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

Wednesday, October 26, 2011

ARDvark Blog Journal of Adhesion Related Disorder: Adhesion-Prevention Strategy in C-Sections: Focus on Risk Reduction

ARDvark Blog Journal of Adhesion Related Disorder: Adhesion-Prevention Strategy in C-Sections: Focus on Risk Reduction

Endometriosis slowly emerges as a debilitating Disease for Women

Endometriosis slowly emerges as a debilitating Disease for Women

Written by Cleophas Mutinda
Imagine a pain in your abdomen so excruciating that you are unable to get out of bed for several days every month. That is horrible enough, but when it continues 12 times a year for more than 27 years, majority of people would agree it is cruel.

Most women with endometriosis will recognise this shocking scenario as not imaginary, but very real. They know the misery of pelvic pain and have poignant stories of how endometriosis has devastated their lives with terrible suffering. Many women feel angry or despondent about being robbed off a normal life during teenage, adulthood and even sometime a ruined motherhood.

Endometriosis is a gynaecological condition, which occurs when, cells like the ones (endometrial cells) lining inside of the uterus (womb) grow outside, usually on the surfaces of organs in pelvic and abdominal areas. It can be found within the peritoneal cavity, on the ovaries and the bowels or bladder. In extremely rare cases, endometriosis can be found in lungs or other parts of the body. Endometriosis can affect any menstruating woman, from time of her first period to menopause, regardless of race, ethnicity or socio-economic status. Endometriosis rarely persists after menopause. The disorder, for which there is no absolute cure, affects over 70 million women and girls worldwide. Often stigmatized as simply “painful periods,” Endometriosis is a puzzling and widely misunderstood illness.

It is not known exactly what causes endometriosis. But over the years several theories have been advanced to explain the probable cause of the disease although none can fully explain the various clinical manifestations of the disease. A theory proposed by John Sampson in the 1920s, suggests that endometriosis may result from something called “retrograde menstrual flow”, in which some of the tissue that a woman sheds during her period flows back through the tubes and grows in the pelvic cavity. While studies show that retrograde menstrual flow is a universal phenomenon among women of reproductive age, the theory fall short of explaining why the tissues survive in some women, but fail in others. Another theory proposed by Iwanoff in 1898, claims that, the transformation of what we call coelomic epithelium into endometrial-like tissue may be a cause of endometriosis. This theory has been supported by experimental data. The induction theory, proposes that an endogenous factor can induce peritoneal cells to develop into endometrial tissue. This theory has been supported by experiments in rabbits.

Lymphatic or vascular hypothesis suggests that endometrial fragments may be transported through blood vessels or the lymphatic system to other parts of the body. This theory speculates how endometriosis ends up in distant sites, such as the lung, brain, or the skin. A genetic linkage has been adduced which claims that, this disease could be inherited, or result from genetic errors, making some women more prone to develop the condition than others.

Studies show that the risk of endometriosis is seven times greater if the disease has affected a first-degree relative. This theory has been supported by experiments in mouse model but has not been verified either in women. Immunological etiology (cause) has also been conjured since studies report that many women with endometriosis exhibit immunological abnormalities. It is speculated that the immune system may fail to clear the menstrual debris in the pelvic cavity, allowing the endometrial cells to implant and develop into endometriosis.

Also most scientists agree that endometriosis is exacerbated by oestrogen; a hormone involved in the thickening of the endometrium and appears to promote the growth of disease implants. Some studies have pointed out environmental factors like toxins may contribute to the development of endometriosis, though this theory has not been confirmed and remains controversial.

The most common symptoms of endometriosis are abdominal pain and infertility. Some studies have reported that endometriosis may occur in 30%-40% of women with infertility and the incidence of endometriosis in women with pelvic pain may be higher than 50%.

Endometriosis associated pain may include but not limited to extremely painful (disabling) menstrual cramps, chronic pelvic pain (which includes lower back pain and pelvic pain), pain during or after sex, painful bowel movements or painful urination during menstrual periods, heavy menstrual periods and bleeding between periods. The amount of pain a women feels is sometimes not linked to degree of endometriosis. Some women have no pain even though their disease is extensive, while others have severe chronic pelvic pain even though they have only few affected areas.

The relation between endometriosis and pain is still shrouded in the mist of intricate puzzle and ignorance. Many women with endometriosis feel pain during their periods. Normally, a woman’s menstrual cycle involves her endometrial tissue to build up, breaks down into blood and tissue debris, and is shed as her menstrual flow or period. This cycle of growth and shedding happens every month under normal condition. Endometriosis grows outside the uterus and also goes through a similar cycle, build-up, breakdown and bleed every month. The problem is the tissue is in the wrong place and can’t leave the body the way a woman’s period normally does. Studies show that as part of this process, endometriosis may spur the production of substances that may irritate the nearby tissue, as well as provoke the release of chemicals that cause or mediate pain. Over time, endometriosis areas can grow and become nodules or bumps on the surface of pelvic organs, or become cysts (fluid-filled sacs) in the ovaries and may cause the organs in the pelvic area to adhere together.

Endometriosis is more than just simple "killer" cramps. Women and girls around the world continue to suffer in silence with a disease that can be potentially devastating to every aspect of their lives. It can be so painful as to render a woman or teenager unable to care for herself or her family, attend work, school, or social functions, or go about her normal routine. Endometriosis has a negative impact on the individual quality of life, affecting both physical and emotional well-being. A study by the American Endometriosis Association, demonstrated that 81% of the endometriosis patients in USA were unable to work, including household chores, because of pelvic pain. Approximately 27% were incapacitated for 3 or more days and 87% complained of fatigue or low energy. These figures are indicators of enormous suffering, in addition to the healthcare costs incurred. The need to develop intervention strategies is eminent, a published poll reveals women have to wait an average of 11.7 years in US and 8 years in UK to get a correct diagnosis after the initial onset of symptoms and a patient will seek the counsel of five or more physicians before her pain is adequately addressed and diagnosed. Once diagnosed, it is not unusual for a patient to undergo repeat surgeries and embark on many different medical therapies in an attempt to treat her symptoms. Endometriosis is a bit puzzling. We do not know why it causes such extreme symptoms in some women, while less in others. The treatment options can sometimes be unsuccessful. Sadly, endometriosis is associated with menstruation, sex, infertility, and pain (taboos in many societies), thus it is a disease that is not well known, understood, or accepted in the general public. This is frustrating for those who suffer from endometriosis, and for those who care for someone with the disease.

There is no non-invasive test to diagnose endometriosis. In fact, the only gold standard diagnosis of endometriosis is a surgical procedure known as laparoscopy and confirm histologically by taking a biopsy of the suspicious tissue.

However, this is an expensive, minimally invasive procedure. Furthermore, a specialised surgeon is needed for adequate assessment of the pelvis, for recognition of the various types and appearances of the disease. If the patients decline surgery, this makes diagnosis a challenge, and therefore an experienced gynaecologist should be able to recognise symptoms suggestive of endometriosis. The fact that there is no non-invasive diagnostic test for endometriosis is frustrating for clinicians as well as for women with the disease and underscores the need for search of better diagnostic tools.

Since the cause of endometriosis remains unknown, a treatment that fully cures the disease is yet to be developed. Choosing a holistic, treatment option comes down to the individual woman's needs, depending on symptoms, age, and reproductive desires.

Pain is the most common symptom in many women with endometriosis, mainly managed by painkillers, which may vary from simple analgesics to non-steroidal anti-inflammatory drugs. Most researchers agree that endometriosis is exacerbated by oestrogen. Subsequently, hormonal treatments for endometriosis attempt to reverse oestrogen production in a woman's body and thereby alleviate symptoms. However, hormonal therapies have varying degrees of side effects, and unfortunately, whatever pain relief is achieved tends to be only temporary for many women. Most gynaecologists agree that laparoscopic surgery is the only way to diagnose and treat endometriosis. Laparoscopy involves a small cut or incision in the abdomen, inflating the abdomen with harmless gas, and then inserts a viewing instrument with help of light (Laparoscope) into the abdomen. The success of surgery depends largely on the skills of the surgeon and the thoroughness of the surgery. The aim is to remove all endometriosis lesions, cysts, and adhesions. Today, most endometriosis surgery is being done through the laparoscopy, although a full abdominal incision called a laparotomy may still be required in rare cases for extensive disease or bowel resections.

Although the prevalence of endometriosis is well documented in women living in the developed world, studies among African women are still limited. The current myth is that endometriosis rarely affects women of African origin. However, among African-American women in the USA, studies have shown endometriosis is one of the common indications for major gynaecological surgery and hysterectomy, and is associated with a high hospital costs. Although genetically, African-American and African women from the African continent are not necessarily identical given the known genetic admixture among the African-American population. Lack of awareness of endometriosis as a potentially disabling disease and poor access to state-of art diagnostic and therapeutic facilities has contributed to the meagre data on prevalence of the disease in the African population. There is need to initiate awareness campaign of endometriosis to reach all women in Africa. Also to highlight the general lack of information, facilitate endometriosis research efforts and draw attention to the impact and implications of the disease to healthcare systems in our country and the continent in general.

The writer is a Senior Scientist with special interest in endometriosis and ovarian cancer research


Monday, October 24, 2011

Putting the pieces together: endometriosis blogs, cognitive authority, and collaborative information behavior

J Med Libr Assoc. 2011 April; 99(2): 127–134.
doi: 10.3163/1536-5050.99.2.004 PMCID: PMC3066582

Copyright © 2011, Authors.
Putting the pieces together: endometriosis blogs, cognitive authority, and collaborative information behavior*
Diane M Neal, PhD
Assistant Professor ; Email: dneal2@uwo.caPamela J McKenzie, PhD
Associate Professor and Assistant Dean Research; Faculty of Information and Media Studies, The University of Western Ontario, North Campus Building, Room 240, London, ON, Canada N6A 5B7 ; Email: pmckenzi@uwo.caReceived June 2010; Accepted October 2010.
Readers may use articles without permission of copyright owners, as long as the author and MLA are acknowledged and the use is educational and not for profit. Other Sections▼
A discourse analysis was conducted of peer-written blogs about the chronic illness endometriosis to understand how bloggers present information sources and make cases for and against the authority of those sources.Methods:
Eleven blogs that were authored by endometriosis patients and focused exclusively or primarily on the authors' experiences with endometriosis were selected. After selecting segments in which the bloggers invoked forms of knowledge and sources of evidence, the text was discursively analyzed to reveal how bloggers establish and dispute the authority of the sources they invoke.Results:
When discussing and refuting authority, the bloggers invoked many sources of evidence, including experiential, peer-provided, biomedical, and intuitive ones. Additionally, they made and disputed claims of cognitive authority via two interpretive repertoires: a concern about the role and interests of the pharmaceutical industry and an understanding of endometriosis as extremely idiosyncratic. Affective authority of information sources was also identified, which presented as social context, situational similarity, or aesthetic or spiritual factors.Conclusions:
Endometriosis patients may find informational value in blogs, especially for affective support and epistemic experience. Traditional notions of authority might need to be revised for the online environment. Guidelines for evaluating the authority of consumer health information, informed by established readers' advisory practices, are suggested. Other Sections▼
•Endometriosis patients who blog about the illness may determine authority of information sources through both cognitive and affective methods.
•Because patients with chronic illnesses might have different authority criteria than medical librarians do, it could be useful to carefully incorporate electronic patient discussion forums, medical blogs written by laypeople, and other nontraditionally authoritative resources into consumer health information selection policies. Standard biomedical resources are certainly important to recommend to consumers, but they do not convey the complete picture of a chronic illness and its related experience.
•Patients with chronic illnesses and caregivers can benefit from sources such as blogs and online discussion lists that provide social and emotional support as well as accounts of “lived experience.”
•An understanding of the patient's potential epistemological community can make the librarian's recommendations more appropriate for the individual user.
Other Sections▼
AbstractINTRODUCTIONMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCESINTRODUCTIONChronic illness is a context in which people may do a great deal of “information work” [1]. Chronic illnesses are often broad in scope and effect, difficult to diagnose, complex, ever changing, and not amenable to conventional treatments. They often have significant physical, emotional, and social repercussions, and their management requires work by the ill person and those around the ill person, much of which may require considerable time and energy, be mentally and emotionally demanding, and occur beyond doctors' offices [1].A major barrier to information access expressed by people with chronic illnesses is the difficulty of finding information relevant to their situations [1, 2]. Chronic illness is an important impetus for collaborative information behavior [3, 4]: As do information seekers in other contexts, people with chronic illnesses tend first to seek help or information from people like themselves [5]. Acquaintances with the same disease can provide socially appropriate opportunities to expose a seeker to disease-relevant information and support [6]. The desire for support underlies the creation of resources, services, and groups in which peers physically or virtually “come together to provide emotional and other support through sharing their personal lived experience as well as exchanging other resources” [7]. Participants in health-oriented support groups [8, 9] and online resources such as discussion forums and peer-authored blogs [10] report receiving both informational and emotional support. Illness blogs have many of the advantages of face-to-face peer sources without the stigma of approaching a peer with a personal question [6].Peer sources may also offer a highly valued and particularly relevant kind of information based on “wisdom and know-how gained through reflection upon personal lived experience” [11] rather than on professional knowledge. Experiential knowledge “consists of the statements, stories or narratives reflecting some aspect of an individual's experience that she or he values and trusts as knowledge. To an uninvolved observer, much experiential knowledge may sound like or appear to be small talk or everyday conversation” [11].The significance of experiential knowledge for people with chronic illnesses poses particular challenges for information professionals, who are schooled in selecting traditionally authoritative resources and employing evidence-based techniques for evaluating health information sources. Selection criteria for a health sciences journal include, among other things, its perceived “scholarly” status, its publisher, the affiliations of the journal's authors and editors, and its impact factor [12]. Health sciences monograph selection tools consist of resources such as core lists, vendors, and book reviews in medical journals [13]. Guidelines for consumer health information collection development focus on patient education literature written by health professionals, as well as by patient advocacy and professional organizations. Consumer-oriented library materials might also include general medical reference books [14]. These and other standard evaluation criteria assume that the most authoritative resources are authored by health care professionals and researchers. However, people with chronic illnesses may use authority criteria that are completely distinct from those that information professionals use [15]. For example, while a blog describing the author's experience with a chronic disease is unlikely to meet librarians' traditional standards for authority, it might be considered very authoritative by someone who is learning to cope emotionally with a new diagnosis [16].Library and information science (LIS) researchers have long been interested in the ways that individuals and communities evaluate the authority of information sources. The concept of cognitive authority has offered a useful framework for explaining an individual's situated judgments about the authority of information sources [17]. Cognitive authority is a particularly important concept for understanding users' evaluations of web resources [18]. It has been defined by Rieh, following Wilson [17], as “the extent to which users think that the information is useful, good, current, and accurate. Cognitive authority is operationalized as to the extent to which users think that they can trust the information” [18]. More recently, LIS researchers have adopted new approaches to the study of authority that consider not the cognitive processes by which an individual makes decisions about an information source, but the social practices whereby a community collaboratively negotiates what counts as an authoritative information source [19–,21]. Depression patients were found to rely on a wide range of resources, while using personal, experiential knowledge as confirmation of treatment effectiveness [20]. A study of the ways that members of a chronic illness community collectively filter, interpret, evaluate, and synthesize as they share can provide insight into the ways that authority is developed and challenged in that community [4]. Studies such as this can provide practitioners with new ways of thinking about the criteria they use when evaluating or recommending peer sources for chronic illness.This article analyzes the ways that peer bloggers with endometriosis present information sources and make cases for and against their authority. Endometriosis is an enigmatic chronic disease that causes uterine tissue implantation in areas other than the uterus. Highly underdiagnosed, it may affect up to 25% of reproductive-age women. Symptoms vary widely, but the most frequent complaint is pelvic pain, and endometriosis is a cause of common infertility. The broad spectrum of presentation and symptoms, as well as the absence of satisfactory treatments, leaves patients largely at a loss for information that they perceive as reliable [22]. For these reasons, Whelan characterizes women with endometriosis who work together to find answers as an “epistemological community” [23]. This analysis will show how bloggers' justification strategies draw on understandings that members of their specific epistemological community commonly hold.Blogs authored by people with chronic illness are of particular interest to LIS researchers, because they provide naturalistic sources of data about the blogger's illness-related information work [2], including selection, justification, evaluation, and interpretation of information identified by the blogger from other sources. Comments and links on blogs provide evidence of what Talja and Hansen call a “community of sharing” [4], a group of people who develop shared understandings and create knowledge structures that may in turn be used by others. Blogs allow both members and nonmembers of epistemic cultures to interact in dialogue and to participate in the culture [24]. They therefore offer the possibility of extending the face-to-face social networks that Veinot [6] has shown to mediate information validation. LIS researchers have begun to study social and community aspects of health- and illness-related information work [6, 25–,27]. Important findings about the readers of illness blogs have been identified [10]. However, there has so far been little consideration of what the blogs themselves can tell librarians and researchers about how people living with chronic illness evaluate information sources.
Read More : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3066582/

New Concepts in Diagnosis and Treatment Summarized from ISGE 8th Annual Congress

By Ted L. Anderson, M.D., Ph.D.
October 24, 2011
"What is the hardest of all to do? To see with our eyes what our eyes lay before us. (Paraphrased, with apologies from Goethe) That essentially is the message of the innovative efforts of Ms. Deborah Bush, Chairperson of the New Zealand Endometriosis Foundation. She has developed an interactive Menstrual Health and Endometriosis Education Program that has been presented to over 40,000 young women (ages 15-24), educators and clinicians. There has been an overwhelmingly positive response as this population gained better knowledge of what is "normal" and how to recognize the symptoms of endometriosis. Of note, anecdotal reports show this program has resulted in increased referrals to gynecologists and increased early diagnosis and treatment. Hopefully, such early intervention will mitigate the long-term sequellae of adhesions, pain and infertility. On the other hand, it is too often that we dismiss endometriosis as a source of pelvic and rectal pain, especially in young women and after hysterectomy and salpingo-oophorectomy.

However, infiltrative endometriosis involving the apical vaginal wall, the anterior rectal wall and the soft tissues of the cul-de-sac are not uncommon. This is the advice from Dr. Ray Garry and his colleagues from WEL Foundation, South Cleveland Hospital, Middleborough, UK. Using his techniques of radical laparoscopic excision, he excises the tissue bounded by the uterosacral ligaments laterally, the anterior rectal wall posteriorly and the posterior cervix. Then he removes the tissue en bloc. This technique offers relief from dysmenorrhea, dyspareunia, rectal pain and general pelvic pain in over 80% of his patients as measured by a standardized questionnaire. They have not examined the potential added benefit of hormonal suppressive therapy pre or post-operatively. Despite excellent results in this difficult patient population, this group continues to follow long-term success, as will we, with great interest."

The patient with pelvic pain continues to be one of the greatest therapeutic challenges to gynaecologists. There have been few developments in recent years that will impact treatment success in these patients, as we will likely see with conscious laparoscopy and pain mapping. This was illustrated beautifully in an excellent workshop on pelvic pain, moderated by Dr. Christopher Sutton (The Guilford Nuffield Hospital, Surrey, UK). Our concepts of pain aetiologies were challenged by Dr. FM. Howard (Rochester General Hospital, NY, USA), who provided evidence that endometriosis lesions accounted for only 1/3 of pain described by patients during conscious pain mapping, with adhesions accounting for another 1/3. This group called into question the routine use of postoperative GnRH agonists in this patient population. Dr. John Steege (University of North Carolina, USA), demonstrated the power of pain mapping by showing a procedure without sound in a post-hysterectomy patient with adhesions involving the pelvic sidewall and vaginal cuff, as well as an ovarian remnant. After an audience poll of operative options, he replayed the tape with audio feedback from the patient during the procedure. Much to our surprise, this experience changed the opinion of appropriate operative intervention in a substantial number of participants. Dr. Lawrence Demco (University of Calgary, Canada), illustrated his techniques of pain mapping through multiple video clips. Interestingly, many patients described pain with touching of peritoneal surfaces up to 2.5 cm away from visible endometriotic lesions. Additionally, he demonstrated that the pain perceived by the patient frequently does not correlate with the position of lesions or pain elicited during mapping. For example, touching visible endometriosis on the left pelvic sidewall often correlated with right-sided pelvic pain experienced by the patient. Using these techniques to guide subsequent operative interventions, he has described greater than 80% of patients remain pain free at 6 months follow-up. Dr. Sutton presented his prospective randomized double-blinded study that demonstrated the efficacy of operative treatment for stage I-III endometriosis compared with no treatment. Not surprisingly, there was increasing benefit of surgical treatment with advancing endometriosis stage. Additionally, he presented the results of a study showing no additional benefit of LUNA when endometriosis is ablated surgically. Certainly the message we can learn from this workshop will continue to guide our ability to understand and treat pelvic pain.


Friday, October 14, 2011

Ovarian cyst

An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst. An ovarian cyst can be as small as a pea, or larger than an orange.

Most ovarian cysts are functional in nature and harmless (benign).[1] In the US, ovarian cysts are found in nearly all premenopausal women, and in up to 14.8% of postmenopausal women.[citation needed]

Ovarian cysts affect women of all ages. They occur most often, however, during a woman's childbearing years.

Some ovarian cysts cause problems, such as bleeding and pain. Surgery may be required to remove cysts larger than 5 centimeters in diameter.

Classification[edit] Non-functional cystsThere are several other conditions affecting the ovary that are described as types of cysts, but are not usually grouped with the functional cysts. (Some of these are more commonly or more properly known by other names.) These include:

Dermoid cyst
Chocolate cyst of ovary: An endometrioma, endometrioid cyst, endometrial cyst, or chocolate cyst is caused by endometriosis, and formed when a tiny patch of endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) bleeds, sloughs off, becomes transplanted, and grows and enlarges inside the ovaries.
A polycystic-appearing ovary is diagnosed based on its enlarged size — usually twice normal —with small cysts present around the outside of the ovary. It can be found in "normal" women, and in women with endocrine disorders. An ultrasound is used to view the ovary in diagnosing the condition. Polycystic-appearing ovary is different from the polycystic ovarian syndrome, which includes other symptoms in addition to the presence of ovarian cysts.
Ovarian serous cystadenoma
Ovarian mucinous cystadenoma
[edit] Signs and symptomsSome or all of the following symptoms[2] [3] [4] [5] [6] may be present, though it is possible not to experience any symptoms:

Dull aching, or severe, sudden, and sharp pain or discomfort in the lower abdomen (one or both sides), pelvis, vagina, lower back, or thighs; pain may be constant or intermittent—this is the most common symptom
Fullness, heaviness, pressure, swelling, or bloating in the abdomen
Breast tenderness
Pain during or shortly after beginning or end of menstrual period.
Irregular periods, or abnormal uterine bleeding or spotting
Change in frequency or ease of urination (such as inability to fully empty the bladder), or difficulty with bowel movements due to pressure on adjacent pelvic anatomy
Weight gain
Nausea or vomiting
Increased level of hair growth
Increased facial hair or body hair
Strange pains in ribs, which feel muscular
Strange nodules that feel like bruises under the layer of skin
[edit] Diagnosis
A 2cm left ovarian cyst as seen on ultrasound
An Axial CT demonstrating a large hemorrhagic ovarian cyst. The cyst is delineated by the yellow bars with blood seen anteriorly.
A CT scan showing a 8.5 cm cyst in a 29 year old female.Ovarian cysts are usually diagnosed by either ultrasound or CT scan.

[edit] TreatmentAbout 95% of ovarian cysts are benign, meaning they are not cancerous.[7]

Treatment for cysts depends on the size of the cyst and symptoms.

Pain caused by ovarian cysts may be treated with:

pain relievers, including acetaminophen/paracetamol (Tylenol), nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil), or narcotic pain medicine (by prescription) may help reduce pelvic pain.[8] NSAIDs usually work best when taken at the first signs of the pain.
a warm bath, or heating pad, or hot water bottle applied to the lower abdomen near the ovaries can relax tense muscles and relieve cramping, lessen discomfort, and stimulate circulation and healing in the ovaries.[9] Bags of ice covered with towels can be used alternately as cold treatments to increase local circulation.[10]
combined methods of hormonal contraception such as the combined oral contraceptive pill – the hormones in the pills may regulate the menstrual cycle, prevent the formation of follicles that can turn into cysts, and possibly shrink an existing cyst. (American College of Obstetricians and Gynecologists, 1999c; Mayo Clinic, 2002e)[8]
Also, limiting strenuous activity may reduce the risk of cyst rupture or torsion.

Cysts that persist beyond two or three menstrual cycles, or occur in post-menopausal women, may indicate more serious disease and should be investigated through ultrasonography and laparoscopy, especially in cases where family members have had ovarian cancer. Such cysts may require surgical biopsy. Additionally, a blood test may be taken before surgery to check for elevated CA-125, a tumor marker, which is often found in increased levels in ovarian cancer, although it can also be elevated by other conditions resulting in a large number of false positives.[11]

For more serious cases where cysts are large and persisting, doctors may suggest surgery. Some surgeries can be performed to successfully remove the cyst(s) without hurting the ovaries, while others may require removal of one or both ovaries.[12][13]

[edit] References1.^ "Ovarian Cysts Causes, Symptoms, Diagnosis, and Treatment". eMedicineHealth.com. http://www.emedicinehealth.com/ovarian_cysts/article_em.htm .
2.^ "Ovarian cysts: Symptoms". MayoClinic.com. http://www.mayoclinic.com/health/ovarian-cysts/DS00129/DSECTION=2 .
3.^ [1]
4.^ "Ovarian Cysts Causes, Symptoms, Diagnosis, and Treatment". eMedicineHealth.com . http://www.emedicinehealth.com/ovarian_cysts/page3_em.htm .
5.^ "Ovarian Cysts – Symptoms, Treatment and Prevention". HealthScout. http://www.healthscout.com/ency/1/725/main.html#SymptomsofOvarianCysts .
6.^ "Ovarian Cysts". http://www.medicineonline.com/topics/O/2/Ovarian-Cysts.html .
7.^ http://www.nhs.uk/Conditions/Ovarian-cyst/Pages/Symptoms.aspx
8.^ a b "Ovarian Cysts Treatment & Monitoring". Medicine Online. http://www.medicineonline.com/topics/O/2/Ovarian-Cysts/info/Treatment-&-Monitoring.html .
9.^ [2]
10.^ [3]
11.^ MedlinePlus Encyclopedia CA-125
12.^ "HealthHints: Gynecologic Health (January/February, 2003)". Texas AgriLife Extension Service: HealthHints. http://fcs.tamu.edu/health/health_education_rural_outreach/Health_Hints/2003/jan-feb/gynecologic_health.php .
13.^ http://ovariancystinfo.weebly.com/  Cyst on Ovary
[edit] External links"Ovarian cyst Introduction". Health encyclopaedia – NHS Direct. http://www.nhs.uk/conditions/Ovarian-cyst/Pages/Introduction.aspx. Retrieved 3 May 2011.
David B. Redwine, MD. "Endometriosis Persisting after Removal of the Uterus, Ovaries and Fallopian Tubes, Removing Disease, Not Organs, Key to Long-Term Relief". http://www.endometriosistreatment.org/html/reprint7.html . Retrieved 23 February 2009.
"Hemorrhagic Ovarian Cyst". http://www.hemorrhagicovariancyst.com/.

"Corpus Luteum Cyst". http://donorivf.org/articles/corpus-luteum-cyst/.

"Ovarian cyst symptoms". http://www.ovariancystreatment.com/category/ovarian-cyst-symptoms/.

Thursday, October 13, 2011

Chronic pain series helps public to see the 'invisible'

Chronic pain series helps public to see the 'invisible'

Re: Chronic pain series, Oct. 1-5

The series typified the reality of people who live with chronic pain. I am thankful for those pieces of journalism. Most of the public still doesn't understand what chronic pain sufferers live with.

My daughter suffers from a number of "invisible" yet crippling disabilities including endometriosis. She is an attractive, engaging, committed and hard-working 26-year-old forced to rely on opiates to get through her day.

Some days she can't get out of bed. Some days her entire body feels like it's been beaten. Some days the pain is "manageable."

Some days she can't function because she has had to take too many opiates to squelch the pain.

People would never guess she is sick because she looks so "beautiful." And every day she needs to justify her illness to someone because it isn't something you can see.

Her good fortune is that she has the support, strength and courage to carry on. Through her family, a few friends and excellent health care professionals she has advocates who do understand.

Chronic pain can be a life sentence - lack of knowledge about it doesn't have to be.

Shirley Ross


Read more: http://www.vancouversun.com/health/Chronic+pain+series+helps+public+invisible/5536855/story.html#ixzz1aeDpkw1L

Wednesday, October 12, 2011

Abdominal pain may be sign of endometriosis

By Christi Myers

HOUSTON (KTRK) -- Women who experience unexplained abdominal pain could be facing endometriosis. The condition can be difficult to diagnose, so here's what women need to look for when it comes to that.

"The nurse and the doctor both looked at me and looked at my stomach and said, 'You look like you're seven months pregnant' and I'm like, 'I know and I'm not pregnant,'" Janet Strickland said.

Strickland was frustrated by her swollen abdomen and the pain she was having. She spent thousands of dollars on tests but got no answers.

"Everyone of those six doctors had told me there's nothing wrong with me," she said.

The doctors were wrong. After four years janet finally got an answer. Fertility Specialists of Houston Dr R.K. Mangal found severe endometriosis, which occurs when the menstrual flow goes back into the body, coating organs like glue.

"It spreads out to the pelvis, into the bowel cavity; we've seen it in lungs, we've seen it in patients with the diaphragm, so anywhere in the abdominal cavity which makes sense," Dr. Mangal said.

Endometriosis can start with painful menstrual cramps, pain during sex, bladder pain, colon pain, and infertility and more. Treatment often starts with the birth control pill to reduces the flow, and laser surgery to remove endometriosis from internal organs.

"I might have been with another doctor and they might have just wanted to do a total hysterectomy because I had it all over," Strickland said.

Instead Dr. Mangal was able to remove it but it took two surgeries to do it, and despite damage that remains, children are still possible.

"I think Janet has a good chance of having a baby," Dr. Mangal said.

But the surgeries, the tests and the pain could have been avoided had one of the first six doctors found it earlier.

Many women only discover they have endometriosis when they have infertility problems. Experts say by catching it early, women can often avoid infertility issues.

Monday, October 10, 2011

What you don't know can hurt you: Knowledge is Power in a Doctor/Patient Relationship

Meet Jennifer Lewis, a long time endo sufferer and advocate for victims of endometriosis.

What you don't know can hurt you: Knowledge is Power in a Doctor/Patient Relationship
By Jennifer Lewis | October 7, 2011

I was intimidated from the get-go. I was a 23 year old woman going on her fourth Laparoscopy for endometriosis. I had been experiencing severe pain and abnormal bleeding with and w/o my periods since I was fifteen, diagnosed with endometriosis at eighteen and already had three surgical laparoscopies to remove the endometial growths. This time the doctor wanted to try a different technique called a LUNA or uterine ablation. This procedure severs the ligaments in the uterus thus reducing pain created by cramping during menstruation. By this time I was having varying degrees of bleeding throughout the month as well as pain that did not correlate with my periods. I thought, "what the heck, maybe the fourth times’ a charm". I didn’t research the fact that LUNA’s are only of considerable benefit to women with pain DIRECTLY associated with their periods. At the time of the surgery I was in pain 75% of the time, and it was NOT only related to what by now had become unbearable menstruation. By the time I was 25 I had two more similar surgeries to relieve pain and abnormal bleeding caused by the regrowth of the endometrial tissue. I inquired on more than one occasion about a hysterectomy but was told by the heroes in white coats that I was either too young, I would regret it, menopause at my age would be ghastly, maybe I should seek therapy and learn to "live" with the pain"(that was a good one!) or that I should, as one of my FORMER GYN’s put it, "Swallow the pain medication and Buck Up". Essentially, I let my doctor be the ringmaster of the circus inside my body. I was intimidated by the number of degrees on his walls and the various snapshots of smiling new mothers and newborns; all having had complete faith in this physician to lead them down the path to a better life. Why should I think any different? I mean, who am I, Jennifer, to question a man who spent half his life learning how to practice medicine? But my gut and my instinct were pulling me in another direction; a direction that saved my life.

Only after seven surgical procedures, years on addictive narcotic medications, high doses of mind altering hormones, ER visits, catheterizations and mental anguish did I learn how to learn about being a patient. After experiencing fear and abandonment along with complete lack of faith in both the field of medicine and the doctors who practice it did I begin my true healing. Essentially, I became my own health advocate, and it changed my life.

Knowledge is power, plain and simple. Whether you are stricken with a life threatening illness or dealing with a persistent problem that affects the quality of your life you must take your health and any problems associated with it and ATTACK it with knowledge. In being your own advocate, it is essential that you approach your provider with sense of self and dignity; a competent individual who is aware of her own body. Your own research on and about the issue at hand is vital as well as your own personal ammunition; use it! As much as your physician would like to be, she/he may not be current on all of the cutting edge research and experimental trials that you may be eligible for. Go to the local University or college and research the medical section. The local hospital will also have up to date periodicals and medical journals that may contain useful information. In doing your own research, you become better able to understand your options. Only then can you make an informed consent on the treatment best suited for you. Utilize your provider as you would a consultant. This will enable a mutually effective exchange and your doctor will not only respect your interest in your own healthcare but respond to it.

It took me ten years of chasing white coats until I sat still enough to see my pattern. Be it intimidation, laziness or apathy, I had no regard for my most precious gift, my health. This is a society where we are inherently trained to entrust our healthcare in the hands of doctors. Asking for a second opinion, questioning a test result or inquiring about or expressing concerns over medications you may be taking can be difficult at best. When I was faced with the option of having my seventh surgery I began to really sit and think about my body, my goals (realistic) of the outcome of the surgery as well as the quality of my life. I was not comfortable speaking freely and easily with my current provider so I changed doctors. Instead of walking in her office uninformed, I confidently presented her with a list of questions I had, similar case studies and outcomes of the treatments and my realistic goals. I was able to weigh the pros and the cons intelligently and make an informed decision based on both my research and her professional experience. Less than two weeks later I had a total hysterectomy, something I had wanted and inquired about many times before only to be told that I could not possibly know for certain that was what I wanted because I was too young, too disillusioned or just too naïve about the consequences. Only after ten years did I find restitution in having the total hysterectomy and the ironic thing is that I was fought all that time by the doctors who proclaimed they wanted to help me. I got better when I finally decided to help myself.

Questions to ask your doctor include:

What are the benefits of doing this?
What are the risks involved?
What are my other options?
What should I do first?
What are the probable outcomes of each of these options?
What are the probable outcomes if I decide NOT to do this?
How many times have you performed/administered this drug before and what were the outcomes?

Remember, this is your body, your healthcare and your decision. Every woman has the potential to be her own powerhouse when it comes to her body, seize the opportunity or someone in a white coat will.

Jennifer Lewis
Author, Endometriosis: One Womans Journey
Freelance writer


Saturday, October 08, 2011

Adhesion Related Disorder International Human Rights Team IHRT: Press Release: Cochrane Collaboration statement on access to clinical trial data

Adhesion Related Disorder International Human Rights Team IHRT: Press Release: Cochrane Collaboration statement on access to clinical trial data


Niger J Med. 2011 Apr-Jun;20(2):191-9.
Okeke TC, Ikeako LC, Ezenyeaku CC.
SourceDepartment of Obstetrics & Gynaecology University of Nigeria Teaching Hospital, Enugu, Nigeria. Ubabikctochukwu@iyahoo.comendometriosis

BACKGROUND: Endometriosis is a common mysterious and fascinating gynaecological condition with diverse clinical manifestations, highly variable and unpredictable clinical course with decreased quality of life. Despite extensive research, endometriosis is fraught with controversies.

METHODS: Review of pertinent literature on endometriosis, selected references, internet services through gynaecological search which have been critical in the understanding of this puzzling gynaecologic condition were included in the review.

RESULTS: Endometriosis most commonly afflict women in there late 20s and 30s. The classic symptom complex include dysmenorrhoea, dyspareunia, menorrhagia and infertility. About 30% of the patients are asymptomatic. The incidence of infertility amongst women suffering from endometriosis ranges from 30%-40%. The factors implicated in causing endometriosis-associated infertility are multiple and its management is shrouded in controversy, complex and imperfectly understood.

CONCLUSION: Inspite of diverse clinical manifestations, variable and unpredictable clinical course, there is a chance to improve pregnancy rates with improvement in assisted reproductive technology.

PMID:21970227[PubMed - in process]

Thursday, October 06, 2011

Neurocrine Wins $20M from Abbott Related to Elagolix for Endometriosis

Neurocrine Biosciences received a $20 million milestone payment from Abbott following a pre-Phase III meeting with FDA on the companies' treatment of endometriosis-related pain called elagolix. That brings the total milestone payments paid by Abbott in the third quarter of this year up to $30 million.

Last month Neurocrine received a $10 million milestone fee after Abbott started a Phase II trial to evaluate elagolix in the treatment of uterine fibroids. The firms' partnership, valued at $575 million, covers elagolix for endometriosis and all next-generation gonadotropin-releasing hormone (GnRH) antagonists for a variety of women’s and men’s health conditions.

Under the exclusive, worldwide collaboration, inked in June 2010, Abbott is responsible for all development, marketing, and commercialization costs and will be entitled to an undisclosed percentage of worldwide sales of GnRH compounds. Abbott made an up-front payment of $75 million.

Neurocrine could receive additional milestone payments of about $500 million from Abbott toward achievement of certain development, regulatory, and commercial milestones; funding for certain internal collaboration expenses; plus royalty payments on any future product sales.



Wednesday, October 05, 2011

Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018

NEW YORK, Sept. 28, 2011 /PRNewswire/ -- Reportlinker.com announces that a new market research report is available in its catalogue:

Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018


Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018


GlobalData, the industry analysis specialist, has released its new report, "Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018". The report is an essential source of information and analysis on the global endometriosis therapeutics market and identifies the key trends shaping and driving it. The report also provides insights on the prevalent competitive landscape and the emerging players expected to significantly alter the market positioning of the current market leaders. Most importantly, the report provides valuable insights on the pipeline products within the global endometriosis therapeutics sector. This report is built using data and information sourced from proprietary databases, primary and secondary research and in-house analysis by GlobalData's team of industry experts.

GlobalData estimates that the global endometriosis therapeutics market was valued at $785m in 2010 and will grow at a Compound Annual Growth Rate (CAGR) of 5.9% to reach $1,239m by 2018. This steady growth is primarily attributed to the recently launched product, Visanne (dienogest) and the expected launch of the pipeline product, Elagolix (NBI-56418) in 2015 in the US and Europe. Organizations, such as the Endometriosis Special Interest Group (EndoSIG), through their work are creating awareness about the disease among the general public. This increasing awareness and the resultant higher treatment seeking rates for the disease are also expectecd to contribute to the growth of the market. The current market is underserved due to the lack of specific as well as non-invasive diagnostic techniques, alongside low disease awareness and the poor safety and moderate efficacy profiles of the current marketed therapies. There is a high unmet need which is largely driven by the unavailability of products with adequate efficacy and safety profiles.


The report provides information on the key drivers and challenges of the endometriosis therapeutics market. Its scope includes -

- Annualized seven key markets (US, France, Germany, Italy, Spain, UK and Japan) endometriosis therapeutics market revenues data from 2005 to 2010, forecast for eight years to 2018.

- Pipeline analysis data providing a split across the different phases, mechanisms of action being developed and emerging trends. Pipeline candidates fall under major therapeutic classes of GnRH agonists, GnRH antagonists, Aromatase inhibitors and others.

- Analysis of the current and future competition in the global endometriosis therapeutics market. Key market players covered are Nobelpharma, Novartis AG and Neurocrine Biosciences/Abbott.

- Insightful review of the key industry drivers, restraints and challenges. Each trend is independently researched to provide a qualitative analysis of its implications.

- Key topics covered include strategic competitor assessment, market characterization, unmet needs and the implications for the endometriosis therapeutics market.

- Analysis of key recent licensing and partnership agreements in the endometriosis therapeutics market.

Reasons to buy

The report will enhance your decision making capability. It will allow you to -

- Develop and design your in-licensing and out-licensing strategies through a review of pipeline products and technologies and by identifying the companies with the most robust pipeline.

- Develop business strategies by understanding the trends shaping and driving the global endometriosis therapeutics market.

- Drive revenues by understanding the key trends, innovative products and technologies, market segments and companies likely to impact on the global endometriosis therapeutics market in the future.

- Formulate effective sales and marketing strategies by understanding the competitive landscape and by analyzing the performance of various competitors.

- Identify emerging players with potentially strong product portfolios and create effective counter-strategies to gain a competitive advantage.

- Organize your sales and marketing efforts by identifying the market categories and segments that present maximum opportunities for consolidations, investments and strategic partnerships.

- What's the next big thing in the global endometriosis therapeutics market landscape? – Identify, understand and capitalize.

To order this report:

: Endometriosis Therapeutics- Pipeline Assessment and Market Forecasts to 2018

More Market Research Report

Check our Industry Analysis and Insights

Nicolas Bombourg
Email: nbo@reportlinker.com
US: (805)652-2626
Intl: +1 805-652-2626

SOURCE Reportlinker

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Tuesday, October 04, 2011

Adhesion Related Disorder International Human Rights Team IHRT: CONFLUENT SPRAYSHIELD MAUDE Adverse Event Report

Adhesion Related Disorder International Human Rights Team IHRT: CONFLUENT SPRAYSHIELD MAUDE Adverse Event Report

ARDvark Blog Journal of Adhesion Related Disorder: Abdominal/Pelvic Pain Can Occur After Surgery.

ARDvark Blog Journal of Adhesion Related Disorder: Abdominal/Pelvic Pain Can Occur After Surgery.

Endometriosis can Reach Your Bowel and Bladder

Endometriosis can Reach Your Bowel and Bladder
By Deborah Ross
Having endometriosis is tricky business. For many women, it’s something you have to “look forward to” every month. Sometimes friends and family don’t understand the pain you are enduring with your cycle. And sometimes endometriosis is causing abnormalities in your reproductive area, pelvis and gut that you can’t even feel.

As defined by the American Congress of Obstetricians and Gynecologists, endometriosis occurs when the tissue that normally lines the uterus and gets shed during menstrual cycles for some reason is found growing outside the uterus, usually on the ovaries, fallopian tubes or other pelvic structures. In many cases that endometrium -- the lining -- can cause problems such as chronic abdominal pain, pressure or fullness in the pelvis, debilitating menstrual cramps, pain with intercourse and, sadly, infertility, according to ACOG.

Endometriosis can be an issue not only in a woman’s reproductive area, but also in the bowel and bladder. That’s because the displaced tissue responds to changes in hormones and can break down and bleed each month just as if it were in the uterus. Scar tissue, or adhesions, can form, sometimes binding organs together with painful results.

So, for many women having endometriosis, it’s not just the discomfort of a menstrual cycle but also pain that extends outward toward the digestive system. During a menstrual period, there can be diarrhea, constipation, bloating, nausea, aches in the lower back, and pain during bowel movements and urination.

More than 5 million American women have endometriosis, with it most often hitting women in their 30s and 40s, according to a fact sheet from womenshealth.gov.

The fact sheet also noted that sometimes women can have endometrial growths in a number of areas outside the uterus yet feel no pain. On the other hand, some women with endometriosis have only a few abnormal growths and still feel severe pain.

Researchers are looking at associations between endometriosis and a number of conditions, including allergies, autoimmune diseases, chronic fatigue syndrome, certain cancers and yeast infections.

Read More:


ARDvark Blog Journal of Adhesion Related Disorder: The inpatient burden of abdominal and gynecological adhesiolysis in the US

ARDvark Blog Journal of Adhesion Related Disorder: The inpatient burden of abdominal and gynecological adhesiolysis in the US

Monday, October 03, 2011

Endometriosis: sharing resources and pooling knowledge

By Lone Hummelshøj Managing Editor, EndoZone.org | October 2, 2011

Dysmenorrhoea, infertility, bowel problems, nausea, dyspareunia, vomiting, fatigue and chronic pelvic pain are all symptoms associated with endometriosis. They are also topics that are taboo in today’s society. These are not issues that we can discuss over Sunday lunch with our nearest and dearest, nor at a family party, and often not even with our friends. These are not issues with which any of us would necessarily wish to be associated, but an estimated 89 million women and girls need to deal with these symptoms — and so do their physicians.

Both of these groups have unmet needs. Effective treatment options is one of them; the other is information about current knowledge and resources that will enable them to put together an individualised treatment plan tailored to the personal circumstances of the woman in question: be it to tackle pain, to resolve subfertility, or both.

Competing for time and being able to provide timely information is one of the challenges of the 21st century. The Internet enables a new way of thinking and a new way of interacting with each other.

The expert patient
According to the International Alliance of Patients’ Organisations, ‘All patients, no matter their condition, background or nationality, have a fundamental and legitimate human right of access to all kinds of information about their health, medical conditions and the availability of treatments including knowledge of the best available management for their disease’[1].

The era of the educated consumer has arrived. For women, a growing desire for information parallels a wish to take more responsibility for their health and be more involved in their treatment decisions. Patients accept less and less that health care professionals should unilaterally make these decisions for them. However, whilst women may be experts at having endometriosis, they are not experts at treating the disease. They need access to information about their options and expect health care professionals to act increasingly as facilitators or partners (Table I).
Click here to read more: http://hcp.obgyn.net/hysterectomy/content/article/1760982/1960967