Seracchioli R, Poggioli G, Pierangeli F, Manuzzi L, Gualerzi B, Savelli L, Remorgida V, Mabrouk M, Venturoli S.
Center of Reconstructive Pelvic Endo-surgery, Reproductive Medicine Unit, S.Orsola Hospital, University of Bologna, Bologna, Italy. seracchioli@orsola-malpighi.med.unibo.it
The aim of this study was to assess the long-term outcome of treating severely symptomatic women with deep infiltrating intestinal endometriosis by laparoscopic segmental rectosigmoid resection. Detailed intraoperative and postoperative records and questionnaires (preoperatively, 1 month postoperatively and every 6 months for 3 years) were collected from 22 women. The estimated blood loss during surgery was 290 +/- 162 ml (range 180-600), and average hospital stay was 8 days (range 6-19). One woman required blood transfusion after surgery. Two cases were converted to laparotomy. One woman had early dehiscence of the anastomosis. Six months after surgery, there was a significant reduction of symptom scores (greater than 50% for most types of pain) related to intestinal localisation of endometriosis (P < 0.05). Score improvements were maintained during the whole period of follow up. Noncyclic pelvic pain scores showed significant reductions (P < 0.05) after 6 and 12 months, but there was a high recurrence rate later. Dysmenorrhoea and dyspareunia improved in 18/21 and 14/18 women with preoperative symptoms, respectively. Constipation, diarrhoea and rectal bleeding improved in all affected women for the whole period of follow up. Laparoscopic segmental rectosigmoid resection seems safe and effective in women with deep infiltrating colorectal endometriosis resulting in significant reductions in painful and dysfunctional symptoms associated with deep bowel involvement.
PMID: 17501958 [PubMed - indexed for MEDLINE]
Thursday, January 31, 2008
Horner's syndrome in a patient presenting with a spontaneous pneumothorax.
Thakar C, Hunt I, Anikin V.
Harefield Hospital, Middlesex, UK.
Spontaneous pneumothoraces are a common thoracic problem presenting to an Accident and Emergency (A&E) department. The symptoms and signs are well described and a chest x-ray examination is usually diagnostic. However the neurological signs, specifically a Horner's syndrome on the ipsilateral side, are not widely recognised. This case illustrates the association and emphasises that when assessing a patient with a suspected spontaneous pneumothorax, an ipsilateral Horner's syndrome supports the clinical diagnosis. Further, its presence makes a tensioning pneumothorax, or as in this case a pneumothorax with significant collapse and apical adhesions, more likely. No previous case reporting the association has had the opportunity for thorascopic assessment and demonstration of likely cause.
PMID: 18212159 [PubMed - in process]
Harefield Hospital, Middlesex, UK.
Spontaneous pneumothoraces are a common thoracic problem presenting to an Accident and Emergency (A&E) department. The symptoms and signs are well described and a chest x-ray examination is usually diagnostic. However the neurological signs, specifically a Horner's syndrome on the ipsilateral side, are not widely recognised. This case illustrates the association and emphasises that when assessing a patient with a suspected spontaneous pneumothorax, an ipsilateral Horner's syndrome supports the clinical diagnosis. Further, its presence makes a tensioning pneumothorax, or as in this case a pneumothorax with significant collapse and apical adhesions, more likely. No previous case reporting the association has had the opportunity for thorascopic assessment and demonstration of likely cause.
PMID: 18212159 [PubMed - in process]
Treatment strategies for endometriosis.
Rodgers AK, Falcone T.
Department of Obstetrics and Gynecology, The Cleveland Clinic, Department of Obstetrics and Gynecology-A81, 9500 Euclid Avenue, Cleveland, Ohio 44159, USA.
BACKGROUND: Endometriosis is a common chronic disease that causes symptoms of pain and infertility. The pain syndrome can be quite incapacitating. The pain symptoms usually originate in the reproductive organs but can also involve the urinary or intestinal tracts if endometriosis implantation has occurred there. The presentation and physical appearance of endometriosis is extremely variable and can be characterized by a chronic intraperitoneal inflammatory process and adhesions. The only definitive diagnostic technique is laparoscopy. OBJECTIVE: To review current literature on the treatment strategies for endometriosis. METHODS: Review of Pubmed, Cochrane database and Medline for current review articles and studies regarding the current treatment strategies for endometriosis. RESULTS: Initial treatment is surgical or medical. Medical therapy is often used as a first-line therapy and can also be used in conjunction with those patients who undergo surgical therapy for pain. No medical therapy has proven effective for infertility. Medical therapy consists mostly of hormonal suppressive therapy in which the medication causes a downregulation of the hypothalamus-pituitary-ovarian pathway. Non-steroidal anti-inflammatory drugs and oral contraceptives are often used as an initial approach even without a definitive diagnosis. Progestins, such as oral norethindrone and depot medroxyprogesterone, are effective while using them but have a high recurrence rate. The norgestrol intrauterine device is also quite effective at relieving pain associated with endometriosis, especially pain arising during menses as well as from lesions in the rectovaginal tissue. Gonadotropin-releasing hormone agonists induce a pseudomenopausal state and have significant side effects, such as hot flashes and genital atrophy. 'Add-back' therapy with a progestin has been shown to relieve most of these drug related symptoms. Gonadotropin-releasing hormone agonists are also very effective at relieving symptoms of pain during treatment but are also associated with a high recurrence rate. New drug therapies that are under investigation are aromatase inhibitors and immunomodulators. Furthermore, new delivery systems are being investigated that may also improve the patient response.
PMID: 18201147 [PubMed - in process]
Department of Obstetrics and Gynecology, The Cleveland Clinic, Department of Obstetrics and Gynecology-A81, 9500 Euclid Avenue, Cleveland, Ohio 44159, USA.
BACKGROUND: Endometriosis is a common chronic disease that causes symptoms of pain and infertility. The pain syndrome can be quite incapacitating. The pain symptoms usually originate in the reproductive organs but can also involve the urinary or intestinal tracts if endometriosis implantation has occurred there. The presentation and physical appearance of endometriosis is extremely variable and can be characterized by a chronic intraperitoneal inflammatory process and adhesions. The only definitive diagnostic technique is laparoscopy. OBJECTIVE: To review current literature on the treatment strategies for endometriosis. METHODS: Review of Pubmed, Cochrane database and Medline for current review articles and studies regarding the current treatment strategies for endometriosis. RESULTS: Initial treatment is surgical or medical. Medical therapy is often used as a first-line therapy and can also be used in conjunction with those patients who undergo surgical therapy for pain. No medical therapy has proven effective for infertility. Medical therapy consists mostly of hormonal suppressive therapy in which the medication causes a downregulation of the hypothalamus-pituitary-ovarian pathway. Non-steroidal anti-inflammatory drugs and oral contraceptives are often used as an initial approach even without a definitive diagnosis. Progestins, such as oral norethindrone and depot medroxyprogesterone, are effective while using them but have a high recurrence rate. The norgestrol intrauterine device is also quite effective at relieving pain associated with endometriosis, especially pain arising during menses as well as from lesions in the rectovaginal tissue. Gonadotropin-releasing hormone agonists induce a pseudomenopausal state and have significant side effects, such as hot flashes and genital atrophy. 'Add-back' therapy with a progestin has been shown to relieve most of these drug related symptoms. Gonadotropin-releasing hormone agonists are also very effective at relieving symptoms of pain during treatment but are also associated with a high recurrence rate. New drug therapies that are under investigation are aromatase inhibitors and immunomodulators. Furthermore, new delivery systems are being investigated that may also improve the patient response.
PMID: 18201147 [PubMed - in process]
Wednesday, January 30, 2008
National Institutes of Health funds new center for reproduction and infertility research at Illinois
The Advisory Council of the National Institute of Child Health and Human Development (NICHD) has approved funding to support a Center for Reproduction and Infertility Research at the University of Illinois at Urbana-Champaign. This Center will support research aimed at expanding the science underlying the success or failure of human reproduction with the goal of improving human reproductive health.
The NICHD supports a national network of Centers of Excellence through a program called the Specialized Centers Program in Reproduction and Infertility Research.
Currently, this national network of Centers is located at 14 sites across the country (for more information, visit http://www.nichd.nih.gov/research/supported/SCCPIR.cfm). The new center would be funded for five years starting in 2008 with a projected budget of about $8 million dollars.
The Center for Reproduction and Infertility Research will support a multidisciplinary research team with a common goal of understanding the mechanisms that control maternal-fetal interactions during early pregnancy and to identify factors that underlie infertility in women suffering from endometriosis, a common gynecologic disorder.
The multidisciplinary team will draw expertise from the U. of I. School of Molecular and Cellular Biology in the College of Liberal Arts & Sciences and the department of veterinary biosciences in the College of Veterinary Medicine. Clinicians from the Emory University Medical School in Atlanta, GA, and a molecular geneticist from Baylor College of Medicine in Houston, TX, will also contribute to the effort.
The U. of I. scientists who will lead synergistic research projects at the Center are: Dr. Milan Bagchi, a professor of molecular and integrative physiology; Dr. Benita Katzenellenbogen, Swanlund professor of molecular and integrative physiology and Swanlund professor of cell and developmental biology; and Dr. Indrani Bagchi, a professor of veterinary biosciences in the College of Veterinary Medicine. Dr. Paul Cooke, professor and Billie Alexander Field Chair in reproductive biology, veterinary biosciences, will lead a microscopy core, which will provide critical support to these research projects. Dr. Robert Taylor, an internationally known clinical scientist and an expert in endometriosis at the Emory University Medical School, and Dr. Francesco DeMayo, a molecular geneticist at the Baylor College of Medicine, will actively collaborate with the U. of I. scientists to achieve the goals of this Center. Dr. Bagchi will function as the Center director and will coordinate research efforts.
A major contribution of the new Center will be its impact on the translational research in the Urbana-Champaign campus. The central goal of the Center is to bring the knowledge gained from basic cell biological studies and unique animal models to the clinical realm to inform the molecular basis of human infertility associated with endometrial dysfunction. This program, therefore, has the potential to serve as a focal point for further development of translational research in biological sciences in the U. of I. campus and will be an excellent fit with the University's current mission of enhancing translational research in biology.
The establishment of the new Center will further stimulate the collaborative research and training in reproductive biology that already exists on this campus.
http://www.eurekalert.org/pub_releases/2008-01/uoia-nio012808.php
The NICHD supports a national network of Centers of Excellence through a program called the Specialized Centers Program in Reproduction and Infertility Research.
Currently, this national network of Centers is located at 14 sites across the country (for more information, visit http://www.nichd.nih.gov/research/supported/SCCPIR.cfm). The new center would be funded for five years starting in 2008 with a projected budget of about $8 million dollars.
The Center for Reproduction and Infertility Research will support a multidisciplinary research team with a common goal of understanding the mechanisms that control maternal-fetal interactions during early pregnancy and to identify factors that underlie infertility in women suffering from endometriosis, a common gynecologic disorder.
The multidisciplinary team will draw expertise from the U. of I. School of Molecular and Cellular Biology in the College of Liberal Arts & Sciences and the department of veterinary biosciences in the College of Veterinary Medicine. Clinicians from the Emory University Medical School in Atlanta, GA, and a molecular geneticist from Baylor College of Medicine in Houston, TX, will also contribute to the effort.
The U. of I. scientists who will lead synergistic research projects at the Center are: Dr. Milan Bagchi, a professor of molecular and integrative physiology; Dr. Benita Katzenellenbogen, Swanlund professor of molecular and integrative physiology and Swanlund professor of cell and developmental biology; and Dr. Indrani Bagchi, a professor of veterinary biosciences in the College of Veterinary Medicine. Dr. Paul Cooke, professor and Billie Alexander Field Chair in reproductive biology, veterinary biosciences, will lead a microscopy core, which will provide critical support to these research projects. Dr. Robert Taylor, an internationally known clinical scientist and an expert in endometriosis at the Emory University Medical School, and Dr. Francesco DeMayo, a molecular geneticist at the Baylor College of Medicine, will actively collaborate with the U. of I. scientists to achieve the goals of this Center. Dr. Bagchi will function as the Center director and will coordinate research efforts.
A major contribution of the new Center will be its impact on the translational research in the Urbana-Champaign campus. The central goal of the Center is to bring the knowledge gained from basic cell biological studies and unique animal models to the clinical realm to inform the molecular basis of human infertility associated with endometrial dysfunction. This program, therefore, has the potential to serve as a focal point for further development of translational research in biological sciences in the U. of I. campus and will be an excellent fit with the University's current mission of enhancing translational research in biology.
The establishment of the new Center will further stimulate the collaborative research and training in reproductive biology that already exists on this campus.
http://www.eurekalert.org/pub_releases/2008-01/uoia-nio012808.php
Tuesday, January 29, 2008
Endometriosis FAQ
Endometriosis
See also:
Infertility
Menstruation
What is endometriosis?
Endometriosis is a common health problem in women. It gets its name from the word endometrium, the tissue that lines the uterus (womb). In women with this problem, tissue that looks and acts like the lining of the uterus grows outside of the uterus in other areas. These areas can be called growths, tumors, implants, lesions, or nodules.
Most endometriosis is found:
on or under the ovaries
behind the uterus
on the tissues that hold the uterus in place
on the bowels or bladder
Endometriosis rarely grows in the lungs or other parts of the body. This "misplaced" tissue can cause pain, infertility (not being able to get pregnant), and very heavy periods.
What are the symptoms of endometriosis?
Pain is one of the most common symptoms of endometriosis. Usually the pain is in the abdomen, lower back, and pelvis. The amount of pain a woman feels does not depend on how much endometriosis she has. Some women have no pain, even though their disease affects large areas. Other women with endometriosis have severe pain even though they have only a few small growths. Symptoms of endometriosis include:
Very painful menstrual cramps
Pain with periods that gets worse over time
Chronic pain in the lower back and pelvis
Pain during or after sex
Intestinal pain
Painful bowel movements or painful urination during menstrual periods
Heavy and/or long menstrual periods
Spotting or bleeding between periods
Infertility (not being able to get pregnant)
Fatigue
Women with endometriosis may also have gastrointestinal problems such as diarrhea, constipation, or bloating, especially during their periods.
Who usually gets endometriosis?
About five million women in the United States have endometriosis. This makes it one of the most common health problems for women.
In general, women with endometriosis:
get their monthly period
are 27-years-old on average
have symptoms for two to five years before finding out they have the disease
Women who have gone through menopause (when a woman stops having her period) rarely still have symptoms.
What can raise my chances of getting endometriosis?
You are more likely to develop endometriosis if you:
began getting your period at an early age
have heavy periods
have periods that last more than seven days
have a short monthly cycle (27 days or less)
have a close relative (mother, aunt, sister) with endometriosis
How can I reduce my chances of getting endometriosis?
Some studies suggest that you may lower your chances of developing endometriosis if you:
exercise regularly
avoid alcohol and caffeine
Why do patches of endometriosis cause pain and health problems?
Growths of endometriosis are almost always benign or not cancerous, but still can cause many problems. To see why, it helps to understand a woman's monthly cycle. Every month, hormones cause the lining of a woman's uterus to build up with tissue and blood vessels. If a woman does not get pregnant, the uterus sheds this tissue and blood. It comes out of the body through the vagina as her menstrual period.
Patches of endometriosis also respond to a woman's monthly cycle. Each month the growths add extra tissue and blood, but there is no place for the built-up tissue and blood to exit the body. For this reason, growths tend to get bigger and the symptoms of endometriosis often get worse over time.
Tissue and blood that is shed into the body can cause inflammation, scar tissue, and pain. As the misplaced tissue grows, it can cover or grow into the ovaries and block the fallopian tubes. This can make it hard for women with endometriosis to get pregnant. The growths can also cause problems in the intestines and bladder.
Why is it important to find out if I have endometriosis?
The pain of endometriosis can interfere with your life. Studies show that women with endometriosis often skip school, work, and social events. This health problem can also get in the way of relationships with your partner, friends, children, and co-workers. Plus, endometriosis can make it hard for you to get pregnant.
Finding out that you have endometriosis is the first step in taking back your life. Many treatments can control the symptoms. Medicine can relieve your pain. And when endometriosis causes fertility problems, surgery can boost your chances of getting pregnant.
How would I know if I have endometriosis?
If you think you have this disease, talk with your obstetrician/gynecologist (OB/GYN). Your OB/GYN has special training to diagnose and treat this condition. The doctor will talk to you about your symptoms and health history. Then she or he will do a pelvic exam. Sometimes during the exam, the doctor can find signs of endometriosis.
Usually doctors need to run tests to find out if a woman has endometriosis. Sometimes doctors use imaging tests to "see" large growths of endometriosis inside the body. The two most common imaging tests are:
ultrasound, which uses sound waves to see inside the body
magnetic resonance imaging (MRI), which uses magnets and radio waves to make a "picture" of the inside of the body
The only way to know for sure if you have endometriosis is to have a surgery called laparoscopy. In this procedure, a tiny cut is made in your abdomen. A thin tube with a light is placed inside to see growths from endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue, or a biopsy, and study it under a microscope.
What causes endometriosis?
No one knows for sure what causes this disease, but scientists have a number of theories.
They know that endometriosis runs in families. If your mother or sister has endometriosis, you are six times more likely to get the disease than other women. So, one theory suggests that endometriosis is caused by genes.
Another theory is that during a woman's monthly periods, some endometrial tissue backs up into the abdomen through the fallopian tubes. This transplanted tissue then grows outside the uterus. Many researchers think a faulty immune system plays a part in endometriosis. In women with the disease, the immune system fails to find and destroy endometrial tissue growing outside of the uterus. Plus, a recent study shows that immune system disorders (health problems in which the body attacks itself) are more common in women with endometriosis. More research in this area may help doctors better understand and treat endometriosis.
How is endometriosis treated?
There is no cure for endometriosis, but there are many treatments for the pain and infertility that it causes. Talk with your doctor about what option is best for you. The treatment you choose will depend on your symptoms, age, and plans for getting pregnant.
Pain Medication. For some women with mild symptoms, doctors may suggest taking over-the-counter medicines for pain. These include: ibuprofen (Advil and Motrin) or naproxen (Aleve). When these medicines don't help, doctors may advise using stronger pain relievers available by prescription.
Hormone Treatment. When pain medicine is not enough, doctors often recommend hormone medicines to treat endometriosis. Only women who do not wish to become pregnant can use these drugs. Hormone treatment is best for women with small growths who don't have bad pain.
Hormones come in many forms including pills, shots, and nasal sprays. Many hormones are used for endometriosis including:
Birth control pills block the effects of natural hormones on endometrial growths. So, they prevent the monthly build-up and breakdown of growths. This can make endometriosis less painful. Birth control pills also can make a woman's periods lighter and less uncomfortable. Most birth control pills contain two hormones, estrogen and progestin. This type of birth control pill is called a "combination pill." Once a woman stops taking them, the ability to get pregnant returns, but so may the symptoms of endometriosis.
Progestins or progesterone medicines work much like birth control pills and can be taken by women who can't take estrogen. When a woman stops taking progestins, she can get pregnant again. But, the symptoms of endometriosis return too.
Gonadotropin releasing hormone agonists or GnRH agonists slow the growth of endometriosis and relieve symptoms. They work by greatly reducing the amount of estrogen in a woman's body, which stops the monthly cycle. Leuprolide (Lupron®) is a GnRH agonist often used to treat endometriosis. GnRH agonists should not be used alone for more than six months. This is because they can lead to osteoporosis. But if a woman takes estrogen along with GnRH agonists, she can use them for a longer time. When a woman stops taking this medicine, monthly periods and the ability to get pregnant return. But, usually the problems of endometriosis also return.
Danazol is a weak male hormone. Nowadays, doctors rarely recommend this hormone for endometriosis. Danazol lowers the levels of estrogen and progesterone in a woman's body. This stops a woman's period or makes it come less often. Danazol also gives pain relief. But it often causes side effects like oily skin, weight gain, tiredness, smaller breasts, and hot flashes. Danazol does not prevent pregnancy and can harm a baby growing in the uterus. Since it can't be used with other hormones, like birth control pills, doctors recommend using condoms, diaphragms, or other "barrier" methods to prevent pregnancy.
Surgery. Surgery is usually the best choice for women with endometriosis who have a severe amount of growths, a great deal of pain, or fertility problems. There are both minor and more complex surgeries that can help. Your doctor might suggest one of the following:
Laparoscopy can be used to diagnose and treat endometriosis. During this surgery, doctors remove growths and scar tissue or destroy them with intense heat. The goal is to treat the endometriosis without harming the healthy tissue around it. Women recover from laparoscopy much faster than from major abdominal surgery.
Laparotomy or major abdominal surgery is a last resort treatment for severe endometriosis. In this surgery, the doctor makes a much bigger cut in the abdomen than with laparoscopy. This allows the doctor to reach and remove growths of endometriosis in the pelvis or abdomen. Recovery from this surgery can take up to two months.
Hysterectomy should only be considered by women who do not want to become pregnant in the future. During this surgery, the doctor removes the uterus. She or he may also take out the ovaries and fallopian tubes at the same time. This is done when the endometriosis has severely damaged them.
How do I cope with a disease that has no cure?
You may feel many emotions—sadness, fright, anger, confusion, and loneliness. It is important to get support to cope with endometriosis. Consider joining a support group to talk with other women who have endometriosis. There are support groups on the Internet and in many communities.
It is also important to learn as much as you can about the disease. Talking with friends, family, and your doctor can help.
For More Information...
You can find out more about endometriosis by contacting the National Women's Health Information Center (NWHIC) at 1-800-994-9662 or the following organizations:
Endometriosis Association Phone Number(s): (414) 355-2200Internet Address: http://www.endometriosisassn.org/
The American College of Obstetricians and Gynecologists Phone Number(s): (800) 762-2264 x 192 (for publication requests only)Internet Address: http://www.acog.org/
Endometriosis Research Center Phone Number(s): (800) 239-7280Internet Address: http://www.endocenter.org/
All material contained in the FAQs is free of copyright restrictions and may be copied, reproduced, or duplicated without permission of the Office on Women's Health within the Department of Health and Human Services. Citation of the source is appreciated.
This FAQ was reviewed by:
Kerri Parks, MDAssistant ProfessorLos Angeles County Women's and Children's HospitalUSC-Keck School of MedicineLos Angeles, CA
Mory Nouriani, MDSher Institute of Reproductive MedicineGlendale, CAhttp://www.4women.gov/FAQ/endomet.htm
See also:
Infertility
Menstruation
What is endometriosis?
Endometriosis is a common health problem in women. It gets its name from the word endometrium, the tissue that lines the uterus (womb). In women with this problem, tissue that looks and acts like the lining of the uterus grows outside of the uterus in other areas. These areas can be called growths, tumors, implants, lesions, or nodules.
Most endometriosis is found:
on or under the ovaries
behind the uterus
on the tissues that hold the uterus in place
on the bowels or bladder
Endometriosis rarely grows in the lungs or other parts of the body. This "misplaced" tissue can cause pain, infertility (not being able to get pregnant), and very heavy periods.
What are the symptoms of endometriosis?
Pain is one of the most common symptoms of endometriosis. Usually the pain is in the abdomen, lower back, and pelvis. The amount of pain a woman feels does not depend on how much endometriosis she has. Some women have no pain, even though their disease affects large areas. Other women with endometriosis have severe pain even though they have only a few small growths. Symptoms of endometriosis include:
Very painful menstrual cramps
Pain with periods that gets worse over time
Chronic pain in the lower back and pelvis
Pain during or after sex
Intestinal pain
Painful bowel movements or painful urination during menstrual periods
Heavy and/or long menstrual periods
Spotting or bleeding between periods
Infertility (not being able to get pregnant)
Fatigue
Women with endometriosis may also have gastrointestinal problems such as diarrhea, constipation, or bloating, especially during their periods.
Who usually gets endometriosis?
About five million women in the United States have endometriosis. This makes it one of the most common health problems for women.
In general, women with endometriosis:
get their monthly period
are 27-years-old on average
have symptoms for two to five years before finding out they have the disease
Women who have gone through menopause (when a woman stops having her period) rarely still have symptoms.
What can raise my chances of getting endometriosis?
You are more likely to develop endometriosis if you:
began getting your period at an early age
have heavy periods
have periods that last more than seven days
have a short monthly cycle (27 days or less)
have a close relative (mother, aunt, sister) with endometriosis
How can I reduce my chances of getting endometriosis?
Some studies suggest that you may lower your chances of developing endometriosis if you:
exercise regularly
avoid alcohol and caffeine
Why do patches of endometriosis cause pain and health problems?
Growths of endometriosis are almost always benign or not cancerous, but still can cause many problems. To see why, it helps to understand a woman's monthly cycle. Every month, hormones cause the lining of a woman's uterus to build up with tissue and blood vessels. If a woman does not get pregnant, the uterus sheds this tissue and blood. It comes out of the body through the vagina as her menstrual period.
Patches of endometriosis also respond to a woman's monthly cycle. Each month the growths add extra tissue and blood, but there is no place for the built-up tissue and blood to exit the body. For this reason, growths tend to get bigger and the symptoms of endometriosis often get worse over time.
Tissue and blood that is shed into the body can cause inflammation, scar tissue, and pain. As the misplaced tissue grows, it can cover or grow into the ovaries and block the fallopian tubes. This can make it hard for women with endometriosis to get pregnant. The growths can also cause problems in the intestines and bladder.
Why is it important to find out if I have endometriosis?
The pain of endometriosis can interfere with your life. Studies show that women with endometriosis often skip school, work, and social events. This health problem can also get in the way of relationships with your partner, friends, children, and co-workers. Plus, endometriosis can make it hard for you to get pregnant.
Finding out that you have endometriosis is the first step in taking back your life. Many treatments can control the symptoms. Medicine can relieve your pain. And when endometriosis causes fertility problems, surgery can boost your chances of getting pregnant.
How would I know if I have endometriosis?
If you think you have this disease, talk with your obstetrician/gynecologist (OB/GYN). Your OB/GYN has special training to diagnose and treat this condition. The doctor will talk to you about your symptoms and health history. Then she or he will do a pelvic exam. Sometimes during the exam, the doctor can find signs of endometriosis.
Usually doctors need to run tests to find out if a woman has endometriosis. Sometimes doctors use imaging tests to "see" large growths of endometriosis inside the body. The two most common imaging tests are:
ultrasound, which uses sound waves to see inside the body
magnetic resonance imaging (MRI), which uses magnets and radio waves to make a "picture" of the inside of the body
The only way to know for sure if you have endometriosis is to have a surgery called laparoscopy. In this procedure, a tiny cut is made in your abdomen. A thin tube with a light is placed inside to see growths from endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue, or a biopsy, and study it under a microscope.
What causes endometriosis?
No one knows for sure what causes this disease, but scientists have a number of theories.
They know that endometriosis runs in families. If your mother or sister has endometriosis, you are six times more likely to get the disease than other women. So, one theory suggests that endometriosis is caused by genes.
Another theory is that during a woman's monthly periods, some endometrial tissue backs up into the abdomen through the fallopian tubes. This transplanted tissue then grows outside the uterus. Many researchers think a faulty immune system plays a part in endometriosis. In women with the disease, the immune system fails to find and destroy endometrial tissue growing outside of the uterus. Plus, a recent study shows that immune system disorders (health problems in which the body attacks itself) are more common in women with endometriosis. More research in this area may help doctors better understand and treat endometriosis.
How is endometriosis treated?
There is no cure for endometriosis, but there are many treatments for the pain and infertility that it causes. Talk with your doctor about what option is best for you. The treatment you choose will depend on your symptoms, age, and plans for getting pregnant.
Pain Medication. For some women with mild symptoms, doctors may suggest taking over-the-counter medicines for pain. These include: ibuprofen (Advil and Motrin) or naproxen (Aleve). When these medicines don't help, doctors may advise using stronger pain relievers available by prescription.
Hormone Treatment. When pain medicine is not enough, doctors often recommend hormone medicines to treat endometriosis. Only women who do not wish to become pregnant can use these drugs. Hormone treatment is best for women with small growths who don't have bad pain.
Hormones come in many forms including pills, shots, and nasal sprays. Many hormones are used for endometriosis including:
Birth control pills block the effects of natural hormones on endometrial growths. So, they prevent the monthly build-up and breakdown of growths. This can make endometriosis less painful. Birth control pills also can make a woman's periods lighter and less uncomfortable. Most birth control pills contain two hormones, estrogen and progestin. This type of birth control pill is called a "combination pill." Once a woman stops taking them, the ability to get pregnant returns, but so may the symptoms of endometriosis.
Progestins or progesterone medicines work much like birth control pills and can be taken by women who can't take estrogen. When a woman stops taking progestins, she can get pregnant again. But, the symptoms of endometriosis return too.
Gonadotropin releasing hormone agonists or GnRH agonists slow the growth of endometriosis and relieve symptoms. They work by greatly reducing the amount of estrogen in a woman's body, which stops the monthly cycle. Leuprolide (Lupron®) is a GnRH agonist often used to treat endometriosis. GnRH agonists should not be used alone for more than six months. This is because they can lead to osteoporosis. But if a woman takes estrogen along with GnRH agonists, she can use them for a longer time. When a woman stops taking this medicine, monthly periods and the ability to get pregnant return. But, usually the problems of endometriosis also return.
Danazol is a weak male hormone. Nowadays, doctors rarely recommend this hormone for endometriosis. Danazol lowers the levels of estrogen and progesterone in a woman's body. This stops a woman's period or makes it come less often. Danazol also gives pain relief. But it often causes side effects like oily skin, weight gain, tiredness, smaller breasts, and hot flashes. Danazol does not prevent pregnancy and can harm a baby growing in the uterus. Since it can't be used with other hormones, like birth control pills, doctors recommend using condoms, diaphragms, or other "barrier" methods to prevent pregnancy.
Surgery. Surgery is usually the best choice for women with endometriosis who have a severe amount of growths, a great deal of pain, or fertility problems. There are both minor and more complex surgeries that can help. Your doctor might suggest one of the following:
Laparoscopy can be used to diagnose and treat endometriosis. During this surgery, doctors remove growths and scar tissue or destroy them with intense heat. The goal is to treat the endometriosis without harming the healthy tissue around it. Women recover from laparoscopy much faster than from major abdominal surgery.
Laparotomy or major abdominal surgery is a last resort treatment for severe endometriosis. In this surgery, the doctor makes a much bigger cut in the abdomen than with laparoscopy. This allows the doctor to reach and remove growths of endometriosis in the pelvis or abdomen. Recovery from this surgery can take up to two months.
Hysterectomy should only be considered by women who do not want to become pregnant in the future. During this surgery, the doctor removes the uterus. She or he may also take out the ovaries and fallopian tubes at the same time. This is done when the endometriosis has severely damaged them.
How do I cope with a disease that has no cure?
You may feel many emotions—sadness, fright, anger, confusion, and loneliness. It is important to get support to cope with endometriosis. Consider joining a support group to talk with other women who have endometriosis. There are support groups on the Internet and in many communities.
It is also important to learn as much as you can about the disease. Talking with friends, family, and your doctor can help.
For More Information...
You can find out more about endometriosis by contacting the National Women's Health Information Center (NWHIC) at 1-800-994-9662 or the following organizations:
Endometriosis Association Phone Number(s): (414) 355-2200Internet Address: http://www.endometriosisassn.org/
The American College of Obstetricians and Gynecologists Phone Number(s): (800) 762-2264 x 192 (for publication requests only)Internet Address: http://www.acog.org/
Endometriosis Research Center Phone Number(s): (800) 239-7280Internet Address: http://www.endocenter.org/
All material contained in the FAQs is free of copyright restrictions and may be copied, reproduced, or duplicated without permission of the Office on Women's Health within the Department of Health and Human Services. Citation of the source is appreciated.
This FAQ was reviewed by:
Kerri Parks, MDAssistant ProfessorLos Angeles County Women's and Children's HospitalUSC-Keck School of MedicineLos Angeles, CA
Mory Nouriani, MDSher Institute of Reproductive MedicineGlendale, CAhttp://www.4women.gov/FAQ/endomet.htm
Monday, January 28, 2008
Dyspareunia
From Wikipedia, the free encyclopedia:
Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The term is used almost exclusively in women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original cause has been removed.
Dyspareunia is considered to be primarily a physical, rather than an emotional, problem until proven otherwise. In most instances of dyspareunia, there is an original physical cause. Extreme forms, in which the woman's pelvic floor musculature contracts involuntarily, is termed vaginismus.
According to DSM-IV (American Psychiatric Association 1994), the diagnosis of dyspareunia is made when the patient complains of recurrent or persistent genital pain before, during, or after sexual intercourse that is not caused exclusively by lack of lubrication or by vaginismus. Clinically, it is often difficult to separate dyspareunia from vaginismus, since vaginismus may occur secondary to a history of dyspareunia and even mild vaginismus is often accompanied by dyspareunia. It is important to establish whether the dyspareunia is acquired or lifelong and whether it is generalized (complete) or situational. Further inquiry should determine whether the pain is superficial or deep - whether it occurs primarily at the vaginal outlet or vaginal barrel or upon deep thrusting against the cervix. Even when the pain can be reproduced during a physical examination, the possible role of psychological factors in either causing or maintaining the pain must be acknowledged and dealt with in treatment.
Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The term is used almost exclusively in women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original cause has been removed.
Dyspareunia is considered to be primarily a physical, rather than an emotional, problem until proven otherwise. In most instances of dyspareunia, there is an original physical cause. Extreme forms, in which the woman's pelvic floor musculature contracts involuntarily, is termed vaginismus.
According to DSM-IV (American Psychiatric Association 1994), the diagnosis of dyspareunia is made when the patient complains of recurrent or persistent genital pain before, during, or after sexual intercourse that is not caused exclusively by lack of lubrication or by vaginismus. Clinically, it is often difficult to separate dyspareunia from vaginismus, since vaginismus may occur secondary to a history of dyspareunia and even mild vaginismus is often accompanied by dyspareunia. It is important to establish whether the dyspareunia is acquired or lifelong and whether it is generalized (complete) or situational. Further inquiry should determine whether the pain is superficial or deep - whether it occurs primarily at the vaginal outlet or vaginal barrel or upon deep thrusting against the cervix. Even when the pain can be reproduced during a physical examination, the possible role of psychological factors in either causing or maintaining the pain must be acknowledged and dealt with in treatment.
Saturday, January 26, 2008
Endometriosis News EndoTimes Blog
How Louise Redknapp beat endometriosis and became a mum
Times Online, UK - 17 hours agoShe suffers from endometriosis, a womb disorder that can cause infertility (see box, facing page), and for years thought that she might never have a baby. ...
Neurocrine Biosciences Announces Conference Call and Webcast to ...CNNMoney.com - Jan 24, 2008... largest pharmaceutical markets in the world including insomnia, anxiety, depression, irritable bowel syndrome, endometriosis and CNS related disorders. ...
Takeda Doses First Patient In A U.S. Phase 1 Study Of Hematide(TM) To Treat Chemotherapy Induced Anemia
Times Online, UK - 17 hours agoShe suffers from endometriosis, a womb disorder that can cause infertility (see box, facing page), and for years thought that she might never have a baby. ...
Neurocrine Biosciences Announces Conference Call and Webcast to ...CNNMoney.com - Jan 24, 2008... largest pharmaceutical markets in the world including insomnia, anxiety, depression, irritable bowel syndrome, endometriosis and CNS related disorders. ...
Takeda Doses First Patient In A U.S. Phase 1 Study Of Hematide(TM) To Treat Chemotherapy Induced Anemia
Thursday, January 24, 2008
The unforgettable ovary
By Gerald W. Deas, M.D.
Ladies, do you remember the velvet voice of Nat King Cole singing that song, "Unforgettable?" It went something like this, "Unforgettable, that's what you are, unforgettable, when near or far," etc. I actually forget the rest of the lyrics. anyhow, I'm sure that your ovaries might have gone crazy while listening to the rest of that romantic song.
The ovaries are not just a nest of eggs, but they secrete hormones which control almost all of the life saving chemical reactions in the female body. The ovaries don't forget what the female body needs to survive. Once every 28 to 30 days, when an egg is released (ovulation), there is an increase in the body temperature. If a pregnancy is desired, that is the time for the sperm to make its move in fertilizing the egg. In other words, make love before the temperature rises rather than later. This whole process of fertilization was not really understood until 1995. Millions of unwanted pregnancies have taken place due to misinformation. Just like I said, the ovary is not just an organ to increase our worldly population. That pair of small prune shaped unforgettable organs is responsible for a whole lot of things that take place in a woman's body and should not be removed unnecessarily when a hysterectomy is performed.
Can you believe, in this day and time at least 300,000 to 600,000 hysterectomies are performed due to abnormal uterine bleeding, fibroids, endometriosis, uterine prolapse and cancer. Often, the patient is advised to have a complete hysterectomy which entails not only removal of the uterus but also of the ovaries, medically known as oopherectomy. This procedure is justified by the surgeon to prevent ovarian and breast cancer.
Read More
Ladies, do you remember the velvet voice of Nat King Cole singing that song, "Unforgettable?" It went something like this, "Unforgettable, that's what you are, unforgettable, when near or far," etc. I actually forget the rest of the lyrics. anyhow, I'm sure that your ovaries might have gone crazy while listening to the rest of that romantic song.
The ovaries are not just a nest of eggs, but they secrete hormones which control almost all of the life saving chemical reactions in the female body. The ovaries don't forget what the female body needs to survive. Once every 28 to 30 days, when an egg is released (ovulation), there is an increase in the body temperature. If a pregnancy is desired, that is the time for the sperm to make its move in fertilizing the egg. In other words, make love before the temperature rises rather than later. This whole process of fertilization was not really understood until 1995. Millions of unwanted pregnancies have taken place due to misinformation. Just like I said, the ovary is not just an organ to increase our worldly population. That pair of small prune shaped unforgettable organs is responsible for a whole lot of things that take place in a woman's body and should not be removed unnecessarily when a hysterectomy is performed.
Can you believe, in this day and time at least 300,000 to 600,000 hysterectomies are performed due to abnormal uterine bleeding, fibroids, endometriosis, uterine prolapse and cancer. Often, the patient is advised to have a complete hysterectomy which entails not only removal of the uterus but also of the ovaries, medically known as oopherectomy. This procedure is justified by the surgeon to prevent ovarian and breast cancer.
Read More
Wednesday, January 23, 2008
Endometriosis has been documented in
From must see Endometriosis website and blog by Glynis D. Wallace, one who must cope herself.
http://blog.catamenialpneumothorax.org/
About This Video
"Endometriosis migration organ documentation"
Added: February 18, 2007
"Endometriosis migration organ documentation" - documented scientific information where endometriosis has been found!
Can endometriosis travel to the Heart?
http://www.youtube.com/watch?v=h9pOi2I-9rM
http://blog.catamenialpneumothorax.org/
About This Video
"Endometriosis migration organ documentation"
Added: February 18, 2007
"Endometriosis migration organ documentation" - documented scientific information where endometriosis has been found!
Can endometriosis travel to the Heart?
http://www.youtube.com/watch?v=h9pOi2I-9rM
Glynis D. Wallace DMD, former Major in the United States Air Force. Diagnosed and treated at military facilities around the world during her illustrious military career. She is an internationally acclaimed champion and authority on living with this often under diagnosed and misunderstood disease.
At-home test aims to give insight into fertility
By Marilyn Kennedy Melia Special to the Tribune
January 22, 2008
Lots of couples want a baby -- someday.Then, when someday finally comes, they want to conceive right now.While some might term such impatience an impudent attempt to control fate, it does have a practical side: It's important to know if you will have trouble getting pregnant as soon as possible. That's because the more time you have during your fertile years to remedy the problem, the better.
The standard advice is that couples who spend 12 months unsuccessfully trying to conceive should see a doctor for fertility screenings; after age 30 they may want to seek help after six months, said Dr. Arthur Haney, a reproductive endocrinologist and chairman of obstetrics and gynecology at the University of Chicago Medical Center.Now an at-home test called Fertell aims to provide an early alert to either male or female fertility problems and thereby shorten the wait for professional help.
Read More
http://www.chicagotribune.com/features/chi-0122_health_fertile_rjan22,1,2287198.story
January 22, 2008
Lots of couples want a baby -- someday.Then, when someday finally comes, they want to conceive right now.While some might term such impatience an impudent attempt to control fate, it does have a practical side: It's important to know if you will have trouble getting pregnant as soon as possible. That's because the more time you have during your fertile years to remedy the problem, the better.
The standard advice is that couples who spend 12 months unsuccessfully trying to conceive should see a doctor for fertility screenings; after age 30 they may want to seek help after six months, said Dr. Arthur Haney, a reproductive endocrinologist and chairman of obstetrics and gynecology at the University of Chicago Medical Center.Now an at-home test called Fertell aims to provide an early alert to either male or female fertility problems and thereby shorten the wait for professional help.
Read More
http://www.chicagotribune.com/features/chi-0122_health_fertile_rjan22,1,2287198.story
Tuesday, January 22, 2008
Food Poisoning Can Be Long-Term Problem
By LAURAN NEERGAARD – 17 hours ago
WASHINGTON (AP) — It's a dirty little secret of food poisoning: E. coli and certain other foodborne illnesses can sometimes trigger serious health problems months or years after patients survived that initial bout.
Scientists only now are unraveling a legacy that has largely gone unnoticed.
What they've spotted so far is troubling. In interviews with The Associated Press, they described high blood pressure, kidney damage, even full kidney failure striking 10 to 20 years later in people who survived severe E. coli infection as children, arthritis after a bout of salmonella or shigella, and a mysterious paralysis that can attack people who just had mild symptoms of campylobacter.
"Folks often assume once you're over the acute illness, that's it, you're back to normal and that's the end of it," said Dr. Robert Tauxe of the Centers for Disease Control and Prevention. The long-term consequences are "an important but relatively poorly documented, poorly studied area of foodborne illness."
These late effects are believed to make up a very small fraction of the nation's 76 million annual food poisonings, although no one knows just how many people are at risk. A bigger question is what other illnesses have yet to be scientifically linked to food poisoning.
And with a rash of food recalls — including more than 30 million pounds of ground beef pulled off the market last year alone — these are questions are taking on new urgency.
"We're drastically underestimating the burden on society that foodborne illnesses represent," contends Donna Rosenbaum of the consumer advocacy group STOP, Safe Tables Our Priority.
Every week, her group hears from patients with health complaints that they suspect or have been told are related to food poisoning years earlier, like a woman who survived severe E. coli at 8 only to have her colon removed in her 20s. Or people who develop diabetes after food poisoning inflamed the pancreas. Or parents who wonder if a child's learning problems stem from food poisoning-caused dialysis as a toddler.
"There's nobody to refer them to for an answer," says Rosenbaum.
So STOP this month is beginning the first national registry of food-poisoning survivors with long-term health problems — people willing to share their medical histories with scientists in hopes of boosting much-needed research.
Consider Alyssa Chrobuck of Seattle, who at age 5 was hospitalized as part of the Jack-in-the-Box hamburger outbreak that 15 years ago this month made a deadly E. coli strain notorious.
She's now a successful college student but ticks off a list of health problems unusual for a 20-year-old: High blood pressure, recurring hospitalizations for colon inflammation, a hiatal hernia, thyroid removal, endometriosis.
"I can't eat fatty foods. I can't eat things that are fried, never been able to eat ice cream or milkshakes," says Chrobuck. "Would I have this many medical problems if I hadn't had the E. coli? Definitely not. But there's no way to tie it definitely back."
Read More
http://ap.google.com/article/ALeqM5iSxdgd9SwKcoSArikR4UzdnMAfOQD8UADJ800
AP
WASHINGTON (AP) — It's a dirty little secret of food poisoning: E. coli and certain other foodborne illnesses can sometimes trigger serious health problems months or years after patients survived that initial bout.
Scientists only now are unraveling a legacy that has largely gone unnoticed.
What they've spotted so far is troubling. In interviews with The Associated Press, they described high blood pressure, kidney damage, even full kidney failure striking 10 to 20 years later in people who survived severe E. coli infection as children, arthritis after a bout of salmonella or shigella, and a mysterious paralysis that can attack people who just had mild symptoms of campylobacter.
"Folks often assume once you're over the acute illness, that's it, you're back to normal and that's the end of it," said Dr. Robert Tauxe of the Centers for Disease Control and Prevention. The long-term consequences are "an important but relatively poorly documented, poorly studied area of foodborne illness."
These late effects are believed to make up a very small fraction of the nation's 76 million annual food poisonings, although no one knows just how many people are at risk. A bigger question is what other illnesses have yet to be scientifically linked to food poisoning.
And with a rash of food recalls — including more than 30 million pounds of ground beef pulled off the market last year alone — these are questions are taking on new urgency.
"We're drastically underestimating the burden on society that foodborne illnesses represent," contends Donna Rosenbaum of the consumer advocacy group STOP, Safe Tables Our Priority.
Every week, her group hears from patients with health complaints that they suspect or have been told are related to food poisoning years earlier, like a woman who survived severe E. coli at 8 only to have her colon removed in her 20s. Or people who develop diabetes after food poisoning inflamed the pancreas. Or parents who wonder if a child's learning problems stem from food poisoning-caused dialysis as a toddler.
"There's nobody to refer them to for an answer," says Rosenbaum.
So STOP this month is beginning the first national registry of food-poisoning survivors with long-term health problems — people willing to share their medical histories with scientists in hopes of boosting much-needed research.
Consider Alyssa Chrobuck of Seattle, who at age 5 was hospitalized as part of the Jack-in-the-Box hamburger outbreak that 15 years ago this month made a deadly E. coli strain notorious.
She's now a successful college student but ticks off a list of health problems unusual for a 20-year-old: High blood pressure, recurring hospitalizations for colon inflammation, a hiatal hernia, thyroid removal, endometriosis.
"I can't eat fatty foods. I can't eat things that are fried, never been able to eat ice cream or milkshakes," says Chrobuck. "Would I have this many medical problems if I hadn't had the E. coli? Definitely not. But there's no way to tie it definitely back."
Read More
http://ap.google.com/article/ALeqM5iSxdgd9SwKcoSArikR4UzdnMAfOQD8UADJ800
AP
Friday, January 18, 2008
Catamenial Pneumothorax
A GYN Disease with Secondary Pulmonary Symptoms
Dr. Glynis D. Wallace
Author: Living With Lung and Colon
Endometriosis: Catamenial Pneumothorax\
glynis.wallace@catamenialpneumothorax.org
Lung endometriosis refers to tissue outside
the uterus where women carry
babies, attached to the lung. The term
‘Catamenial Pneumothorax’ describes
collapse of the lung during menstruation.
The first reported cases of this disease
were in the 1930’s. Menstrual bleeding
from a lung tumor associated
with endometriosis was by Schwarz
in 1938. A laboratory investigation
by Hobbs and Bortnick 1940 was able
to produce pulmonary endometriosis in
rabbits by intravenous infusion of endometrial
tissue suspension. Bungeler
and associates in 1939 reported autopsy
findings of three small nodules of
endometriosis on the right upper
pleural surface in a 42-year-old woman.
Nicholson in 1951 was the first to
report histologically proven endometriosis
in a clinical case of recurrent
hemorrhagic pleural effusion. Many
cases of endometriosis have been
reported within the thorax in various
sites: lung parenchyma, pleura,
diaphragm, myocardium and bronchial
tree. This has been referred to as Thoracic,
Pulmonary, Extrapelvic and
Lung Endometriosis. This disease
is considered to be extremely rare,
but actually it is, under recognized and
under diagnosed.
Pioneers of Thoracic Endometriosis:
Abd
Author Year Age Loc Symptoms Proof Endo
Pleural
Bungeler et al. 1939 42 Rt None, autopsy material Micro --
Nicholson 1951 23 Rt Hemothorax, recurrent Micro Yes
Charles 1957 33 Rt Hemothorax, recurrent None Yes
Ripstein et al. 1959 24 Rt Hemothorax, recurrent Micro Yes
Williams et al. 1962 26 Rt Hemothorax None Yes
Diaphragmatic
Brews 1954 39 Rt Pleural effusion, ascites Micro Yes
Maurer et al. 1958 35 Rt Pneumothorax Micro Yes
Skobel 1963 39 Rt Hemothorax Micro Yes
McSwain et al 1964 30 Rt Pneumothorax, recurrent -- Yes
Pulmonary
Schwarz 1938 - - Hemoptysis, cyclic None --
Lattes et al. 1956 34 Rt Hemoptysis during menses Micro No
Fleishman et al. 1959 39 Lft Hemoptysis during menses Radio No
Sturzennegger 1960 52 Rt None, x-ray finding Micro --
Mobbs et al. 1963 31 Rt None, x-ray finding Micro --
Kishkovsky et al 1963 34 Rt Hemoptysis during menses Radio --
Bronchial
Rodman et al. 1962 26 1Ab Lft Hemoptysis during menses Micro --
Myocardial
Felson et al. 1960 46 - RV Pleural effusion Microscopic
Adenomyosis
Definitions
Catamenial pneumothorax is a
condition of collapsed lung occurring in
conjunction with menstrual periods
(catamenial refers to menstruation),
believed to be caused primarily by
endometriosis of the pleura
(the membrane surrounding the lung).
Catamenial Hemopneumothorax is
when endometrial cells attaches to the
lung release blood which accumulates to
large levels, and air moves in through
fenestrations in the diaphragm by an
unknown mechanism causing the lung to
collapse.
Catamenial Hemothorax is the
accumulation of blood without lung
collapse.
Catamenial Hemoptysis: Coughing up
blood from the respiratory tract during
menstruation because of intrathoracic
endometriosis. Endometrial cells have
moved into the tracheo-bronchial tree
REFERENCES
1 Brews, A.: Endometriosis of Diaphragm and
Meig’s Syndrome, Proc. Roy. Soc. Med. 47:
461, 1954.
2 Bungeler, W., and Silveira, D. F.: Quoted in
Lattes et al.”
3 Charles, D.: Endometriosis and Hemorrhagic
Pleural Effusion, Obst. & Gynec. 10: 309.
1957
4 Felson, H., McGuire, J., and Wasserman, P.:
Stromal Endometriosis Involving the Heart,
Am. J. Med, 19: 1072, 1960.
5 Fleishman, S. J., and Davidson, J. F., Vicarious
Menstruation, a Likely Case of Pulmonary
Endometriosis, Lancet 2: 88, 1959
6 Hobbs, J. E., and Bortnick, A. R.: Endometriosis
of Lungs: Experimental and Clinical
Study, Am. J. Obst. & Gynec. 40: 832 1940.
7 Kishkovsky, A. N., and Baskaskov, V. P.:
Roenigen Diagnosis of Pulmonary Endometriosis,
Vesin, Renigen, 38: 44, 1963
(Russian)
8 Lattes, R., Shepard, F., Tovell, H., and Wylie,
R.: Clinical and Pathological Study of Endo-
Metriosis of Lung, Surg., Gynec. & Obst. 103:
552, 1956
9 Maurer, E, R., Schaal, J. A., and Mendez, F.
L.: Chronic Recurring Spontaneous Pneumo-
Thorax Due to Endometriosis of the Diaphragm,
J. A. M. A.. 168: 2013, 1958
10 McSwain, H, T., and Siebel, E. K.: Spontaneous
Pneumothorax Associated with Menstruation
or Endometriosis. Presented at the Annual
Meeting of Southern Thoracic Surgical Association,
1964
11 Mobbs, G. A., and Planner, D. W.: Endometriosis
of the Lung, Lancet 1: 472, 1963
12 Nicholson, H.: Endometriosis of the Pleura, Thorax
6: 75, 1951
13 Ripstein, C. B., Rohman, M., and Wallech
J. B.: Endometriosis Involving the Pleura,
J. THORACIC SURG, 37: 464, 1958
14 Rodman, M. H., and Jones, C. W.: Catamenial
Hemoptysis Due to Bronchial Endometriosis,
New England J. Med. 266: 805,
1962
15 Schwartz, O. H.: Endometriosis of the Lung.
In discussion of “Endometriosis, a Clinical
and Surgical Review” by V. S. Counsellor,
Am. J. Obst. & Gynec. 36: 887, 1938
16 Skobel, P.: Diaphragmatic Complications in
Endometriosis and Miegs Syndrome, Ziachr,
Tuberk, 120: 22, 1963 (German)
17 Sturzennegger, H.: Endometriosis of the Lungs
Simulating Tuberculoma, Schweiz Z, Tuberk.
17: 259, 1960 (German)
18 Williams,J. F., Williams, J. B., and Harper,
J W.: Thoracic Endometriosis, Am. J. Obst.
& Gynec. 84: 1512, 1962.
Dr. Wallace has written a book
LIVING WITH LUNG AND COLON ENDOMETRIOSIS
Please visit Dr Wallace's website for more information and to order your copy http://www.catamenialpneumothorax.org/
Dr. Glynis D. Wallace
Author: Living With Lung and Colon
Endometriosis: Catamenial Pneumothorax\
glynis.wallace@catamenialpneumothorax.org
Lung endometriosis refers to tissue outside
the uterus where women carry
babies, attached to the lung. The term
‘Catamenial Pneumothorax’ describes
collapse of the lung during menstruation.
The first reported cases of this disease
were in the 1930’s. Menstrual bleeding
from a lung tumor associated
with endometriosis was by Schwarz
in 1938. A laboratory investigation
by Hobbs and Bortnick 1940 was able
to produce pulmonary endometriosis in
rabbits by intravenous infusion of endometrial
tissue suspension. Bungeler
and associates in 1939 reported autopsy
findings of three small nodules of
endometriosis on the right upper
pleural surface in a 42-year-old woman.
Nicholson in 1951 was the first to
report histologically proven endometriosis
in a clinical case of recurrent
hemorrhagic pleural effusion. Many
cases of endometriosis have been
reported within the thorax in various
sites: lung parenchyma, pleura,
diaphragm, myocardium and bronchial
tree. This has been referred to as Thoracic,
Pulmonary, Extrapelvic and
Lung Endometriosis. This disease
is considered to be extremely rare,
but actually it is, under recognized and
under diagnosed.
Pioneers of Thoracic Endometriosis:
Abd
Author Year Age Loc Symptoms Proof Endo
Pleural
Bungeler et al. 1939 42 Rt None, autopsy material Micro --
Nicholson 1951 23 Rt Hemothorax, recurrent Micro Yes
Charles 1957 33 Rt Hemothorax, recurrent None Yes
Ripstein et al. 1959 24 Rt Hemothorax, recurrent Micro Yes
Williams et al. 1962 26 Rt Hemothorax None Yes
Diaphragmatic
Brews 1954 39 Rt Pleural effusion, ascites Micro Yes
Maurer et al. 1958 35 Rt Pneumothorax Micro Yes
Skobel 1963 39 Rt Hemothorax Micro Yes
McSwain et al 1964 30 Rt Pneumothorax, recurrent -- Yes
Pulmonary
Schwarz 1938 - - Hemoptysis, cyclic None --
Lattes et al. 1956 34 Rt Hemoptysis during menses Micro No
Fleishman et al. 1959 39 Lft Hemoptysis during menses Radio No
Sturzennegger 1960 52 Rt None, x-ray finding Micro --
Mobbs et al. 1963 31 Rt None, x-ray finding Micro --
Kishkovsky et al 1963 34 Rt Hemoptysis during menses Radio --
Bronchial
Rodman et al. 1962 26 1Ab Lft Hemoptysis during menses Micro --
Myocardial
Felson et al. 1960 46 - RV Pleural effusion Microscopic
Adenomyosis
Definitions
Catamenial pneumothorax is a
condition of collapsed lung occurring in
conjunction with menstrual periods
(catamenial refers to menstruation),
believed to be caused primarily by
endometriosis of the pleura
(the membrane surrounding the lung).
Catamenial Hemopneumothorax is
when endometrial cells attaches to the
lung release blood which accumulates to
large levels, and air moves in through
fenestrations in the diaphragm by an
unknown mechanism causing the lung to
collapse.
Catamenial Hemothorax is the
accumulation of blood without lung
collapse.
Catamenial Hemoptysis: Coughing up
blood from the respiratory tract during
menstruation because of intrathoracic
endometriosis. Endometrial cells have
moved into the tracheo-bronchial tree
REFERENCES
1 Brews, A.: Endometriosis of Diaphragm and
Meig’s Syndrome, Proc. Roy. Soc. Med. 47:
461, 1954.
2 Bungeler, W., and Silveira, D. F.: Quoted in
Lattes et al.”
3 Charles, D.: Endometriosis and Hemorrhagic
Pleural Effusion, Obst. & Gynec. 10: 309.
1957
4 Felson, H., McGuire, J., and Wasserman, P.:
Stromal Endometriosis Involving the Heart,
Am. J. Med, 19: 1072, 1960.
5 Fleishman, S. J., and Davidson, J. F., Vicarious
Menstruation, a Likely Case of Pulmonary
Endometriosis, Lancet 2: 88, 1959
6 Hobbs, J. E., and Bortnick, A. R.: Endometriosis
of Lungs: Experimental and Clinical
Study, Am. J. Obst. & Gynec. 40: 832 1940.
7 Kishkovsky, A. N., and Baskaskov, V. P.:
Roenigen Diagnosis of Pulmonary Endometriosis,
Vesin, Renigen, 38: 44, 1963
(Russian)
8 Lattes, R., Shepard, F., Tovell, H., and Wylie,
R.: Clinical and Pathological Study of Endo-
Metriosis of Lung, Surg., Gynec. & Obst. 103:
552, 1956
9 Maurer, E, R., Schaal, J. A., and Mendez, F.
L.: Chronic Recurring Spontaneous Pneumo-
Thorax Due to Endometriosis of the Diaphragm,
J. A. M. A.. 168: 2013, 1958
10 McSwain, H, T., and Siebel, E. K.: Spontaneous
Pneumothorax Associated with Menstruation
or Endometriosis. Presented at the Annual
Meeting of Southern Thoracic Surgical Association,
1964
11 Mobbs, G. A., and Planner, D. W.: Endometriosis
of the Lung, Lancet 1: 472, 1963
12 Nicholson, H.: Endometriosis of the Pleura, Thorax
6: 75, 1951
13 Ripstein, C. B., Rohman, M., and Wallech
J. B.: Endometriosis Involving the Pleura,
J. THORACIC SURG, 37: 464, 1958
14 Rodman, M. H., and Jones, C. W.: Catamenial
Hemoptysis Due to Bronchial Endometriosis,
New England J. Med. 266: 805,
1962
15 Schwartz, O. H.: Endometriosis of the Lung.
In discussion of “Endometriosis, a Clinical
and Surgical Review” by V. S. Counsellor,
Am. J. Obst. & Gynec. 36: 887, 1938
16 Skobel, P.: Diaphragmatic Complications in
Endometriosis and Miegs Syndrome, Ziachr,
Tuberk, 120: 22, 1963 (German)
17 Sturzennegger, H.: Endometriosis of the Lungs
Simulating Tuberculoma, Schweiz Z, Tuberk.
17: 259, 1960 (German)
18 Williams,J. F., Williams, J. B., and Harper,
J W.: Thoracic Endometriosis, Am. J. Obst.
& Gynec. 84: 1512, 1962.
Dr. Wallace has written a book
LIVING WITH LUNG AND COLON ENDOMETRIOSIS
Please visit Dr Wallace's website for more information and to order your copy http://www.catamenialpneumothorax.org/
Glynis D. Wallace DMD, former Major in the United States Air Force. Diagnosed and treated at military facilities around the world during her illustrious military career. She is an internationally acclaimed champion and authority on living with this often under diagnosed and misunderstood disease.
Endometriosis has been documented in
almost every body organ.
http://www.youtube.com/watch?v=h9pOi2I-9rM
Endometriosis has been documented in
almost every body organ.
http://www.youtube.com/watch?v=h9pOi2I-9rM
Endometriosis Headlines EndoTimes Blog
Sexual Function in Women Before and After Transvaginal Mesh Repair for Pelvic Organ Prolapse - AbstractFriday, 18 January 2008Department of Obstetrics and Gynecology, Pavillon Mère-Enfant, Rouen University Hospital—Charles Nicolle, 1, rue de Germont, 76031, Rouen, France read more
Some Wood Floor Finishes Are A Likely Source Of PCB Exposure
Group targets pollution sources
FDA Asserts New Policy To Restrict Women's Access To Bioidentical Hormones
Osteoporosis: Eight Tips For 2008
Plasticizers Leaching Unto Food Make People Sick ...
PRLog.Org (press release), Romania - Jan 16, 2008
When Cynthia was diagnosed with endometriosis in 2005, she had never heard of the word. The Endometriosis Association (http://www.endometriosisassn.org ) ...
Some Wood Floor Finishes Are A Likely Source Of PCB Exposure
Group targets pollution sources
FDA Asserts New Policy To Restrict Women's Access To Bioidentical Hormones
Osteoporosis: Eight Tips For 2008
Plasticizers Leaching Unto Food Make People Sick ...
PRLog.Org (press release), Romania - Jan 16, 2008
When Cynthia was diagnosed with endometriosis in 2005, she had never heard of the word. The Endometriosis Association (http://www.endometriosisassn.org ) ...
Monday, January 14, 2008
Judge Gives Monsanto Suits Class-Action Status
http://www.wsaz.com/news/headlines/13729697.html
Lawsuits alleging dioxin from a former Monsanto Company plant contaminated residential properties and streams will be tried as class-action cases.
According to court documents, Putnam County Circuit Court Judge O.C. Spaulding certified two lawsuits against Monsanto as class-action cases this week. Thousands of current and former Nitro residents are included in one case. The second case includes owners of about 100 properties in the Manila and Heizer Creek areas near Nitro.
Monsanto owned the Nitro plant from 1934 until 2000. The plant closed in 2004.
The lawsuits allege that dioxin from Monsanto's production of 2, 4, 5-T, a powerful herbicide ingredient, polluted local properties and local streams.
Dioxin has been linked to cancer, birth defects, learning disabilities, endometriosis, infertility and suppressed immune functions. The chemical builds up in tissue over time, so even small exposures can accumulate to dangerous levels.
Lawsuits alleging dioxin from a former Monsanto Company plant contaminated residential properties and streams will be tried as class-action cases.
According to court documents, Putnam County Circuit Court Judge O.C. Spaulding certified two lawsuits against Monsanto as class-action cases this week. Thousands of current and former Nitro residents are included in one case. The second case includes owners of about 100 properties in the Manila and Heizer Creek areas near Nitro.
Monsanto owned the Nitro plant from 1934 until 2000. The plant closed in 2004.
The lawsuits allege that dioxin from Monsanto's production of 2, 4, 5-T, a powerful herbicide ingredient, polluted local properties and local streams.
Dioxin has been linked to cancer, birth defects, learning disabilities, endometriosis, infertility and suppressed immune functions. The chemical builds up in tissue over time, so even small exposures can accumulate to dangerous levels.
Thursday, January 10, 2008
ARDANA ANNOUNCES OUTCOME OF PRE-IND MEETING WITH FDA ON TEVERELIX LA FOR THE TREATMENT OF ENDOMETRIOSIS
RNS Number:3659LArdana PLC09 January 2008
ARDANA ANNOUNCES OUTCOME OF PRE-IND MEETING WITH FDA ON TEVERELIX LA FOR THE TREATMENT OF ENDOMETRIOSIS
Edinburgh, UK, January 9, 2008: Ardana Plc (LSE:ARA), the emerging
pharmaceutical company specialising in improving human reproductive health,today announces the positive outcome of a pre-Investigational New Drug (IND)meeting with the United States Food and Drug Administration (FDA) for thedevelopment of its lead compound Teverelix LA (long-acting) for the treatment ofendometriosis.The pre-IND meeting resulted in agreement with the FDA on the clinicaldevelopment path for Teverelix LA in this indication. Ardana plans to open anIND in 2008 and submit the first Phase II study design shortly thereafter.
Endometriosis arises in pre-menopausal women when the lining of the womb(endometrium) grows outside the uterus, typically in the pelvic cavity. Symptoms associated with endometriosis include cyclical or chronic pelvic pain, heavy periods and infertility. It is well documented that endometriosis is a hormone sensitive condition and a reduction in estrogen levels causes a shrinkage of the endometriotic lesions and an improvement in symptoms. Current treatment options include GnRH agonists however this class of compounds is associated with side effects similar to menopausal symptoms including hot flushes, reduced libido and loss of bone density, due to the reduction in estrogen levels to those seen inpost-menopausal women.
In two previous Phase I clinical studies of different dose-regimens,
Teverelix LA has been shown to reduce estrogen levels rapidly and in a dose-dependent manner. Preliminary data from the second Phase I, randomised, single-blind,placebo-controlled study of a single subcutaneous injection of Teverelix LA, atone of two doses to 24 healthy female subjects, indicated that Teverelix LA could reduce estrogen levels to a desired level at the lower end of the normal range which should help to avoid menopausal symptoms. In this study estrogen levels were reduced to average concentrations over a period of 8 weeks of 40.5pg/ml and 49.0 pg/ml respectively vs. 88.8 pg/ml for placebo.
The effect of Teverelix LA on certain bone absorption markers such as serum
telopeptides and urine deoxypyridinoline were also investigated in this study and these markers appeared to be unaffected by Teverelix LA.
Commenting on today's announcement Dr Huw Jones, Ardana's CEO, said: "We are encouraged by the feedback we have received from the FDA on the way forward for Teverelix LA in endometriosis.
There is, in our view, a high unmet medical need for an effective treatment for endometriosis which does not produce menopausal symptoms or a loss of bone mineral density.
"It has been estimated1 that 1 in 10 women suffer from some form of endometriosis during their lives and in 2004 it was estimated that there were approximately 17 million cases of endometriosis in the seven major pharmaceutical markets (US,Japan, France, Germany, Italy, Spain and the UK), of which approximately 3.9million cases were diagnosed.
Teverelix LA is also being developed for the treatment of prostate cancer and BPH (benign prostatic hyperplasia) both of which currently have active INDs.
Ardana announced positive Phase II data in both these indications in the secondhalf of 2007.
Source
ARDANA ANNOUNCES OUTCOME OF PRE-IND MEETING WITH FDA ON TEVERELIX LA FOR THE TREATMENT OF ENDOMETRIOSIS
Edinburgh, UK, January 9, 2008: Ardana Plc (LSE:ARA), the emerging
pharmaceutical company specialising in improving human reproductive health,today announces the positive outcome of a pre-Investigational New Drug (IND)meeting with the United States Food and Drug Administration (FDA) for thedevelopment of its lead compound Teverelix LA (long-acting) for the treatment ofendometriosis.The pre-IND meeting resulted in agreement with the FDA on the clinicaldevelopment path for Teverelix LA in this indication. Ardana plans to open anIND in 2008 and submit the first Phase II study design shortly thereafter.
Endometriosis arises in pre-menopausal women when the lining of the womb(endometrium) grows outside the uterus, typically in the pelvic cavity. Symptoms associated with endometriosis include cyclical or chronic pelvic pain, heavy periods and infertility. It is well documented that endometriosis is a hormone sensitive condition and a reduction in estrogen levels causes a shrinkage of the endometriotic lesions and an improvement in symptoms. Current treatment options include GnRH agonists however this class of compounds is associated with side effects similar to menopausal symptoms including hot flushes, reduced libido and loss of bone density, due to the reduction in estrogen levels to those seen inpost-menopausal women.
In two previous Phase I clinical studies of different dose-regimens,
Teverelix LA has been shown to reduce estrogen levels rapidly and in a dose-dependent manner. Preliminary data from the second Phase I, randomised, single-blind,placebo-controlled study of a single subcutaneous injection of Teverelix LA, atone of two doses to 24 healthy female subjects, indicated that Teverelix LA could reduce estrogen levels to a desired level at the lower end of the normal range which should help to avoid menopausal symptoms. In this study estrogen levels were reduced to average concentrations over a period of 8 weeks of 40.5pg/ml and 49.0 pg/ml respectively vs. 88.8 pg/ml for placebo.
The effect of Teverelix LA on certain bone absorption markers such as serum
telopeptides and urine deoxypyridinoline were also investigated in this study and these markers appeared to be unaffected by Teverelix LA.
Commenting on today's announcement Dr Huw Jones, Ardana's CEO, said: "We are encouraged by the feedback we have received from the FDA on the way forward for Teverelix LA in endometriosis.
There is, in our view, a high unmet medical need for an effective treatment for endometriosis which does not produce menopausal symptoms or a loss of bone mineral density.
"It has been estimated1 that 1 in 10 women suffer from some form of endometriosis during their lives and in 2004 it was estimated that there were approximately 17 million cases of endometriosis in the seven major pharmaceutical markets (US,Japan, France, Germany, Italy, Spain and the UK), of which approximately 3.9million cases were diagnosed.
Teverelix LA is also being developed for the treatment of prostate cancer and BPH (benign prostatic hyperplasia) both of which currently have active INDs.
Ardana announced positive Phase II data in both these indications in the secondhalf of 2007.
Source
Q&A Endometriosis and Lupron
Expert: Heather Guidone
Date: 3/27/2007
Subject: LupronQuestion
Hi Heather,I have stage 4 Endo. I was diagnosed over 10 years ago. My future goal is to have another surgery but without health insurance, that is not foreseen anytime soon. I had the worst pain I have ever had yesterday. For five hours straight I was in so much pain that I was crying, screaming, contstantly throwing up. It was horrible. It was so bad that my husband begged me to go to the ER. Pain meds did not help at all. When I was first diagnosed with Endo I had laser ablation and was offered Lupron. My insurance would not cover Lurpon so I was paying out of pocket. After 2 months I just couldn't afford it anymore. After yesterday, my husband and I are considering going through Lupron treatment again. Well, it's a new husband then before so he doesn't know what it was like. I never had all the symptoms because I was not on it long enough before. Can you tell me what the side effects are? Well, more like the long lasting side effects? What won't go awway after taking ending the treatment?
Thanks for any advice you can give me.Karen
Answer
Hi Karen! Thanks for writing.
I'm sorry for what you've been going through.
This is not an easy (or financially simple to treat) disease, for certain.
I'm going to tell you the same thing that I tell other patients who are considering Lupron. Ultimately, it's your choice, of course, but it helps to make an educated decision - something that is very hard when most doctors are either uninformed or outright dishonest about the effects of GnRH therapy and the company has one of the biggest, most successful marketing campaigns in the world.
It's easy to find positive stories and info about Lupron "out there;" it's not so easy to get to the heart of the accurate facts and first person experiences.
Anyone can read http://www.endoknow.com for "fluff" about the drug. For the other side of the story, I offer this info to anyone who asks:
Perhaps you will be one of the lucky ones in whom Lupron is effective and confers minimally negative, short-lived side effects.
Lupron is merely a temporary, stop-gap measure only which often affects women in a highly negative manner (with long-lasting side effects) and doesn't even temporarily remove the symptoms. There is a reason that the Endo treatment centers do not use or prescribe Lupron in their practices (see http://www.endoexcision.com, http://www.centerforendo.com, http://www.endometriosissurgeon.com).
You may want to contact one of the specialty centers to discuss payment plans, discounts and other options for excision surgery.
For even more explicit details on the drug and its effects and shortcomings, you will definitely want to read http://www.endocenter.org/pdf/surgery%20vs.%20gnrh.pdf
and http://www.endocenter.org/pdf/PreDiagnosisGnRH.pdf.
Potential side effects of Lupron are extremely negative and long-lasting, and include (as reported by the manufacturer itself, not just those who hate the drug):
Asthenia, General pain, Headache, Hot flashes/sweats, Nausea/vomiting, GI disturbances, Edema, Weight gain/loss, Acne, Hirsutism, Joint disorder, Myalgia, Decreased libido, Depression/emotional lability, Dizziness, Nervousness, Neuromuscular disorders, Paresthesias, Skin reactions at injection site, Breast changes/tenderness/pain, Vaginitis, Flu-like symptoms, Heart palpitations, Syncope, Tachycardia, Appetite changes, Dry mouth, Thirst, Ecchymosis, Lymphadenopathy, Anxiety, Insomnia/Sleep disorders, Delusions, Memory disorder, Personality disorders, Rhinitis, Alopecia, Hair disorder, Nail disorder, Conjunctivitis, Ophthalmologic disorders, Taste perversion, and Dysuria. And that's just a few.
Check the prescribing literature or check a PDR for the long list.As an aside, there have also been several lawsuits against TAP, including the largest one in federal history - ever - against a pharmaceutical company - $875 million, prosecuted under the RICO statutes (racketeer influenced criminal organization) for the kickbacks they gave prescribers to give the med to their patients. Unfortunately, while that lawsuit was huge and brought justice, it did not bring justice to those who are suffering the horrific long-term side effects, because the suits were about pricing, not side effects.You may want to check out the following sites to read up on and talk to thousands of others who are in your shoes and can offer insight and advice:
http://groups.yahoo.com/group/erc
http://www.geocities.com/lupronfacts/facts.html http://www.redflagsweekly.com/letters/letters5.htm
http://health.groups.yahoo.com/group/lupron
http://groups.yahoo.com/group/LupronVictims
There are very few pros associated with Lupron. The key to successful treatment of Endometriosis is removal of disease - true removal (i.e., excision, not superficial ablation, vaporization, etc. and not ovarian suppression). There is no guarantee you will be pain free for 6 minutes, let alone 6 months with Lupron, but the excision stats speak for themselves (only a 20% recurrence rate over the course of 20 yrs. in thousands of patients).
In any event, should you decide Lupron is right for you and you wish to pursue it, this might help with some of the expense:
Lupron Patient Assistance Program call 1-800-621-1020, option 7
This can help you get low or no cost Lupron.
I do wish you luck and hope that whatever you decide is the right answer for you. Entering into an educated treatment option is never wrong; just make sure you've asked all the questions and been satisified with the answers.
Good luck no matter what you decide.
Thank you Heather! From the ERC
Source
Date: 3/27/2007
Subject: LupronQuestion
Hi Heather,I have stage 4 Endo. I was diagnosed over 10 years ago. My future goal is to have another surgery but without health insurance, that is not foreseen anytime soon. I had the worst pain I have ever had yesterday. For five hours straight I was in so much pain that I was crying, screaming, contstantly throwing up. It was horrible. It was so bad that my husband begged me to go to the ER. Pain meds did not help at all. When I was first diagnosed with Endo I had laser ablation and was offered Lupron. My insurance would not cover Lurpon so I was paying out of pocket. After 2 months I just couldn't afford it anymore. After yesterday, my husband and I are considering going through Lupron treatment again. Well, it's a new husband then before so he doesn't know what it was like. I never had all the symptoms because I was not on it long enough before. Can you tell me what the side effects are? Well, more like the long lasting side effects? What won't go awway after taking ending the treatment?
Thanks for any advice you can give me.Karen
Answer
Hi Karen! Thanks for writing.
I'm sorry for what you've been going through.
This is not an easy (or financially simple to treat) disease, for certain.
I'm going to tell you the same thing that I tell other patients who are considering Lupron. Ultimately, it's your choice, of course, but it helps to make an educated decision - something that is very hard when most doctors are either uninformed or outright dishonest about the effects of GnRH therapy and the company has one of the biggest, most successful marketing campaigns in the world.
It's easy to find positive stories and info about Lupron "out there;" it's not so easy to get to the heart of the accurate facts and first person experiences.
Anyone can read http://www.endoknow.com for "fluff" about the drug. For the other side of the story, I offer this info to anyone who asks:
Perhaps you will be one of the lucky ones in whom Lupron is effective and confers minimally negative, short-lived side effects.
Lupron is merely a temporary, stop-gap measure only which often affects women in a highly negative manner (with long-lasting side effects) and doesn't even temporarily remove the symptoms. There is a reason that the Endo treatment centers do not use or prescribe Lupron in their practices (see http://www.endoexcision.com, http://www.centerforendo.com, http://www.endometriosissurgeon.com).
You may want to contact one of the specialty centers to discuss payment plans, discounts and other options for excision surgery.
For even more explicit details on the drug and its effects and shortcomings, you will definitely want to read http://www.endocenter.org/pdf/surgery%20vs.%20gnrh.pdf
and http://www.endocenter.org/pdf/PreDiagnosisGnRH.pdf.
Potential side effects of Lupron are extremely negative and long-lasting, and include (as reported by the manufacturer itself, not just those who hate the drug):
Asthenia, General pain, Headache, Hot flashes/sweats, Nausea/vomiting, GI disturbances, Edema, Weight gain/loss, Acne, Hirsutism, Joint disorder, Myalgia, Decreased libido, Depression/emotional lability, Dizziness, Nervousness, Neuromuscular disorders, Paresthesias, Skin reactions at injection site, Breast changes/tenderness/pain, Vaginitis, Flu-like symptoms, Heart palpitations, Syncope, Tachycardia, Appetite changes, Dry mouth, Thirst, Ecchymosis, Lymphadenopathy, Anxiety, Insomnia/Sleep disorders, Delusions, Memory disorder, Personality disorders, Rhinitis, Alopecia, Hair disorder, Nail disorder, Conjunctivitis, Ophthalmologic disorders, Taste perversion, and Dysuria. And that's just a few.
Check the prescribing literature or check a PDR for the long list.As an aside, there have also been several lawsuits against TAP, including the largest one in federal history - ever - against a pharmaceutical company - $875 million, prosecuted under the RICO statutes (racketeer influenced criminal organization) for the kickbacks they gave prescribers to give the med to their patients. Unfortunately, while that lawsuit was huge and brought justice, it did not bring justice to those who are suffering the horrific long-term side effects, because the suits were about pricing, not side effects.You may want to check out the following sites to read up on and talk to thousands of others who are in your shoes and can offer insight and advice:
http://groups.yahoo.com/group/erc
http://www.geocities.com/lupronfacts/facts.html http://www.redflagsweekly.com/letters/letters5.htm
http://health.groups.yahoo.com/group/lupron
http://groups.yahoo.com/group/LupronVictims
There are very few pros associated with Lupron. The key to successful treatment of Endometriosis is removal of disease - true removal (i.e., excision, not superficial ablation, vaporization, etc. and not ovarian suppression). There is no guarantee you will be pain free for 6 minutes, let alone 6 months with Lupron, but the excision stats speak for themselves (only a 20% recurrence rate over the course of 20 yrs. in thousands of patients).
In any event, should you decide Lupron is right for you and you wish to pursue it, this might help with some of the expense:
Lupron Patient Assistance Program call 1-800-621-1020, option 7
This can help you get low or no cost Lupron.
I do wish you luck and hope that whatever you decide is the right answer for you. Entering into an educated treatment option is never wrong; just make sure you've asked all the questions and been satisified with the answers.
Good luck no matter what you decide.
Thank you Heather! From the ERC
Source
Wednesday, January 09, 2008
Role of shigella infection in endometriosis: A novel hypothesis.
Kodati VL, Govindan S, Movva S, Ponnala S, Hasan Q.
Vasavi Hospital, # 6-1-91 Khairtabad, Hyderabad, AP 500004, India.
Endometriosis is the presence of endometrial cells and stroma at ectopic sites outside the uterine cavity. The natural history of endometriosis is uncertain, its etiology unknown, the clinical presentation inconsistent, diagnosis difficult and the treatment poorly standardized. It causes significant morbidity due to pelvic pain and infertility among 15-25% of women during their reproductive age. The benign disease causes peritoneal inflammation, fibrosis, adhesions and ovarian cysts but displays features of malignancy, like neo-vascularization, local invasion and distant metastasis. Mechanical, hormonal, immunological, environmental and genetic factors have been implicated in its etiology but provide inconclusive explanations. Present study was carried out on ectopic and eutopic endometriotic tissue specimens collected during laproscopy/laprotomy from cases of endometriosis. mRNA was isolated from the tissues and converted to cDNA by RT and subsequently subjected to differential display Polymerase Chain Reaction using seven sets of arbitrary primers. A unique band was identified only in the ectopic endometriotic tissue, which was sequenced. BLAST search results revealed sequence homology to shigella bacterial DNA leading us to hypothesize that infection may be playing a role in the etiology of endometriosis. This is the first report implicating the role of bacterial infection in the etiology of endometriosis. Shigella is known to invade the mucosa of the colon through the feco-oral route causing Shigellosis. The pathogenesis of shigellosis involves inflammation, ulceration, haemorrhage, tissue destruction and fibrosis of the colonic mucosa resulting in abdominal pain and diarrrhoea/dysentery, this is similar to the pathogenesis of endometriosis which also involves inflammation, haemorrhage, tissue destruction and fibrotic adhesions of the pelvic peritoneum resulting in abdominal pain and infertility. The non-motile shigella bacteria invade the deeper mucosal layers by travelling from cell to cell of colonic epithelium, reaching the lamina propria of the colonic mucosa. We propose that, by the same mechanism, the bacteria travel across the colon wall to reach the outer peritoneal surface of the colon, which is in close proximity to the posterior uterine surface in the Pouch of Douglas, the site which incidentally happens to be the commonest site of early endometriosis. Our hypothesis therefore proposes that shigella or shigella-like organisms may be the trigger for the initiation of immunological changes in the pelvic peritoneum causing endometriosis. Once the endometrial cells are implanted at ectopic sites they are sustained by hormones and angiogenic factors. Hence "Infection hypothesis" provides a novel explanation for the etiopathogenesis of endometriosis.
PMID: 17888583 [PubMed - in process]
Vasavi Hospital, # 6-1-91 Khairtabad, Hyderabad, AP 500004, India.
Endometriosis is the presence of endometrial cells and stroma at ectopic sites outside the uterine cavity. The natural history of endometriosis is uncertain, its etiology unknown, the clinical presentation inconsistent, diagnosis difficult and the treatment poorly standardized. It causes significant morbidity due to pelvic pain and infertility among 15-25% of women during their reproductive age. The benign disease causes peritoneal inflammation, fibrosis, adhesions and ovarian cysts but displays features of malignancy, like neo-vascularization, local invasion and distant metastasis. Mechanical, hormonal, immunological, environmental and genetic factors have been implicated in its etiology but provide inconclusive explanations. Present study was carried out on ectopic and eutopic endometriotic tissue specimens collected during laproscopy/laprotomy from cases of endometriosis. mRNA was isolated from the tissues and converted to cDNA by RT and subsequently subjected to differential display Polymerase Chain Reaction using seven sets of arbitrary primers. A unique band was identified only in the ectopic endometriotic tissue, which was sequenced. BLAST search results revealed sequence homology to shigella bacterial DNA leading us to hypothesize that infection may be playing a role in the etiology of endometriosis. This is the first report implicating the role of bacterial infection in the etiology of endometriosis. Shigella is known to invade the mucosa of the colon through the feco-oral route causing Shigellosis. The pathogenesis of shigellosis involves inflammation, ulceration, haemorrhage, tissue destruction and fibrosis of the colonic mucosa resulting in abdominal pain and diarrrhoea/dysentery, this is similar to the pathogenesis of endometriosis which also involves inflammation, haemorrhage, tissue destruction and fibrotic adhesions of the pelvic peritoneum resulting in abdominal pain and infertility. The non-motile shigella bacteria invade the deeper mucosal layers by travelling from cell to cell of colonic epithelium, reaching the lamina propria of the colonic mucosa. We propose that, by the same mechanism, the bacteria travel across the colon wall to reach the outer peritoneal surface of the colon, which is in close proximity to the posterior uterine surface in the Pouch of Douglas, the site which incidentally happens to be the commonest site of early endometriosis. Our hypothesis therefore proposes that shigella or shigella-like organisms may be the trigger for the initiation of immunological changes in the pelvic peritoneum causing endometriosis. Once the endometrial cells are implanted at ectopic sites they are sustained by hormones and angiogenic factors. Hence "Infection hypothesis" provides a novel explanation for the etiopathogenesis of endometriosis.
PMID: 17888583 [PubMed - in process]
Dual therapy improves endometriosis pain control
Tue Jan 8, 2008 6:15pm EST
NEW YORK (Reuters Health) - Hormone suppression and diet therapy can relieve pain in women with endometriosis who undergo conservative therapy, according to a report in the medical journal Fertility and Sterility.
Although most women experience pain relief after undergoing minimally invasive surgery to remove excess endometrial tissue, the authors explain, about one quarter report worsening of pain and more than one third eventually require further surgery.
Endometriosis is a painful condition, affecting women during their reproductive years, caused by the growth of endometrium -- the tissue lining the uterus - in other parts of the abdomen outside of the uterus.
Dr. Francesco Sesti and associates from Tor Vergata University Hospital, Rome, examined the effectiveness of 6 months of hormone suppression therapy or diet therapy to relieve pain in 222 women who had conservative pelvic surgery for severe endometriosis.
One hundred ten women received placebo (sugar pill), 35 were assigned to dietary supplementation with vitamins, mineral salts, lactic ferments, and omega-3 and omega-6 fatty acids, and 77 women were treated with hormone suppression therapy.
READ MORE
NEW YORK (Reuters Health) - Hormone suppression and diet therapy can relieve pain in women with endometriosis who undergo conservative therapy, according to a report in the medical journal Fertility and Sterility.
Although most women experience pain relief after undergoing minimally invasive surgery to remove excess endometrial tissue, the authors explain, about one quarter report worsening of pain and more than one third eventually require further surgery.
Endometriosis is a painful condition, affecting women during their reproductive years, caused by the growth of endometrium -- the tissue lining the uterus - in other parts of the abdomen outside of the uterus.
Dr. Francesco Sesti and associates from Tor Vergata University Hospital, Rome, examined the effectiveness of 6 months of hormone suppression therapy or diet therapy to relieve pain in 222 women who had conservative pelvic surgery for severe endometriosis.
One hundred ten women received placebo (sugar pill), 35 were assigned to dietary supplementation with vitamins, mineral salts, lactic ferments, and omega-3 and omega-6 fatty acids, and 77 women were treated with hormone suppression therapy.
READ MORE
Friday, January 04, 2008
Endometriosis: Marijuana Treatment
Dr. Phil Leveque Salem-News.com
Phillip Leveque has spent his life as a Combat Infantryman, Physician, Toxicologist and Pharmacologist.
(MOLALLA, Ore.) - I don't think I have to explain what this is to anybody. If you have it, you know it. Endometriosis is graded in stages I,II, III & IV, with stage I being "minimized" inconvenience while stage IV is severe and usually requires surgery.
As a physician, I had known about endometriosis for years and that some women become narcotic addicts because of it. Pre Menstrual Tension (PMS) may be concurrent though different and I had many PMS patients as well. Some of them became addicts also. I was not surprised when lady patients came to our clinics offering chart notes that they had been prescribed every conceivable analgesic and other medications but they also told me marijuana works better than any regular prescription.
I have a severe pain problem myself caused by too high of a concentration of spinal anesthesia. I got disgusted by the anesthesiologist telling me he didn't cause it but I got a new understanding for patients in pain.
If the patient says marijuana works for pain, I believe them. Actually in Oregon about sixty percent of patients have some chronic pain syndrome of nerve, muscle, joint, bone, intestinal or genitourinary. It doesn't seem to matter whatever the source of pain, the bottom line is that MJ gives relief.
I presume stage I endometriosis and minor PMS are effectively treated with aspirin-like drugs, but when the pain etc. is in the moderate/severe level, the ladies have found out by themselves that marijuana/cannabis is effective without the hazard of narcotic addiction or alcoholism.
The U.S. government publicizes that as many as 77 million Americans have used marijuana and perhaps ten million use it frequently.
Marijuana as folk medicine has been used in the U.S. since the middle 1800's and probably in Mexico and Latin America since the Spanish introduced it in the late 1500's.
It is no longer amazing to me when a patient tells me of some new disease for which they have discovered marijuana treatment is beneficial.
It is time the DEA and its hoodlums backed off and allow the therapeutic use of medical marijuana, as more and more people are reverting to this tried and true "folk medicine" everyday.
Phillip Leveque has spent his life as a Combat Infantryman, Physician, Toxicologist and Pharmacologist.
(MOLALLA, Ore.) - I don't think I have to explain what this is to anybody. If you have it, you know it. Endometriosis is graded in stages I,II, III & IV, with stage I being "minimized" inconvenience while stage IV is severe and usually requires surgery.
As a physician, I had known about endometriosis for years and that some women become narcotic addicts because of it. Pre Menstrual Tension (PMS) may be concurrent though different and I had many PMS patients as well. Some of them became addicts also. I was not surprised when lady patients came to our clinics offering chart notes that they had been prescribed every conceivable analgesic and other medications but they also told me marijuana works better than any regular prescription.
I have a severe pain problem myself caused by too high of a concentration of spinal anesthesia. I got disgusted by the anesthesiologist telling me he didn't cause it but I got a new understanding for patients in pain.
If the patient says marijuana works for pain, I believe them. Actually in Oregon about sixty percent of patients have some chronic pain syndrome of nerve, muscle, joint, bone, intestinal or genitourinary. It doesn't seem to matter whatever the source of pain, the bottom line is that MJ gives relief.
I presume stage I endometriosis and minor PMS are effectively treated with aspirin-like drugs, but when the pain etc. is in the moderate/severe level, the ladies have found out by themselves that marijuana/cannabis is effective without the hazard of narcotic addiction or alcoholism.
The U.S. government publicizes that as many as 77 million Americans have used marijuana and perhaps ten million use it frequently.
Marijuana as folk medicine has been used in the U.S. since the middle 1800's and probably in Mexico and Latin America since the Spanish introduced it in the late 1500's.
It is no longer amazing to me when a patient tells me of some new disease for which they have discovered marijuana treatment is beneficial.
It is time the DEA and its hoodlums backed off and allow the therapeutic use of medical marijuana, as more and more people are reverting to this tried and true "folk medicine" everyday.
Thursday, January 03, 2008
Clinical evaluation of endometriosis and differential response to surgical therapy with and without application of Oxiplex/AP* adhesion barrier gel.
diZerega GS, Coad J, Donnez J.
Livingston Reproductive Biology Laboratories, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. dizerega@usc.edu
OBJECTIVE: To correlate parameters of endometriosis obtained during routine clinical evaluation with the subsequent formation of adhesions following surgical treatment by laparoscopy. DESIGN: Randomized, controlled, double-blind, clinical trial. SETTING: Tertiary referral centers for the treatment of endometriosis. PATIENT(S): Thirty-seven patients (65 with adnexa) with stage I-III endometriosis; endometrioma-only patients were excluded. INTERVENTION: Laparoscopic surgical treatment of endometriosis, followed by randomization to Oxiplex/AP (FzioMed, Inc., San Luis Obispo, California) gel treatment (treated group) of adnexa, or surgery alone (control group); follow-up laparoscopy 6-10 weeks later. MAIN OUTCOME MEASURE(S): Adnexal Americn Fertility Society score, correlated with color and location of endometriosis, as well as stage of disease determined by masked review of videotapes. RESULT(S): Control patients with at least 50% red lesions had a greater increase in ipsilateral adnexal adhesion scores than patients with mostly black or white and/or clear lesions. Treated patients with red lesions had a greater decrease in adnexal adhesion scores than control patients. There was a correlation between baseline endometriosis stage and postoperative adhesion formation in control patients, but not treated patients. CONCLUSION(S): Patients with red endometriotic lesions had greater increases in their adhesion scores than patients with only black, white, and/or clear lesions. Oxiplex/AP gel was effective in reducing adhesions, compared to surgery alone, in all groups.
PMID: 17126335 [PubMed - indexed for MEDLINE]
Livingston Reproductive Biology Laboratories, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. dizerega@usc.edu
OBJECTIVE: To correlate parameters of endometriosis obtained during routine clinical evaluation with the subsequent formation of adhesions following surgical treatment by laparoscopy. DESIGN: Randomized, controlled, double-blind, clinical trial. SETTING: Tertiary referral centers for the treatment of endometriosis. PATIENT(S): Thirty-seven patients (65 with adnexa) with stage I-III endometriosis; endometrioma-only patients were excluded. INTERVENTION: Laparoscopic surgical treatment of endometriosis, followed by randomization to Oxiplex/AP (FzioMed, Inc., San Luis Obispo, California) gel treatment (treated group) of adnexa, or surgery alone (control group); follow-up laparoscopy 6-10 weeks later. MAIN OUTCOME MEASURE(S): Adnexal Americn Fertility Society score, correlated with color and location of endometriosis, as well as stage of disease determined by masked review of videotapes. RESULT(S): Control patients with at least 50% red lesions had a greater increase in ipsilateral adnexal adhesion scores than patients with mostly black or white and/or clear lesions. Treated patients with red lesions had a greater decrease in adnexal adhesion scores than control patients. There was a correlation between baseline endometriosis stage and postoperative adhesion formation in control patients, but not treated patients. CONCLUSION(S): Patients with red endometriotic lesions had greater increases in their adhesion scores than patients with only black, white, and/or clear lesions. Oxiplex/AP gel was effective in reducing adhesions, compared to surgery alone, in all groups.
PMID: 17126335 [PubMed - indexed for MEDLINE]
Impact of endocrine disruptor chemicals in gynaecology.
Caserta D, Maranghi L, Mantovani A, Marci R, Maranghi F, Moscarini M.
Institute of Gynecology, Perinatology and Child Health, Sant'Andrea Hospital, University of Rome La Sapienza, Via di Grottarossa 1035, 00189 Rome, Italy.
The potential hazardous effects that estrogen- and androgen-like chemicals may have both on wildlife and human health have attracted much attention from the scientific community. Endocrine disruptors (EDCs) are chemicals that have the capacity to interfere with normal signalling systems. EDCs may mimic, block or modulate the synthesis, release, transport, metabolism and binding or elimination of natural hormones. Even though potential EDCs may be present in the environment at only very low levels, they may still cause harmful effects, especially when several different compounds act on one target. EDCs include persistent pollutants, agrochemicals and widespread industrial compounds. Not all EDCs are man-made compounds; many plants produce substances (phytoestrogens) that can have different endocrine effects either adverse or beneficial in certain circumstances. Natural substances such as sex hormones from urban or farm wastes can become concentrated in industrial, agricultural and urban areas; thus, such wastes may be considered potential 'EDCs' for humans and/or wildlife. Much attention has focussed on changing trends in male reproductive parameters in relation to EDC exposure; however, studies on the female reproductive system have been less comprehensive. We have focussed this article on four major aspects of female reproductive health: fertility and fecundability, endometriosis, precocious puberty and breast and endometrial cancer.
PMID: 18070835 [PubMed - in process]
Institute of Gynecology, Perinatology and Child Health, Sant'Andrea Hospital, University of Rome La Sapienza, Via di Grottarossa 1035, 00189 Rome, Italy.
The potential hazardous effects that estrogen- and androgen-like chemicals may have both on wildlife and human health have attracted much attention from the scientific community. Endocrine disruptors (EDCs) are chemicals that have the capacity to interfere with normal signalling systems. EDCs may mimic, block or modulate the synthesis, release, transport, metabolism and binding or elimination of natural hormones. Even though potential EDCs may be present in the environment at only very low levels, they may still cause harmful effects, especially when several different compounds act on one target. EDCs include persistent pollutants, agrochemicals and widespread industrial compounds. Not all EDCs are man-made compounds; many plants produce substances (phytoestrogens) that can have different endocrine effects either adverse or beneficial in certain circumstances. Natural substances such as sex hormones from urban or farm wastes can become concentrated in industrial, agricultural and urban areas; thus, such wastes may be considered potential 'EDCs' for humans and/or wildlife. Much attention has focussed on changing trends in male reproductive parameters in relation to EDC exposure; however, studies on the female reproductive system have been less comprehensive. We have focussed this article on four major aspects of female reproductive health: fertility and fecundability, endometriosis, precocious puberty and breast and endometrial cancer.
PMID: 18070835 [PubMed - in process]
Tuesday, January 01, 2008
Caesarean scar endometriosis presenting as an acute abdomen: a case report and review of literature.
Arch Gynecol Obstet. 2008 Feb;277(2):167-9. Epub 2007 Aug 14.
Links
Caesarean scar endometriosis presenting as an acute abdomen: a case report and review of literature.
Gajjar KB, Mahendru AA, Khaled MA.
Luton and Dunstable Hospital, Lewsey Road, Luton, LU4 0FH, Bedfordshire, UK, gajjarkb@hotmail.com.
OBJECTIVE: To report a case of Caesarean scar endometriosis presenting as acute abdomen and a review of literature. DESIGN: Case report and literature review. PATIENT: A 27-year-old woman presented in Accident and Emergency Department with pain and lump near left edge of pfannenstiel incision scar. INTERVENTION: After initial investigations the patient underwent examination under anesthesia. MAIN OUTCOME MEASURE: Excision of a tumour-like mass adherent to the skin and the surrounding subcutaneous tissue. The mass was dissected free from the surrounding fat tissue and excised with clear margins. RESULT: Histology of the mass confirmed endometriosis in tumour and showed a 2 cm fibrotic nodule within. CONCLUSION: In light of increasing rate of caesarean section, it is important to emphasize the early diagnosis as well as optimum management of scar endometrioma. Many recommendations have been given to modify practices at caesarean section to prevent transplantation of decidual endometrial tissue in the abdominal scar but without any published randomised trials.
PMID: 17701194 [PubMed - in process]
Links
Caesarean scar endometriosis presenting as an acute abdomen: a case report and review of literature.
Gajjar KB, Mahendru AA, Khaled MA.
Luton and Dunstable Hospital, Lewsey Road, Luton, LU4 0FH, Bedfordshire, UK, gajjarkb@hotmail.com.
OBJECTIVE: To report a case of Caesarean scar endometriosis presenting as acute abdomen and a review of literature. DESIGN: Case report and literature review. PATIENT: A 27-year-old woman presented in Accident and Emergency Department with pain and lump near left edge of pfannenstiel incision scar. INTERVENTION: After initial investigations the patient underwent examination under anesthesia. MAIN OUTCOME MEASURE: Excision of a tumour-like mass adherent to the skin and the surrounding subcutaneous tissue. The mass was dissected free from the surrounding fat tissue and excised with clear margins. RESULT: Histology of the mass confirmed endometriosis in tumour and showed a 2 cm fibrotic nodule within. CONCLUSION: In light of increasing rate of caesarean section, it is important to emphasize the early diagnosis as well as optimum management of scar endometrioma. Many recommendations have been given to modify practices at caesarean section to prevent transplantation of decidual endometrial tissue in the abdominal scar but without any published randomised trials.
PMID: 17701194 [PubMed - in process]
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