Endometriosis slowly emerges as a debilitating Disease for Women

Endometriosis slowly emerges as a debilitating Disease for Women
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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

http://www.africasciencenews.org/en/index.php/health/63-health/194-endometriosis-slowly-emerges-as-a-life-threatening-disease-for-women

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.

http://www.genengnews.com/gen-news-highlights/neurocrine-wins-20m-from-abbott-related-to-elagolix-for-endometriosis/81245782/ 


http://www.genengnews.com/gen-news-highlights/neurocrine-wins-20m-from-abbott-related-to-elagolix-for-endometriosis/81245782/

Endometriosis can Reach Your Bowel and Bladder

Endometriosis can Reach Your Bowel and Bladder


By Deborah Ross  August 31, 2011 - 2:25pm

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 the rest by clicking here: http://www.empowher.com/endometriosis/content/endometriosis-can-reach-your-bowel-and-bladder

If your doctor wants you to take Lupron, please watch this news clip first!

I took a 6 months course of Lupron when I was 32. All I can seem to remember about this is I wished  I had never done it. The side effects were awful. The pain of stage 4 endometriosis and their accompanying adhesions came right back.
I am now 49 with osteoperosis and almost an inch shorter than I was my whole adult life.
One time I presented at ER Mass General....and that witch sneered at me...."why aren't you taking lupron?"
I got off the table and just kept walking.....outta there!

Please....Lupron does not cure endometriosis.

Watch this investigative report before you decide to go this course.

'Top Chef's Padma Lakshmi gets personal about endometriosis

'I didn’t know how much pain I was in until I wasn’t in pain anymore"

Cause Celeb highlights a celebrity’s work on behalf of a specific cause. This week, we speak with model, actress and television host Padma Lakshmi about her charity, the Endometriosis Foundation of America. Lakshmi herself had the painful disorder, which affects millions of women and adolescent girls in the United States.



Lakshmi joined the organization and relaunched it with Dr. Tamer Seckin in 2009. Lakshmi, host of “Top Chef” on Bravo channel, uses her celebrity to bring awareness to the disease and its symptoms. Endometriosis is an often painful disorder in which tissue that normally lines the inside of the uterus grows outside the uterus.On March 18, the Endometriosis Foundation of America hosted its third annual Blossom Ball to raise funds to combat the debilitating condition. To find out more information about endometriosis and future events, you can visit http://www.endofound.org/.

Click here to read more

March is Endometriosis Awareness Month

Endometriosis Research Center Celebrates Disease Awareness Throughout Month of March in Honor of Women and Girls Living with Painful Illness
Source: Endometriosis Research CenterMar 03, 2008 14:11:05

Mar 03, 2008 – Backed by formal legislation, the Endometriosis Research Center (ERC) is once again celebrating March as “Endometriosis Awareness Month” in honor of all those affected by the illness. Endometriosis is a painful reproductive and immunological disease in which tissue similar to the uterine lining (endometrium) migrates outside the uterus and implants in other areas of the body. The disorder, for which there is no absolute cure, affects over 5.5 million women and girls in the United States alone and over 70 million more worldwide. Often stigmatized as simply “painful periods,” Endometriosis is a puzzling and widely misunderstood illness. A primary cause of chronic pelvic pain, female infertility and a myriad of related symptoms, Endometriosis is a leading cause of gynecologic surgery, including more than half of the 600,000 hysterectomies performed in the U.S. annually. Symptoms include pelvic pain at any point in a woman or girl's menstrual cycle, infertility, pain with sexual activity, gastrointestinal difficulties, urinary tract difficulties, fatigue, allergies, and immune system dysfunction. The disease can also implant in extrapelvic areas such as the lungs, diaphragm and in rarer cases, even locations like the brain. Recent research has also shown an elevated risk of certain cancers and autoimmune disorders in those with Endometriosis, as well as malignant changes within the disease itself. Researchers remain unsure as to the definitive cause of Endometriosis, which can only be diagnosed through surgery like laparoscopy, and there is no definitive cure. Current studies indicate that genetics, immune system dysfunction or exposure to environmental toxicants may be contributing factors to disease development. Leading experts such as Robert B. Albee, Jr., MD, FACOG, ACGE and Ken Sinervo, MD, FRCSC, ACGE of the Center for Endometriosis Care, a specialty treatment center, believe multiple causative etiologies exist. The ERC maintains that Endometriosis is more than just simple "killer" cramps. “We continue to find that even now, Endometriosis remains misdiagnosed, misunderstood and ineffectively treated, despite being one of the most prevalent causes of pain in women and teens around the globe," said Michelle E. Marvel, ERC Founder and Executive Director. "Even in 2008, we see women and girls from all around the world continuing to suffer in silence with a disease that can be potentially devastating to every aspect of their lives," she noted. The economic impact of Endometriosis is staggering: American businesses lose billions of dollars each year in lost productivity and work time because of the disease. Endometriosis knows no racial or socioeconomic barriers, and can affect women ranging from adolescence to post-menopause. It can be so painful as to render a woman or teen unable to care for herself or her family, attend work, school, or social functions, or go about her normal routine. Despite the hallmark symptoms associated with the illness, the average delay in diagnosis remains an astounding nine years, 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. Many such therapies carry significantly negative and long-lasting side effects, and none offer long-term relief. A growing number of younger women are being diagnosed each year, with studies indicating that as many as 70% of teenagers with chronic pelvic pain ultimately have Endometriosis proven by laparoscopy. Other reports show that as many as 41% of patients experienced Endometriosis pain early in life as an adolescent. The illness can be quite disruptive and cause significant dysfunction, especially at a time in life when self-esteem, school attendance and performance, and social involvement are all critical. Many adolescents with Endometriosis find themselves unable to attend or participate in classes, social functions, extracurricular activities, and sports due to significant pain and other symptoms of Endometriosis. Of even greater concern, recent studies have shown that Endometriosis may in fact have an even bigger impact on younger patients than older women: in patients under 22 years of age, the rate of disease recurrence was double that of older women (35% versus 19%). Studies have also revealed that the disease behaves differently in younger women; leading some researchers to believe it is a different form of Endometriosis altogether. “We are seeing the focus of research aimed at the infertility aspect of the disease, and treatment efforts continue to be directed towards medical therapies, rather than curative efforts for all women and girls,” said Marvel. “It is imperative that we recognize the far-reaching impact this illness continues to have on patients of all ages, not just those trying to conceive, in order to ensure that our daughters do not suffer as we have,” she said. The ERC is an established 501(c)3 non-profit organization focused on research facilitation, providing education and support, and raising awareness. The ERC strongly advocates early intervention, timely diagnosis, and efficacy of treatment for the disease. Through the ERC's efforts to raise public awareness, the organization hopes to facilitate better support of patients, increase physician understanding of the disease, and raise research funding leading to more effective treatments and ultimately, a cure. The organization has long pioneered and led efforts to increase recognition of Endometriosis among local, state and federal policymakers throughout the nation since the organization was founded in 1997. Through the ERC’s work, Congress previously passed the country's first-ever National Endometriosis Awareness Resolution, the first and only of its kind to formally recognize the disease and declare March as Endometriosis Awareness Month. The states of New York, Utah, Florida, Colorado, California, Wyoming, Pennsylvania, Michigan and others have also worked with the ERC to pass similar legislation recognizing the disease. The ERC is a completely free foundation available to anyone wishing to learn more about Endometriosis. The organization is sponsoring various educational, awareness and fundraising endeavors throughout March. For details, visit www.endocenter.org or contact the organization's Director of Fundraising, Denise Childs, at FundraisingDirector@EndoCenter.org.
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The ERC is an established 501(c)3 non-profit organization focused on disease research facilitation, providing education and support, and raising awareness about Endometriosis.
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Pelvic inflammatory disease

Pelvic inflammatory disease (or disorder) (PID) is a generic term for inflammation of the female uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to tissue necrosis with/or without abscess formation. Pus can be released into the peritoneum. Two thirds of patients with laparoscopic evidence of previous PID were not aware they had had PID.[1] PID is often associated with sexually transmitted diseases, as it is a common result of such infections. PID is a vague term and can refer to viral, fungal, parasitic, though most often bacterial infections. PID should be classified by affected organs, the stage of the infection, and the organism(s) causing it. Although an STD is often the cause, other routes are possible, including lymphatic, postpartum, postabortal (either miscarriage or abortion) or intrauterine device (IUD) related, and hematogenous spread.

Epidemiology
In the United States, more than one million women are affected by PID each year, and the rate is highest with teenagers. Over 100,000 women become infertile in the US each year from PID.[2] N. gonorrhoea is isolated in only 40-60% of women with acute salpingitis.[3] C. trachomatis was estimated by current obgyn 9th ed to be the cause in about 60% of cases of salpingitis, which may lead to PID. It is unsure how much is due to a single organism and how much is due to multiple organisms; many other pathogens that are in normal vaginal flora become involved in PID. 10% of women in one study had asymptomatic Chlamydia trachomatis infection and 65% had asymptomatic infection with Neisseria gonorrhoeae.[3] It was noted in one study that 10-40% of untreated women with N. gonorrhoea develop PID and 20-40% of women infected with C. trachomitis developed PID.[1] PID is the leading cause of infertility. "A single episode of PID results in infertility in 13% of women."[1] This rate of infertility increases with each infection.

Diagnosis
There may be no actual symptoms of PID. If there are symptoms then fever, cervical motion tenderness, lower abdominal pain, new or different discharge, painful intercourse, or irregular menstrual bleeding may be noted. It is important to note that PID can occur and cause serious harm without causing any noticeable symptoms. Laparoscopic identification is helpful in diagnosing tubal disease, 65-90% positive predictive value in patients with presumed PID.[3] Regular Sexually transmitted disease (STD) testing is important for prevention. Treatment is usually started empirically because of the terrible complications. Definitive criteria include: histopathologic evidence of endometritis, thickened filled fallopian tubes, or laparoscopic findings. Gram-stain/smear becomes important in identification of rare and possibly more serious organisms.[1]

Differential diagnosis
Appendicitis, ectopic pregnancy, septic abortion, hemorrhagic or ruptured ovarian cysts or tumors, twisted ovarian cyst, degeneration of a myoma, and acute enteritis must be considered. Pelvic inflammatory disease is more likely to occur when there is a history of pelvic inflammatory disease, recent sexual contact, recent onset of menses, or an IUD in place or if the partner has a sexually transmitted disease.
Acute pelvic inflammatory disease is highly unlikely when recent intercourse has not taken place or an IUD is not being used. A sensitive serum pregnancy test should be obtained to rule out ectopic pregnancy. Culdocentesis will differentiate hemoperitoneum (ruptured ectopic pregnancy or hemorrhagic cyst) from pelvic sepsis (salpingitis, ruptured pelvic abscess, or ruptured appendix).
Pelvic and vaginal ultrasounds are helpful in the differential diagnosis of ectopic pregnancy of over six weeks. Laparoscopy is often utilized to diagnose pelvic inflammatory disease, and it is imperative if the diagnosis is not certain or if the patient has not responded to antibiotic therapy after 48 hours.
No single test has adequate sensitivity and specificity to diagnose pelvic inflammatory disease. A large mulitsite U.S. study found that cervical motion tenderness as a minimum clinical criterion increases the sensitivity of the CDC diagnostic criteria from 83% to 95%. However, even the modified 2002 CDC criteria does not identify women with subclinical disease.[4]

Prognosis
Although the PID infection itself may be cured, effects of the infection may be permanent. This makes early identification by someone who can prescribe appropriate curative treatment so important in the prevention of damage to the reproductive system. Since early gonococcal infection may be asymptomatic, regular screening of individuals at risk for common agents (history of multiple partners, history of any unprotected sex, or people with symptoms) or because of certain procedures (post pelvic operation, postpartum, miscarriage or abortion). Prevention is also very important in maintaining viable reproduction capabilities.
If the initial infection is mostly in the lower tract, after treatment the person may have few difficulties. If the infection is in the fallopian tubes or ovaries, more serious complications are more likely to occur.

Complications
PID can cause scarring inside the reproductive organs, which can later cause serious complications, including chronic pelvic pain, infertility (difficulty becoming pregnant), ectopic pregnancy (the leading cause of pregnancy-related deaths in adult females), and other dangerous complications of pregnancy. Multiple infections and infections that are treated later are more likely to result in complications.
Infertile women may wish to see a specialist, because there may be a possibility in restoring fertility after scarring. Traditionally tuboplastic surgery was the main approach to correct tubal obstruction or adhesion formation, however success rates tended to be very limited. In vitro fertilization (IVF) was developed to bypass tubal problems and has become the main treatment for patients who want to become pregnant.

Treatment
Treatment depends on the cause and generally involves use of antibiotic therapy. If the patient has not improved within two to three days after beginning treatment with the antibiotics, they should return to the hospital for further treatment. Drugs should also be given orally and/or intravaneously to the patient while in the hospital to begin treatment immediately to increase the effectiveness of antibiotic treatment. Hospitalization may be necessary if Tubo-ovarian abscess, very ill, immunodeficient, pregnancy, incompetence, or because this or something else life threatening can not be ruled out. Treating partners for STD's is a very important part of treatment and prevention. Anyone with PID and partners of patients with PID since six months prior to diagnosis should be treated to prevent reinfection. Psychotherapy is highly recommended to women diagnosed with PID as the fear of redeveloping the disease after being cured may exist. It is important for a patient to communicate any issues and/or uncertainties they may have to a doctor, especially a specialist such as a gynecologist, and in doing so, to seek follow-up care.
A systematic review of the literature related to PID treatment was performed prior to the 2006 CDC sexually transmitted diseases treatment guidelines. Strong evidence suggests that neither site nor route of antibiotic administration affects the short or long-term major outcome of women with mild or moderate disease. Data on women with severe disease was inadequate to influence the results of the study. [5]

Prevention
Risk reduction against sexually transmitted diseases through abstinence or barrier methods such as condoms, see human sexual behavior for other listings.
Going to the doctor immediately if symptoms of PID, sexually transmitted diseases appear, or after learning that a current or former sex partner has, or might have had a sexually transmitted disease.
Getting regular gynecological (pelvic) exams with STD testing to screen for symptomless PID.[6]
Discussing sexual history with a trusted physician in order to get properly screened for sexually transmitted diseases.
Regularly scheduling STD testing with a physician and discussing which tests will be performed that session.
Getting a STD history from your current partner and insisting they be tested and treated before intercourse.
Understanding when a partner says that they have been STD tested they usually mean chlamydia and gonorrhea in the US, but that those are not all of the sexually transmissible diseases.
Treating partners to prevent reinfection or spreading the infection to other people.

Other diseases that can lead to or be involved in PID
Salpingitis, any infection of the fallopian tubes.
Tubo-ovarian abscess an abscess of the fallopian tube or ovary.
Endometritis
Pelvic peritonitis
The Dalkon Shield (withdrawn from the market in 1975 for this reason)
Bacterial Vaginosis

References
^ a b c d Loscalzo, Joseph; Andreoli, Thomas E.; Cecil, Russell L.; Carpenter, Charles A.; Griggs, Robert C. (2001). Cecil essentials of medicine. Philadelphia: W.B. Saunders. ISBN 0-7216-8179-4.
^ STD Facts - Pelvic inflammatory disease (PID). Retrieved on 2007-11-23.
^ a b c Lauren Nathan; DeCherney, Alan H.; Pernoll, Martin L. (2003). Current obstetric & gynecologic diagnosis & treatment. New York: Lange Medical Books/McGraw-Hill. ISBN 0-8385-1401-4.
^ Blenning CE, Muench J, Judkins DZ, Roberts KT (2007). "Clinical inquiries. Which tests are most useful for diagnosing PID?". J Fam Pract 56 (3): 216–20. PMID 17343812. 
^ Walker CK, Wiesenfeld HC (2007). "Antibiotic therapy for acute pelvic inflammatory disease: the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines". Clin. Infect. Dis. 44 Suppl 3: S111–22. doi:10.1086/511424. PMID 17342664. 
^ Smith KJ, Cook RL, Roberts MS (2007). "Time from sexually transmitted infection acquisition to pelvic inflammatory disease development: influence on the cost-effectiveness of different screening intervals". Value Health 10 (5): 358–66. doi:10.1111/j.1524-4733.2007.00189.x. PMID 17888100. 

External links
NIH/Medline
CDC
Pelvic Inflammatory Disease (PID; Salpingitis, Endometritis)

Pelvic Pain? Solve the Mystery

Use this checklist to explore the possible reasons—and remedies.
Remember New Year’s Day when you decided to jump-start your weight-loss program—by doing 500 sit-ups? That robo-routine could be the reason for the chronic ache in your pelvis. Then again, maybe not. One in seven women suffers from chronic pelvic pain, and the cause is often a mystery. To get relief, your first step (after the totally legit complaining) should be figuring out what’s wrong. Talk to your doctor about these possibilities, and to rule out ovarian cancer (which is rare):
It’s gynecological. Endometriosis—when uterine tissue grows outside the uterus—could be the culprit; roughly 10 percent of women have it. Also, prolonged pushing, a difficult forceps delivery, or certain types of incisions or lacerations during a vaginal delivery could lead to chronic pain. But don’t just assume it’s a female problem, cautions OB-GYN Andrea Rapkin, MD, director of the University of California, Los Angeles, Pelvic Pain Clinic.
It’s physical. Maybe it sounds odd, but a size mismatch between you and your partner could be to blame. If his penis is big, sex can bruise your cervix or tear the opening of your vagina. An injury from a fall could be responsible, too.
It’s intestinal or urological. Chronic constipation may trigger pain in the muscles of the pelvic floor, and malfunctions such as colitis, irritable bowel syndrome (IBS), and diverticulitis might feel like something more gyno than gastro. IBS is more common in women than men and often includes pain with constipation or diarrhea. Then there’s interstitial cystitis, a chronic inflammation in the bladder that can lead to pain, pressure, and tenderness.
And remember: It’s fixable. The pain may be chronic, but you don’t have to suffer. Experts say all of these underlying problems are treatable. Remedies may include hormonal therapy, antibiotics, pain relievers, antidepressants, counseling, relaxation exercises, physical therapy, or even surgery. And exhale now if fear of a disease like ovarian cancer is keeping you from seeing a doctor; pelvic pain is rarely a symptom. In fact, Rapkin says the chances of cancer being the problem are very low among premenopausal women.

(Well......Sometimes it isn't)

http://www.tamilstar.com/news/health/article_5630.shtml

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]

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

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.

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

http://www.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