscle it tends to be more likely to produce symptoms (3, 4). It is also often associated with fibroids (5 and often associated with other conditions such as ovarian cysts, prolapse and even gynecological cancers (6) that can cause pelvic pain. How is adenomyosis diagnosed?
Up until recent years it was said that adenomyosis was only diagnosable by the pathologist looking at a hysterectomy specimen. Now magnetic resonance imaging (MRI) can more accurately diagnose adenomyosis although many physicians feel this is too expensive a test to use routinely. Patterns of adenomyosis as recognized by MRI seem to either be diffusely spread throughout the uterus (about 66%) or focal lesions (33%) that only occur in one or two places (7). If a non hysterectomy treatment is being considered for adenomyosis, then MRI should be used for the diagnosis and if focal disease were shown, then surgical resection of the endometriosis without doing a hysterectomy could be considered.
Ultrasound especially using color flow doppler can also be used to diagnose adenomyosis (8) . Sometimes it has difficulty differentiating smaller fibroids (leiomyomas) from adenomyosis but it is able to pick up about 80% of the existing lesions. For an in depth discussion on pre surgical ultrasound imaging and diagnosis of adenomyosis, see (The Presurgical Diagnosis of Diffuse Adenomyosis by Helen Bickerstaff, MB, BChir.
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Thursday, February 01, 2007

More thoughts on ENDO

In the language of the iVillage message boards I have started reading on the recommendation of my SIL, AF arrived today with the expected discomfort. I've been on Aleve and glued to a hot pad all day with periods of nausea that come and go. I thought I could get some work done today, but didn't have the patience to monkey around with spreadsheets.Earlier this morning I felt better at one point and got out my laptop to download the latest surveymonkey data in the hopes that enough people participated over the weekend to fill up a cell I still need participants for. I got as far as requesting the data so that I can download it when surveymonkey makes it available. It can take them anywhere from a day or two to 15 minutes to make it available for me to download. It takes me an afternoon to get it all into SPSS depending on the number of people.I was just about to check back with surveymonkey when I got inundated with phone calls. First my mom (who is normally absentee mom) called to tell me she found the perfect post-surgery outfit. I have been looking for something ultra-comfortable around the waist because the gas they pump in for the surgery is decidedly uncomfortable according to everyone who has had the procedure. Then my SIL called just to say hi and pass on warm thoughts. I called the kennel to get the doggy hotel squared away; in haste I reserved their kennel stay for the day of the surgery and the day Mr. Sleyed needs to get back to work, totally forgetting that we are leaving early so I don't have to do the day-before-surgery prep in the car. I have to totally void my digestive system, to put it delicately. I can't eat anything that day either.... so, we are leaving early so that whole business can happen at my home away from home during the lap experience. Fortunately the kennel had space and I was able to straighten out the problem with over-vaccinating our dogs for kennel cough.Finally I was on the horn to find out how much it will cost us to get the bloodwork done that my FBCD (fancy big city doc) wants me to get done to find out if my hormone levels will allow me to conceive and sustain a pregnancy. Insurance won't cover the tests because they don't cover any infertility diagnosis or treatment. Rat bastards! It's absolutely assinine that they are allowed to get away with that at the same time they cover insanely expensive end-of-life care and conditions people earn through bad habits. Some states actually have passed laws to make insurance companies cover infertility treatments if they provide pregnancy care. Unfortunately WA is not one of those states. My former state of MT is. Weird. This list identifies states with mandated infertility coverage. The cost of the bloodwork is $420.I would be surprised if they revealed anything abnormal, but I suppose he wants to know the results so that he can help me figure out what the best post-op treatment will be. Getting pregnant is one approach, but if I can't do that w/o some form of treatment (who knows the cost of that???) then I may have to go on BCPs until I go through menopause. Endo isn't something that can go untreated. If BCPs don't work I may have to take Lupron which gives you menopause and all of the side effects early. I don't want to become a She-Man in my early thirties !@&^% Yuck. If I am unlikely to get pregnant according to the tests, and the cost of treatment to try to get me pregnant is too much, well, then I will have to keep my fingers crossed that BCPs will keep my endo from getting worse and also get used to the idea of only ever having fur kids.With my time spent laid up today I searched blogger for people who have endo and have had or will have laparoscopic surgery. I have found and read quite a few so I know what to expect. This story of one woman's laparoscopy was the most informative. If you want to know what will be happening to me in a few weeks, check it out.Unfortunately I also read a lot of stories about people never being able to conceive even after the surgery. And - to make me really worry - quite a few have had more than one laparscopy. One even had more than TEN! Zounds! Why? The endo aggressively comes back even after it's surgically removed, and adhesions (scar tissue) forms where the endo was cut/burned away. That can actually make pain worse. So....Now I am feeling like there is a chance that this surgery may actually make my pain much, much worse in time, and I will have to have another lap to get rid of the pain. Sheeeesh!Maybe I should call Ruth (who is incidentally a gyno) so she is actually Dr. Ruth, just not the Dr. Ruth.*********The BEST thing that happened today -- I received a card in the mail today from my dissertation advisor. There's a chimp holding a beach ball and wishing me well with my surgery on the front, and inside a hopeful messgae about being well enough to get back to monkeying around again soon. It was really so sweet and unexpected that I actually felt some regret for all of the times I complained about her being a horrible advisor. She really came through, in a small albeit symbolic way.
posted by Holly at 5:48 PM