Endometriosis After Hysterectomy And Oophorectomy

Frequently Asked Questions

  1. QUESTION:
    What is the recovery time after having a hysterectomy and is it like a c- section?
    I am having a hysterectomy in 12 days and I am so nervous. I had a C-Section 3 years ago and I know how painful that was, is it any thing like that? I know it will be abdominal. I am just trying to figure out how I am going to do this, it is bad enough I am going to have to climb 3 flights of stairs after the surgery to get to my apartment and have to take care of my 8 and 3 year old kids. I also had to move to this town with no family to help me (cause of hurricane katrina). I am just hoping I can do this by myself. My main worry is after the surgery I have 2 weeks until my son starts school and I am wondering if I will be ok to drive him to school ? Please let me know any experiences anyone have had .

    • ANSWER:
      Good luck with your upcoming surgery.

      Honestly, it depends on what you have done, how you have it done and why. I know you said abdominal, but why is that your doc's only option/choice for you? For example, an LAVH [laparoscopic assisted vaginal hyst] is less invasive and offers quicker recovery. An abdominal hyst is far more invasive and has longer recovery. Vaginal hyst is less invasive and has faster recovery overall than the others above, but can affect sexual function. Vaginal hysterectomy is preferable to abdominal hysterectomy where possible, however. Where vaginal hysterectomy is not possible, laparoscopic hysterectomy is preferable to abdominal hysterectomy, although it brings a higher chance of bladder or ureter injury [Methods of Hysterectomy: Systematic Review & Meta-analysis of Randomised Controlled Trials; BMJ. 2005 Jun 25;330(7506):1478].

      Also, how well you recuperate depends on how well you tolerate the procedure; i.e., any reaction to anesthesia, complications, etc. A hyst. is not that similar to a c-section in all honesty.

      You also need to discuss with your doc exactly what will be done, i.e., removal of uterus only, hysterectomy with oophorectomy [removal of one or both ovaries], hysterectomy with salpingoopherectomy [removal of one or both fallopian tubes], radical hysterectomy, which removes the uterus, cervix, the top portion of the vagina and most of the tissue that surrounds the cervix in the pelvic cavity. Pelvic lymph nodes may also be removed; supracervical hysterectomy, also referred to as a subtotal hysterectomy, which removes the uterus while leaving the cervix intact.

      It is a major operation, any way you cut it (no pun intended). It will take at least 2 weeks or longer to be completely healed, again, depending on what was done, how complicated your surgery was, etc. Abdominal surgery recovery is expected to be easily longer than 2 weeks till you feel "normal."

      As an aside, if heavy bleeding or similar concern is the "only" reason for your hysterectomy, you may want to look into alternatives, such as endometrial ablation or similar procedure. If you have having it because of Endometriosis or fibroids, please know that there are alternatives and that hyst is not a cure for Endo.

      I do NOT recommend climbing 3 flights of stairs afterwards. I honestly think you need to have a friend or neighbor help with the 3 yr. old following surgery for a few days. You will only be doing yourself harm and jeopardizing your recovery if you do too much, too soon. You will also be on narcotic pain meds and it's hard to be a great parent when you're feeling dopey from the pills. You really need some help - if you do too much, you can experience complications or adhesion development, etc. This is not a surgery I recommend recuperating alone with 2 children from.

      Again, good luck to you, I hope all turns out ok.

  2. QUESTION:
    How young is too young for a hysterectomy and oophorectomy?
    I'm 27 with 2 kids I was told I'd never have. I have endometriosis and recurring ovarian cysts and adhesions. I've had 7 surgeries (6 laparoscopies and 1 laparotomy) in the last 10 years and I'm going to have another one in less than 2 weeks. DH and I were hoping to try for a 3rd baby later this year but with the pain I'm in I'm almost ready to throw in the towel. Is it too soon to give up? BTW - my mom was only 23 when she HAD to have a hysterectomy.

    • ANSWER:
      There's never a 'right age' for a hysterectomy. There are extensive potential long-term risks involved in early surgical menopause. However, often, the reason or basis for the hysterectomy outweighs the potential risks. However, Endometriosis is not one of those reasons.

      Endometriosis is absolutely not cured by hysterectomy and it needs no HRT to continue thriving following removal of the uterus/ovaries. Endo implants themselves produce their own estrogen-synthesizing enzyme, known as aromatase, and therefore, any disease left behind during the hysterectomy will continue to cause symptoms.

      The key to living well with Endo is to remove disease, not healthy organs. Before going into this next surgery, take time to learn about excision surgery. See the following websites:

      http://www.centerforendo.com
      http://www.endometriosistreatment.org
      http://www.endoexcision.com

      Hysterectomy has a role in Endometriosis treatment, particularly in advanced stages in those who also have adenomyosis. However, it is not a valid treatment to simply remove the uterus and ovaries without removing all the disease left behind.

      Good luck to you.

  3. QUESTION:
    What exactly will happen when i go in for a hysterectomy inc taking the ovaries away due to endometriosis.?
    need to know what the best hormone therapy will be best? Endometriosis is affecting my quality of life so hysterectomy is only option for me now i've exhausted all other treatments. How will it make me feel once the op is done.

    • ANSWER:
      The trouble is that endometriosis may be deposited in many different areas of the pelvis, thus the last resort plan of hysterectomy and bilateral oophorectomy ( removal of tubes and ovaries) must be all that is left for you.

      Your gynaecologist must decide on your hormone replacement. He will probably choose oestrogen only, since you have no uterus there is no increase in uterine cancer risk. I quite like premarin, it is a natural oestrogen, the one from pregnant mares urine, but it is sometimes better tolerated than the synthetics.

      It tends to elevate mood and helps prevent osteoporosis. I suspect once things have settles down you will feel better than pre-op.

      Breast cancer risks on hormone replacement don't seem to rise until after 50 years, so you will probably be kept on oestrogen until then.

  4. QUESTION:
    Is it possible for Endometriosis to turn into cancer?
    This a problem affecting lots of women who has had children.

    • ANSWER:
      Endometriosis is a leading cause of infertility and does not just affect women who have had childen. Endo affects women all of ages. It is not a cancer, but recent research has shown an increase in certain cancers in women with the disease as well as malignant changes in the disease itself.

      Ref:

      Some researchers even estimate that approximately 0.7-1.0% of patients with Endometriosis have lesions that will ultimately undergo malignant transformation, and urge consideration of performing bilateral oophorectomy at the time of abdominal surgery in patients with significant disease. "Endometrial stromal sarcoma of the vulva arising in extraovarian endometriosis: a case report and literature review," Gynecol Oncol 1998 Nov;71(2):313-6. Irvin W; Pelkey T; Rice L; Andersen W.

      In a similar study targeting women who had undergone hysterectomy with oophorectomy because of Endometriosis, authors noted that "Endometriosis can undergo estrogen-dependent changes similar to the endometrium and may carry a risk of developing hyperplasia and carcinoma during unopposed estrogen stimulation." The researchers concluded that unopposed estrogen therapy may lead to premalignant or malignant transformation in the residual foci of Endometriosis and encouraged the addition of progestins to estrogen replacement therapy. - "Malignancy arising in extraovarian endometriosis during estrogen stimulation," Eur J Gynaecol Oncol 1998;19(1):39-41. Gucer F; Pieber D; Arikan MG.

      Findings of a survey conducted of over 4,000 Endometriosis patients in the United States and Canada have indicated possible links to other serious medical conditions, including a 9.8% incidence of melanoma, compared with 0.01% in the general population, a 26.9% incidence of breast cancer, compared with 0.1% in the general population and an 8.5% incidence of ovarian cancer, as compared with 0.04% in the general population. Women with Endometriosis who participated in the survey also had a greater incidence of autoimmune conditions and Meniere's disease. - Endometriosis & Cancer: What is the Connection?" 1999; Duczman, Linda & Ballweg, Mary Lou, 8585 N. 76th Pl., Milwaukee, WI 53223.

      In a study of 20,686 Swedish women hospitalized for Endometriosis, results showed that the women had a 20% greater risk of developing cancer overall, particularly of the breast, ovaries, blood and lymph cells during an 11-year period. - "Cancer risk after a hospital discharge diagnosis of endometriosis," Am J Obstet Gynecol 1997;176:572-9. Brinton, Louise A., PhD; Gridley, Gloria, MS; Persson, Ingemar, MD; Baron, John, MD; Bergqvist, Agneta MD, PhD.

      In another study of 79 patients with Stage I epithelial ovarian cancer at Massachusetts General Hospital, evidence of Endometriosis was found in 22 of the 79 cases (28%), leading researchers to conclude that "Endometriosis may play a role in the pathogenesis of some early stage malignant ovarian epithelial neoplasms." In a similar study,(9) researchers reviewed 147 cases of ovarian Endometriosis to clarify the incidence of malignant transformation. Authors noted that "malignant change in ovarian Endometriosis occurred in 0.7% of this disease."
      - "Histologic transformation of benign endometriosis to early epithelial ovarian cancer," Gynecol Oncol 1996 Feb;60(2):238-44. Sainz de la Cuesta R; Eichhorn JH; Rice LW; Fuller AF Jr; Nikrui N; Goff BA.

      While ovarian neoplasms are among the most common malignancies, other sites have been found to undergo malignant changes as well, including clear cell carcinoma arising in an Endometriosis implant in a low abdominal transverse scar, a clear cell carcinoma arising in a cesarean section scar, and even the liver. - "Ovarian atypical endometriosis: its close association with malignant epithelial tumours," Histopathology 1997 Mar;30(3):249-55. Fukunaga M; Nomura K; Ishikawa E; Ushigome S.
      "Clear cell carcinoma arising in extragonadal endometriosis in a caesarean section scar during pregnancy," Gynecol Oncol 1998 Jul;70(1):127-30. Miller DM; Schouls JJ; Ehlen TG. "Clear cell carcinoma arising in a Cesarean section scar endometriosis: a case report," J Korean Med Sci (Korea 1999 Apr;14(2):217-9. Park SW; Hong SM; Wu HG; Ha SW. "CT diagnosis of perihepatic endometriosis complicated by malignant transformation," Abdom Imaging 1998 Mar-Apr;23(2):183-4. Weinfeld RM; Johnson SC; Lucas CE; Saksouk FA.

      Endometriosis is by and large benign, but while rare, malignancies can and do occur and should be an indicator that Endometriosis is a serious disease requiring serious treatments.

  5. QUESTION:
    What, if any, health concerns does a person have when they have PCOD post-hysterectomy?
    I was originally diagnosed with Stein-Levinthal syndrome at age 19 and had PCOD throughout my 20's and 30's. I had a few surgeries for the cysts and finally a hysterectomy at age 43 because of a large cyst and endometriosis. I know that PCOD is associated with other endocrine problems (syndrome x, diabetes, insulin resistance, etc.) Once a person has a hysterectomy (including ovaries) are these health risks still an issue?

    • ANSWER:
      Hystersisters addresses this on their site:

      Will a hysterectomy or oophorectomy cure my PCOS/PCOD?

      Unfortunately, there is no cure at this time for PCOS.

      Polycystic Ovarian Syndrome/Disorder is a disorder of the endocrine system. While one of the symptoms can be polycystic ovaries, it is only one of many symptoms. Some women have polycystic ovaries, but do not have PCOS, while other women have PCOS yet do not have polycystic ovaries.

      An oophorectomy will obviously put an end to polycystic ovaries by removing them. It will not alter the other symptoms, which can include insulin resistance. If you were suffering from other symptoms before your surgery, they will remain after your surgery. One possible exception is that since the ovaries produce up to 60% of your body’s testosterone, when they are removed, it may be enough of a decrease in androgens to no longer cause unpleasant side affects.

      Are there any special HRT requirements after an oopherectomy?

      There has been very little, if any research concerning PCOS and HRT therapy after an oophorectomy. From experience, we see that it can take longer for the woman with PCOS to attain a balance of their hormones. This is because of other issues with additional hormones which may also need to be addressed. One thing that seems to be agreed upon by all is that the woman with PCOS should rarely be given testosterone or DHEA supplements.

      It is very important that the woman who has PCOS find a doctor who understands PCOS and surgical menopause. Not everyone in the medical community is up-to-date with the latest research and treatment options. It is important to get treatment for insulin resistance.

      For more information and support for PCOS symptoms and treatment, here is a link to www.soulcysters.com.

  6. QUESTION:
    I have endometriosis. Can anyone suggest a way to eliminate the pain with taking a derpo lupron shot?
    The doctor says that I have no other choice but to have a hysterectomy.

    • ANSWER:
      Currently, there is no cure for endometriosis, though in some patients menopause (natural or surgical) will abate the process. Nevertheless, a hysterectomy and/or removal of the ovaries will not guarantee that the endometriosis areas and/or the symptoms of endometriosis will not come back. Conservative treatments usually try to address pain or infertility issues. Medical herbal treatments can sometimes be effective in controlling the disease.
      The treatments for endometriosis pain include:
      NSAIDs and other pain medication: They often work quite well as they not only reduce pain but also menstrual flow. They are commonly used in conjunction with other therapy. For more severe cases narcotic prescription drugs may be used.
      Gonadotropin Releasing Hormone (GnRH) Agonist: These agents work by increasing the levels of GnRH. Consistent stimulation of the GnRH receptors results in downregulation. This causes a decrease in FSH and LH, thereby decreasing estrogen and progesterone levels.
      It is suggested but unproven that pregnancy and childbirth can stop endometriosis.
      Hormone suppression therapy: This approach tries to reduce or eliminate menstrual flow and estrogen support. Typically, it needs to be done for several months or even years.
      Progesterone or Progestins: Progesterone counteracts estrogen and inhibits the growth of the endometrium. Such therapy can reduce or eliminate menstruation in a controlled and reversible fashion. Progestins are chemical variants of natural progesterone.
      Avoiding products with xenoestrogens, which have a similar effect to naturally produced estrogen and can increase growth of the endometrium.
      Continuous birth control pills consist of the use of birth control pills without the use of placebo pills. This eliminates monthly bleeding episodes.
      Danazol (Danocrine) and gestrinone are suppressive steroids with some androgenic activity. Both agents inhibit the growth of endometriosis but their use remains limited as they may cause hirsutism. There has been some research done at Case Western Reserve University on a topical Danocrine, applied locally, which has not produced the hirsutism characteristics. The study has not yet been published in a medical journal.
      Gonadotropin releasing hormone agonists (GnRH agonists) induce a profound hypoestrogenism by decreasing FSH and LH levels. While quite effective, they induce unpleasant menopausal symptoms, and over time may lead to osteoporosis. To counteract such side effects some estrogen may have to be given back (add-back therapy).
      Aromatase inhibitors are medications that block the formation of estrogen and have become of interest for researchers who are treating endometriosis.[8]
      Surgical treatment is usually a good choice if endometriosis is extensive, or very painful. Surgical treatments range from minor to major surgical procedures.
      Laparoscopy is very useful not only to diagnose endometriosis, but to treat it. With the use of scissors, cautery, lasers, hydrodissection, or a sonic scalpel, endometriotic tissue can be ablated or removed in an attempt to restore normal anatomy.
      Laparotomy can be used for more extensive surgery either in attempt to restore normal anatomy, or at least preserve reproductive potential.
      Hysterectomy (removal of the uterus and surrounding tissue) and bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries).
      For patients with extreme pain, a presacral neurectomy may be indicated where the nerves to the uterus are cut.
      Raising your serotonin level: low serotonin levels reduce the pain threshold, and make people more vulnerable to every pain. Women particularly need adequate amounts of light during the second half of their menstrual cycles, when their serotonin levels may already be low.
      Many people like sweets: eating sugar or chocolate temporarily increases serotonin levels, but creates a rebound effect, characterized by heightened PMS symptoms.
      Avoid coffee and alcohol.
      Melatonin and serotonin are increased by meditation, and the stress hormone cortisol is decreased. Melatonin causes you to go into delta-sleep, during which period Human Growth Hormone is released. As melatonin levels drop from childhood (100%) to age 20 (30%) and age 30 (20%), recovering takes more time, so good deep sleep is essential.
      Serotonin is manufactured by the body from a partial protein or amino acid called tryptophan. This amino acid is found in many foods, including soy, turkey, chicken, halibut, and beans.
      Lavender, primarily in the form of oil, has been found to reduce several physiological parameters of stress by stimulating serotonin and inducing a feeling of calm and happiness.
      Light therapy increases your serotonin levels.
      In many cases, Marijuana (Cannabis Sativa) has proven to relax or suppress the pain and relieve stress. Although doctors consider this to be an unorthodox method given all the treatments available for this condition and the fact that it may not produce any long term effects, this may still be an effective way to combat endometriosis. Research on this method is minimal since the drug is banned in most countries.[citation needed]
      Complementary or Alternative medicine are used by many women who get great relief from the pain and discomforts from a variety of available treatments.
      Nutrition There has been research showing that prostaglandins series 1 and 3 have an anti inflammatory effect which can help with endometriosis. Nutrition acan also help to boost the immune system, which is important if endometriosis is an auto-immune disorder.

  7. QUESTION:
    What is a Gyneacologist? Does it involove anything with pregnancy and BAbies?
    If there is a Gyneacologist out there or someone knoes alot about that career could you help me out! My questions are:

    What is a Gyneacologist? (what does it do and what are some of her everyday tasks?)

    What interest should you have to become a Gyneacologist?

    Does it involve something to do with pregnancy and babies?

    THanks for your help and any other info is always welcome!

    • ANSWER:
      Gynaecology or gynecology (see spelling differences) refers to the surgical specialty dealing with health of the female reproductive system (uterus, vagina and ovaries). Literally, outside medicine, it means "the science of women". Almost all modern gynaecologists are also obstetricians; see Obstetrics and gynaecology.

      The main conditions dealt with by a gynaecologist are:

      1.Cancer and pre-cancerous diseases of the reproductive organs including ovaries, fallopian tubes, uterus, vagina, and vulva
      2.Incontinence of urine.
      3.Amenorrhea (absent menstrual periods)
      4.Dysmenorrhoea (painful menstrual periods)
      Infertility
      5.Menorrhagia (heavy menstrual periods). This is a common indication for hysterectomy.
      6.Prolapse of pelvic organs
      7.Scabies

      There is some crossover in these areas. For example a woman with incontinence may be referred to a urologist

      Some of the more common operations that gynaecologists perform include:

      1.Dilation and curettage (removal of the uterine contents for various reasons, including partial miscarriage and dysfunctional uterine bleeding refractive to medical therapy)
      2.Hysterectomy (removal of the uterus)
      3.Oophorectomy (removal of the ovaries)
      4.Tubal ligation
      5.Hysteroscopy
      6.Diagnostic laparoscopy - used to diagnose and treat sources of pelvic and abdominal pain; perhaps most famously used to provide definitive diagnosis of endometriosis.
      7.Exploratory laparotomy - may be used to investigate the level of progression of benign or malignant disease, or to assess and repair damage to the pelvic organs.
      8.Various surgical treatments for urinary incontinence, including cystoscopy and sub-urethral slings.
      Surgical treatment of pelvic organ prolapse, including correction of cystocele and rectocele.
      9.Appendectomy - often performed to remove site of painful endometriosis implantation and/or prophylactically (against future acute appendicitis) at the time of hysterectomy or Cesarean section. May also be performed as part of a staging operation for ovarian cancer.
      10.Cervical Excision Procedures (including cryosurgery, LLETZ, LEEP) - removal of the surface of the cervix containing pre-cancerous cells which have been previously identified on Pap smear.

      hope this helps xxxx

  8. QUESTION:
    What can a ob/gyn in do to help me with my horrible cramps and heavy bleeding.Is there a surgical procedure?
    I've already tried to take birth control and can't .

    • ANSWER:
      Depends on the cause of you heavy bleeding, aka menorrahgia. You could have endometriosis or another disease that causes pain and heavy bleeding. You can have cysts and lesions caused by endometriosis removed by laparoscopic surgery.

      If you do not want (more) children in the future, there are several procedures to "thin" the lining of the uterus. It's not surgery but it is a procedure only a qualified doctor can perform. The thinner living will either bleed less or not at all.

      Drug therapy for menorrhagia may include:
      Iron supplements. If the condition is accompanied by anemia, your doctor may recommend that you take iron supplements regularly. If your iron levels are low but you're not yet anemic, you may be started on iron supplements rather than waiting until you become anemic.
      Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve), help reduce menstrual blood loss. NSAIDs have the added benefit of relieving painful menstrual cramps (dysmenorrhea).
      Oral contraceptives. Aside from providing effective birth control, oral contraceptives can help regulate menstrual cycles and reduce episodes of excessive or prolonged menstrual bleeding.
      Oral progesterone. When taken for 10 or more days of each menstrual cycle, the hormone progesterone can help correct hormonal imbalance and reduce menorrhagia.
      The hormonal IUD (Mirena). This type of intrauterine device releases a type of progestin called levonorgestrel, which makes the uterine lining thin and decreases menstrual blood flow and cramping.

      If you have menorrhagia from taking hormone medication, you and your doctor may be able to treat the condition by changing or stopping your medication.

      You may need surgical treatment for menorrhagia if drug therapy is unsuccessful. Treatment options include:
      Dilation and curettage (D&C). In this procedure, your doctor opens (dilates) your cervix and then scrapes or suctions tissue from the lining of your uterus to reduce menstrual bleeding. Although this procedure is common and often treats menorrhagia successfully, you may need additional D&C procedures if menorrhagia recurs.
      Operative hysteroscopy. This procedure uses a tiny tube with a light (hysteroscope) to view your uterine cavity and can aid in the surgical removal of a polyp that may be causing excessive menstrual bleeding.
      Endometrial ablation. Using a variety of techniques, your doctor permanently destroys the entire lining of your uterus (endometrium). After endometrial ablation, most women have little or no menstrual flow. Endometrial ablation reduces your ability to become pregnant.
      Endometrial resection. This surgical procedure uses an electrosurgical wire loop to remove the lining of the uterus. Both endometrial ablation and endometrial resection benefit women who have very heavy menstrual bleeding. Like endometrial ablation, this procedure reduces your ability to become pregnant.
      Hysterectomy. Surgical removal of the uterus and cervix is a permanent procedure that causes sterility and cessation of menstrual periods. Hysterectomy is performed during anesthesia and requires hospitalization. Additional removal of the ovaries (bilateral oophorectomy) may cause premature menopause.

      Except for hysterectomy, these surgical procedures are usually done on an outpatient basis. Although you may need a general anesthetic, it's likely that you can go home later on the same day.

      When menorrhagia is a sign of another condition, such as thyroid disease, treating that condition usually results in lighter periods.

  9. QUESTION:
    How can I stop Endometriosis pain?
    I have endometriosis and its excrushiatingly painful 24/7, im not joking either, it never ends. How can I cure myself of this or atleast stop the pain, and will i be able to have kids??
    I have endometriosis and its excrushiatingly painful 24/7, im not joking either, it never ends. How can I cure myself of this or atleast stop the pain, and will i be able to have kids??

    • ANSWER:
      This is Respiratory Diseases. This belongs in Women's Health. Aren't you under the care of a Gyn?

      "How can I cure myself of this" -- You can't.

      "or atleast stop the pain" -- If you don't find OTC pain relievers effective, you need to communicate this to your doctor. Sometimes supplemental hormone therapy is used to alleviate pain, like contraceptives, gonadotropin-releasing hormone (Gn-RH) agonists and antagonists, Danazol, Depo-Provera and aromatase inhibitors. Conservative surgery is a more extreme step and a radical hysterectomy with bilateral salpingo-oophorectomy is a final solution.

      "and will i be able to have kids??" -- Come on! No here at the YA can predict this. Why would you ask?

      The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women who have endometriosis have difficulty getting pregnant. The longer you have endometriosis, the greater your chance of becoming infertile so this is something you'll have to take up with your doctor.

  10. QUESTION:
    how much the range of Ca125 in endometriosis?
    what's the range of Ca125 in endometriosis? how much Ca125 should increase in malignancy?does Ca125 exclude endometriosis?

    • ANSWER:
      Hi.. I've looked at a couple of sites and this is the best description I could find,

      Blood Test (CA 125)
      This is a tumor marker most commonly used to diagnose ovarian cancer. It has been found that 30-60% of all cases of Endometriosis can have an elevated level of this blood test. It is important to note that a high CA 125 level isn't necessarily cause for alarm. Moderate to severe cases of Endometriosis can have normal levels yet mild cases can sometimes have high CA 125 levels.

      At the Institute, Dr. Del Junco Jr. has treated many women who have had both an elevated CA 125 level and an ovarian mass detected by ultrasound. These women had all received several medical opinions recommending hysterectomy and removal of the ovaries (oophorectomy). We at the Institute, however, council women that if their ovarian masses prove benign, radical surgery would be unnecessary.

      Often times, during surgery, we find the presence of an endometrioma (Endometriosis of the ovary). Female Alternative Surgery focuses on the removal of these cysts while at the same time, preserving the ovary.

      The very best of luck.

  11. QUESTION:
    What kind procedures are done to stop having period at over age 50?
    I have heard that some people who are over age 50 and still having a heavy period can get some kind of "thing" in their uterus. So that would stop the period until they get their menopause..do you all know what that is exactly? and how does it work? any link regarding this would be a help too..thanks :)

    • ANSWER:
      Here's a list of what can be done.
      http://www.mayoclinic.com/health/menorrhagia/DS00394/DSECTION=treatments-and-drugs
      Dilation and curettage (D and C). In this procedure, your doctor opens (dilates) your cervix and then scrapes or suctions tissue from the lining of your uterus to reduce menstrual bleeding. Although this procedure is common and often treats menorrhagia successfully, you may need additional D and C procedures if menorrhagia recurs.
      Operative hysteroscopy. This procedure uses a tiny tube with a light (hysteroscope) to view your uterine cavity and can aid in the surgical removal of a polyp that may be causing excessive menstrual bleeding.
      Endometrial ablation. Using a variety of techniques, your doctor permanently destroys the entire lining of your uterus (endometrium). After endometrial ablation, most women have little or no menstrual flow. Endometrial ablation reduces your ability to become pregnant.
      Endometrial resection. This surgical procedure uses an electrosurgical wire loop to remove the lining of the uterus. Both endometrial ablation and endometrial resection benefit women who have very heavy menstrual bleeding. Like endometrial ablation, this procedure reduces your ability to become pregnant.
      Hysterectomy. Surgical removal of the uterus and cervix is a permanent procedure that causes sterility and cessation of menstrual periods. Hysterectomy is performed under anesthesia and requires hospitalization. Additional removal of the ovaries (bilateral oophorectomy) may cause premature menopause in younger women.

      A hysterectomy can be done but it doesn't mean the ovaries have to be removed with it and it should be the last resort because a hysterectomy is major surgery that involves major cutting and stitching. A woman who has a vaginal hysterectomy can have over 200 internal stitches and the minimum recovery is six weeks. The term hysterectomy refers to the removal of the uterus. If the ovaries are taken it's called a bilateral salpingo oopherectomy. When the entire uterus is taken it includes the cervix which is the neck or bottom of the uterus and is termed a total hysterectomy. It's possible to have a total hysterectomy and keep both ovaries. I had a TVH and kept both ovaries. There's also another procedure that may be able to be done in an outpatient setting but I think it's similar to ablation usually with all of them it's recommended that women don't have kids after them. While some may not be a guarantee it's also important to know the causes of heavy bleeding. Some cases may not respond to the other things and a hysterectomy would be the only choice which could work. If there's endometriosis or adenomyosis (endometriosis inside the uterine muscle) a hysterectomy is the only cure.

      Edited: About what the previous responder Mike said about a hysterectomy not intended to stop periods...When the uterus and cervix are removed there shouldn't be any bleeding at all even if both ovaries are present. It's the linning of the uterus and sometimes the linning left in the cervix that builds up every month which causes bleeding. Women who have a tubal ligation simply don't pass the eggs into their uterus and they still have periods because of the uterine linning that builds up from hormones and such. Because I kept my ovaries with my total hysterectomy (see note at bottom for definition of total hysterctomy) my doctor said the eggs would just disinigrate into my body but because I don't have a uterus or cervix anymore I don't get anymore periods. I don't need any hormone replacement therapy because my ovaries are still providing enough hormones until I go into menopause. There have been women who have had both ovaries removed and still have the uterus although it's not as common to leave the uterus in when both ovaries are out and they still get periods or messed up cycles because of the unbalanced amount of hormones. It's the linning from the uterus that sheds every month.

      Here is a list of the different types of hysterectomies and please do not confuse the term partial and total hysterectomy.
      Note: The term hysterectomy refers to the removal of the uterus not the ovaries. A total hysterectomy is when the cervix is removed with the uterus which is the bottom part or neck of the uterus and is about the size of a coat button. It can still contain a linning and shed every month for women who opt to keep their cervix. Some women have had to go back in and have the cervix removed because it bled so much. One can have a total hysterectomy while keeping both ovaries and tubes.

      http://www.hystersisters.com/vb2/view_hysterectomy_defined.htm
      Total Hysterectomy
      A total hysterectomy is removal of the entire uterus which includes the cervix. A radical hysterectomy is the removal of the uterus, the tissue on both sides of the cervix (parametrium), and the upper part of the vagina.

      Partial Hysterectomy
      A partial (or supracervical) hysterectomy is removal of just the upper portion of the uterus, leaving the cervix intact
      Removal of the ovaries and the fallopian tubes (bilateral salpingo oopherectomy) may also be done at the same time.

      Hysterectomy Types
      A hysterectomy may be done through an abdominal incision - Abdominal Hysterectomy

      A hysterectomy may be done through a vaginal incision - Vaginal Hysterectomy

      A hysterectomy may be done completely through laparoscopic incisions (small incisions on the abdomen -- Laparoscopic Hysterectomy.

      A hysterectomy may be done completely through the use of a robotic surgical device through small incisions in the abdomen - da Vinci® Hysterectomy.

      Your physician will help you decide which type of hysterectomy is most appropriate for you, depending on your medical history and the reason for your surgery.

  12. QUESTION:
    How to treat an ovarian cyst?
    I just found out I have a little ovarian cyst. I've already been in pain for two weeks. I can't take anymore. What's gonna happen?? Supposebly they go away on their own, how long till it goes awayy? Help

    • ANSWER:
      Hi,
      You can't depend on symptoms alone to tell you if you have an ovarian cyst. In fact, you'll likely have no symptoms at all. Or if you do, the symptoms may be similar to those of other conditions, such as endometriosis, pelvic inflammatory disease, ectopic pregnancy or ovarian cancer. Even appendicitis and diverticulitis can produce signs and symptoms that mimic a ruptured ovarian cyst.

      Still, it's important to be watchful of any symptoms or changes in your body and to know which symptoms are serious. If you have an ovarian cyst, you may experience one or more of the following signs and symptoms:

      ■Menstrual irregularities
      ■Pelvic pain — a constant or intermittent dull ache that may radiate to your lower back and thighs
      ■Pelvic pain shortly before your period begins or just before it ends
      ■Pelvic pain during intercourse (dyspareunia)
      ■Pain during bowel movements or pressure on your bowels
      ■Nausea, vomiting or breast tenderness similar to that experienced during pregnancy
      ■Fullness or heaviness in your abdomen
      ■Pressure on your rectum or bladder — difficulty emptying your bladder completely
      When to see a doctor
      Seek immediate medical attention if you have:

      ■Sudden, severe abdominal or pelvic pain
      ■Pain accompanied by fever or vomiting
      These signs and symptoms — or those of shock, such as cold, clammy skin, rapid breathing, and lightheadedness or weakness — indicate an emergency and mean that you need to see a doctor right away.
      Treatment depends on your age, the type and size of your cyst, and your symptoms. Your doctor may suggest:

      ■Watchful waiting. You can wait and be re-examined in one to three months if you're in your reproductive years, you have no symptoms and an ultrasound shows you have a simple, fluid-filled cyst. Your doctor will likely recommend that you get follow-up pelvic ultrasounds at periodic intervals to see if your cyst has changed in size.

      Watchful waiting, including regular monitoring with ultrasound, is also a common treatment option recommended for postmenopausal women if a cyst is filled with fluid and is less than 2 centimeters in diameter.

      ■Birth control pills. Your doctor may recommend birth control pills to reduce the chance of new cysts developing in future menstrual cycles. Oral contraceptives offer the added benefit of significantly reducing your risk of ovarian cancer — the risk decreases the longer you take birth control pills.
      ■Surgery. Your doctor may suggest removal of a cyst if it is large, doesn't look like a functional cyst, is growing or persists through two or three menstrual cycles. Cysts that cause pain or other symptoms may be removed.

      Some cysts can be removed without removing the ovary in a procedure known as a cystectomy. Your doctor may also suggest removing the affected ovary and leaving the other intact in a procedure known as oophorectomy. Both procedures may allow you to maintain your fertility if you're still in your childbearing years. Leaving at least one ovary intact also has the benefit of maintaining a source of estrogen production.

      If a cystic mass is cancerous, however, your doctor will advise a hysterectomy to remove both ovaries and your uterus. After menopause, the risk of a newly found cystic ovarian mass being cancerous increases. As a result, doctors more commonly recommend surgery when a cystic mass develops on the ovaries after menopause.

  13. QUESTION:
    Is there a correlation between endometriosis and ovarian cancer?

    • ANSWER:
      From the ERC (www.endocenter.org), posted to their listserv at http://groups.yahoo.com/group/erc:

      Endometriosis-ovarian cancer link 'underestimated'
      Source: Human Reproduction 2006; 21: 1237-42

      Researchers assess the relative risks of individual cancers over a long period of follow-up among women with endometriosis.

      Women with endometriosis appear to be up to twice as likely as the general population to develop ovarian cancer, say researchers.

      Co-existence of endometriosis and cancer has been reported several times. One study showed an overall relative risk of 1.2 in women with endometriosis compared with those without it, and risks for ovarian cancer and non-Hodgkin's lymphoma of 1.9 and 1.8, respectively.

      Anna Melin (Karolinska University Hospital, Stockholm, Sweden) and colleagues evaluated whether these risk ratios stood in an extended study. They identified women (n = 64,492) who were discharged from a Swedish hospital with a diagnosis of endometriosis between 1969 and 2000, and assessed their incidence of cancer, using the National Swedish Cancer Register.

      Excluding the first year of follow-up, there were 3349 cases of cancer. The overall risk of cancer was no higher than that expected on the basis of the female Swedish population, but ovarian cancer (standardized incidence ratio [SIR] = 1.43), endocrine tumors (SIR = 1.36), non-Hodgkin's lymphoma (SIR = 1.24), and brain tumors (SIR = 1.22) were all more prevalent.

      An even higher risk of ovarian cancer was seen in women with early diagnosed (SIR = 2.01) and long-standing (SIR = 2.23) endometriosis, respectively.

      "This study has shown an increased risk of some types of malignancy, above all ovarian cancer, in women with endometriosis," the researchers conclude.

      "The material indicates that the risk might have been underestimated."

      19 April 2006

      ------------------

      Endometriosis & Malignancies

      We know that Endometriosis can impact every aspect of our lives, from our interpersonal relationships to our careers; from our ability to have children to our ability to get out of bed in the morning. It can change our views on life and how we think about ourselves - and how we think about others. The consequences of Endometriosis touch every part of us, inside and out, prompting some women to refer to their disease as a "benign cancer." Can Endometriosis go one step further and actually turn malignant? Can it even place us at risk for certain cancers and other illnesses? Unfortunately, research shows that for some women, it may.

      Malignant transformation of Endometriosis can and does occur. Some researchers even estimate that approximately 0.7-1.0% of patients with Endometriosis have lesions that will ultimately undergo malignant transformation, and urge consideration of performing bilateral oophorectomy at the time of abdominal surgery in patients with significant disease.(1)

      We have also begun learning of the elevated risks women with the disease have for certain cancers, including non-Hodgkin’s lymphoma. The reasons why remain unclear; however, women with Endometriosis are more likely take certain drugs, such as Progestagens, and are more likely to have had their ovaries or uterus removed, another factor that influences hormone levels and possibly increases cancer risk. One patient undergoing Tamoxifen therapy was discovered to have malignant endometrioid neoplasia arising within her Endometriosis, suggesting to her physicians that the Tamoxifen, as a result of its estrogenic effects, caused proliferative and malignant changes in her disease.(2)

      In a similar study targeting women who had undergone hysterectomy with oophorectomy because of Endometriosis, authors noted that "Endometriosis can undergo estrogen-dependent changes similar to the endometrium and may carry a risk of developing hyperplasia and carcinoma during unopposed estrogen stimulation." The researchers concluded that unopposed estrogen therapy may lead to premalignant or malignant transformation in the residual foci of Endometriosis and encouraged the addition of progestins to estrogen replacement therapy.(3)

      It is also possible that women with Endometriosis may be screened more often certain cancers (i.e., breast) and therefore are more likely to be diagnosed. Endometriosis has also been linked to a lack of physical activity and exposure to the environmental contaminant, dioxin. These two factors may be to blame for the cancer risk, rather than Endometriosis itself.

      Another link being investigated is the role genetic alterations might play in the development and potentially malignant progression of the Endometriotic lesions.(4)

      Age may also be a factor. One study specifically investigating the connection between endometrioid carcinoma of the ovary and Endometriosis in postmenopausal women suggested that ovarian Endometriosis in the postmenopausal patient has the potential to undergo malignant transformation and, when detected, "should be removed surgically."(5)

      Still further overwhelming evidence exists of these malignant transformations and elevated risks. Findings of a survey conducted of over 4,000 Endometriosis patients in the United States and Canada have indicated possible links to other serious medical conditions, including a 9.8% incidence of melanoma, compared with 0.01% in the general population, a 26.9% incidence of breast cancer, compared with 0.1% in the general population and an 8.5% incidence of ovarian cancer, as compared with 0.04% in the general population. Women with Endometriosis who participated in the survey also had a greater incidence of autoimmune conditions and Meniere's disease.(6)

      In a study of 20,686 Swedish women hospitalized for Endometriosis, results showed that the women had a 20% greater risk of developing cancer overall, particularly of the breast, ovaries, blood and lymph cells during an 11-year period. The women actually had a lower risk of cancer of the cervix.(7)

      In another study of 79 patients with Stage I epithelial ovarian cancer at Massachusetts General Hospital, evidence of Endometriosis was found in 22 of the 79 cases (28%), leading researchers to conclude that "Endometriosis may play a role in the pathogenesis of some early stage malignant ovarian epithelial neoplasms."(8) In a similar study,(9) researchers reviewed 147 cases of ovarian Endometriosis to clarify the incidence of malignant transformation. Authors noted that "malignant change in ovarian Endometriosis occurred in 0.7% of this disease."

      While ovarian neoplasms are among the most common malignancies,(10) other sites have been found to undergo malignant changes as well, including clear cell carcinoma arising in an Endometriosis implant in a low abdominal transverse scar,(11) a clear cell carcinoma arising in a cesarean section scar,(12) and even the liver.(13)

      These are just a few examples of such accounts. The increase in such findings should encourage surgeons to excise and biopsy Endometriosis - particularly recurrent disease - as malignant transformation can and does occur.(14)

      These important research findings are not meant to frighten women with Endometriosis, but rather, to make them aware of the true significance and potential impact of the disease. By knowing the risks, patients can take measures to protect themselves; measures such as a change in their diet/nutrition, stopping (or starting) specific medications, getting regularly screened for concerns other than just Endometriosis, and adopting an overall improvement in their lifestyle habits if necessary. Not every woman with Endometriosis is at an elevated risk for other conditions, nor will she develop such malignancies, but every woman with the disease can take steps to help prevent such transformations and opportunistic illnesses from affecting her.

      References:
      1) "Endometrial stromal sarcoma of the vulva arising in extraovarian endometriosis: a case report and literature review," Gynecol Oncol 1998 Nov;71(2):313-6. Irvin W; Pelkey T; Rice L; Andersen W.
      2) "Benign, borderline, and malignant endometrioid neoplasia arising in endometriosis in association with tamoxifen therapy," Int J Gynecol Pathol 2000 Jul;19(3):276-9. McCluggage WG; Bryson C; Lamki H; Boyle DD.
      3) "Malignancy arising in extraovarian endometriosis during estrogen stimulation," Eur J Gynaecol Oncol 1998;19(1):39-41. Gucer F; Pieber D; Arikan MG.
      4) "Increased heterogeneity of chromosome 17 aneuploidy in endometriosis," Am J Obstet Gynecol 1999;180:792-7. Yoshinori Kosugi, MD, Sherman Elias, MD, L. Russell Malinak, MD, Junko Nagata, MD, Keiichi Isaka, MD, Masaomi Takayama, MD, Joe Leigh Simpson, MD, Farideh Z. Bischoff, PhD."
      5) "Endometrioid carcinoma of the ovary and endometriosis: the association in postmenopausal women," Gynecol Oncol 1992 Oct;47(1):71-5. De Priest PD; Banks ER; Powell DE; van Nagell JR Jr; Gallion HH; Puls LE; Hunter JE; Kryscio RJ; Royalty MB.
      6) Endometriosis & Cancer: What is the Connection?" 1999; Duczman, Linda & Ballweg, Mary Lou, 8585 N. 76th Pl., Milwaukee, WI 53223.
      7) "Cancer risk after a hospital discharge diagnosis of endometriosis," Am J Obstet Gynecol 1997;176:572-9. Brinton, Louise A., PhD; Gridley, Gloria, MS; Persson, Ingemar, MD; Baron, John, MD; Bergqvist, Agneta MD, PhD.
      8) "Histologic transformation of benign endometriosis to early epithelial ovarian cancer," Gynecol Oncol 1996 Feb;60(2):238-44. Sainz de la Cuesta R; Eichhorn JH; Rice LW; Fuller AF Jr; Nikrui N; Goff BA.
      9) "Malignant Transformation of Ovarian Endometriosis," Gynecol Obstet Invest 2000 Oct;50 Suppl S1:18-25. Nishida M; Watanabe K; Sato N; Ichikawa Y.
      10) "Ovarian atypical endometriosis: its close association with malignant epithelial tumours," Histopathology 1997 Mar;30(3):249-55. Fukunaga M; Nomura K; Ishikawa E; Ushigome S.
      11) "Clear cell carcinoma arising in extragonadal endometriosis in a caesarean section scar during pregnancy," Gynecol Oncol 1998 Jul;70(1):127-30. Miller DM; Schouls JJ; Ehlen TG.
      12) "Clear cell carcinoma arising in a Cesarean section scar endometriosis: a case report," J Korean Med Sci (Korea 1999 Apr;14(2):217-9. Park SW; Hong SM; Wu HG; Ha SW.
      13) "CT diagnosis of perihepatic endometriosis complicated by malignant transformation," Abdom Imaging 1998 Mar-Apr;23(2):183-4. Weinfeld RM; Johnson SC; Lucas CE; Saksouk FA.
      14) "Vaginal adenosarcoma arising from endometriosis," Gynecol Oncol 2000 Jan;76(1):123-5. Judson PL; Temple AM; Fowler WC Jr; Novotny DB; Funkhouser WK Jr.

  14. QUESTION:
    Anyone ever have a hysterectomy? Please tell me what it was like?
    What was it like and what was recovery time? Any lasting problems? What medications did you take?
    How long were you in hospital?What type of surgery did you have? Scars?

    • ANSWER:
      I had an abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy in September 2008. In English ( :-0) ) this means I had my uterus, both tubes, and both ovaries removed but the cervix was left. My gynie told me that he left it because women usually heal faster with the cervix left intact.

      I had to have an abdominal because of my size (I am considerably overweight). Other factors that indicate abdominal rather than vaginal would be if you had never given birth vaginally.

      I was in the hospital from Thursday morning very early (surgery at 8:30) to Saturday afternoon. I was given morphine for the pain with a little pump for the first couple of days. I also had a catheter that was taken out two days after surgery, just before i was discharged.

      When I went home, I was given pain medicine to take every four hours and instructed to take Advil or Tylenol two hours in between, so that I always had some kind of pain relief "on board." I recommend getting up at night to take the meds the first few days, because otherwise you will wake up and REALLY be in pain. You will also be very tired and should rest a lot the first couple of weeks. You will not be allowed to drive and should stay home, doing no lifting over 10 pounds, no housework, etc.

      (If you have your surgery abdominally) The staples from the abdominal incision come out at 2 weeks and you feel MUCH better after that. I tried to go back to work at 4 weeks post-op and it was just too soon. I ended up being out from September 25 (surgery day) to November 10, when I started working 4 hours per day, and returned full time on December 1.

      I had the surgery after suffering through 28 years of heavy periods, crippling pain and nausea and cramps nearly every month, and PCOS. When they opened me up, they found fibroids and endometriosis as well. Yuck.

      Other than the fact that losing your ovaries plunges you into instant menopause, I have felt better since my surgery than I felt in years (I was 43 at the time of the surgery). Even the menopause is pretty tame compared to the monthly ordeal. LOL

      I also recommend hystersisters.com, I had questions there and the ladies were very nice and helpful. Good luck to you!

  15. QUESTION:
    Is a hysterectomy painful after wards?
    I am in alot of pain with Endometriosis and I want the pain to stop but will the histerectomy hurt as well when the surgery is done and what about all the hormones will they change my sex life?

    • ANSWER:
      Depends on a lot of factors...for instance:

      "Why": if Endo is the "only" reason for the hysterectomy, please know that there are alternative treatments and that a hyst is *not* in any way a cure for Endo. At all. If you have disease left behind anywhere in the body after the hyst, whether the ovaries are removed or not, you will have disease recurence without fail. Endo implants produce their own estrogen-synthesizing enzyme called Aromatase; it is because of Aromatase that the majority of women who have undergone hyst without proper removal of disease (excision, see www.centerforendo.com for details) will continue to experience pain. "Hyst as a cure" is an old wives tale, along with "pregnancy is a cure" and "menopause is a cure."

      "How:" an LAVH [laparoscopic assisted vaginal hyst] is less invasive and offers quicker recovery. An abdominal hyst is far more invasive and has longer recovery. Vaginal hyst is less invasive and has faster recovery overall than the others above, but can affect sexual function. Vaginal hysterectomy is preferable to abdominal hysterectomy where possible, however. Where vaginal hysterectomy is not possible, laparoscopic hysterectomy is preferable to abdominal hysterectomy, although it brings a higher chance of bladder or ureter injury [Methods of Hysterectomy: Systematic Review & Meta-analysis of Randomised Controlled Trials; BMJ. 2005 Jun 25;330(7506):1478].

      "What:" as in, what will be done, i.e., removal of uterus only, hysterectomy with oophorectomy [removal of one or both ovaries], hysterectomy with salpingoopherectomy [removal of one or both fallopian tubes], radical hysterectomy, which removes the uterus, cervix, the top portion of the vagina and most of the tissue that surrounds the cervix in the pelvic cavity. Pelvic lymph nodes may also be removed; supracervical hysterectomy, also referred to as a subtotal hysterectomy, which removes the uterus while leaving the cervix intact.

      It is a major operation, any way you cut it (no pun intended). It will take at least 2 weeks or longer to be completely healed, again, depending on what was done, how complicated your surgery was, etc. Abdominal surgery recovery is expected to be easily longer than 2 weeks till you feel "normal."

      If the surgery is done for a good and valid reason (valid scientific research has offered abundant evidence that Endometriosis does not count as a "good, valid reason" if no other treatment has been conferred previously), and all precautions are being taken to give the patient the most effective, safest and least invasive method of surgery, AND her surgical menopause issues will be addressed (if ovaries are removed) by her concerned, compassionate doctor afterward, AND she feels comfortable with all of the decisions, then the long-term outlook should be perfectly fine. It hurts, just as with any other surgery, but the pain does resolve.

      I am concerned for you that you are undergoing a hyst without being fully informed. Please - do talk to others first and do some research on excision of Endometriosis as a worthwhile, advanced treatment option before consenting to the hyst. I would hate for you to suffer needlessly. http://www.endocenter.org, http://groups.yahoo.com/group/erc and http://www.centerforendo.com are good places to start.

      Good luck no matter what you decide.

  16. QUESTION:
    types of treatments for endometriosis that worked for you?
    I just want to know what else is used other than birth control and causing menopause

    • ANSWER:
      From the Endo Research Center, a free foundation for Endo, available online at www.endocenter.org:

      "Endometriosis, a leading cause of pelvic pain, hysterectomy and female infertility, is a reproductive and immunological disease affecting nearly 89 million women and teens worldwide. The average delay in diagnosis is a staggering 9 years, and the disease can only be definitively diagnosed through gynecologic surgery.

      With Endometriosis, tissue like the endometrium is found outside the uterus, in other areas of the body. These growths, called "implants" or "lesions," still respond to hormonal commands each month, breaking down and bleeding. However, unlike the endometrium, the tissue has no way of leaving the body. The result is internal bleeding, degeneration of blood and tissue shed from the growths, inflammation of the surrounding areas and formation of scar tissue. Depending on the location of the growths, interference with the bowel, bladder, intestines and other areas of the abdominal cavity can occur. Endometriosis has even been found lodged in the skin, the lungs and even the brain.

      There is currently no definitive cure for Endometriosis, but there are several effective methods of disease management. Many women can and do live well in spite of their Endometriosis.

      Endometriosis staging has been defined by the American Society for Reproductive Medicine, with criteria based on the location, amount, depth and size of disease implants. These factors are graded on a point system based on biopsy samples obtained during surgery. The first classification scheme was developed in 1973, but since then it has been revised and refined 3 times for a more precise method of documentation. As of 1985, the stages are classified as 1 though 4; minimal, mild, moderate, and severe. Stage is not indicative of pain levels, infertility or symptoms. A woman in Stage 4 can be asymptomatic while a Stage 1 patient might be in debilitating pain.

      Malignant transformation of Endometriosis can and does occur. Some researchers even estimate that approximately 0.7-1.0% of patients with Endometriosis have lesions that will ultimately undergo malignant transformation, and urge consideration of performing bilateral oophorectomy at the time of abdominal surgery in patients with significant disease. We have also begun learning of the elevated risks women with the disease have for certain cancers, including non-Hodgkin’s lymphoma. The reasons why remain unclear; however, women with Endometriosis are more likely take certain drugs, such as Progestagins, and are more likely to have had their ovaries or uterus removed, another factor that influences hormone levels and possibly increases cancer risk. One patient undergoing Tamoxifen therapy was discovered to have malignant endometrioid neoplasia arising within her Endometriosis, suggesting to her physicians that the Tamoxifen, as a result of its estrogenic effects, caused proliferative and malignant changes in her disease. In a similar study targeting women who had undergone hysterectomy with oophorectomy because of Endometriosis, authors noted that "Endometriosis can undergo estrogen-dependent changes similar to the endometrium and may carry a risk of developing hyperplasia and carcinoma during unopposed estrogen stimulation." The researchers concluded that unopposed estrogen therapy may lead to premalignant or malignant transformation in the residual foci of Endometriosis and encouraged the addition of progestins to estrogen replacement therapy. It is also possible that women with Endometriosis may be screened more often certain cancers (i.e. breast) and therefore are more likely to be diagnosed.

      While no one is certain exactly what causes Endometriosis, there are several theories, though none are definitive. Common ones include:

      Sampson's Theory of Retrograde Menstruation
      In 1921, Dr. John Sampson contended that "during menstruation, a certain amount of menstrual fluid is regurgitated, or forced backward, from the uterus through the fallopian tubes and showered upon the pelvic organs and pelvic lining." There has been evidence to support Dr. Sampson's theory; however, studies have shown that while many women experience retrograde menstruation and have evidence of a "tipped" uterus, not all women will develop the disease. His theory also fails to explain the presence of Endometriosis in such remote areas as the lungs, skin, lymph nodes, breasts and other areas.

      Transplantation Theory
      Believes that Endometriosis is spread through the lymphatic and circulatory systems. This would explain Endometriosis in most sites, but does not explain the presence of disease to begin with.

      Iatrogenic Transplantation ("Doctor Caused")
      Holds that the accidental transference of diseased tissue occurs from one site to another during surgery. However, this is highly uncommon today due to advanced surgical management. It also does not explain the presence of the disease to begin with.

      Coelomic Metaplasia
      Drs. Ivanoff and Meyer's theory that "certain cells, when stimulated, can transform themselves into a different kind of cell." This would explain the presence of the disease in absence of menstruation, and further, the presence of Endometriosis in the few men who have been diagnosed with it.

      Heredity
      A very popular theory that women with relatives who have the disease may be genetically predisposed to developing it themselves. This theory was suggested as early as 1943, and research is currently underway by Oxegene Study scientists at the University of Oxford in the United Kingdom.

      Immunity
      According to the Institute for the Study and Treatment of Endometriosis in IL, "two different arms of the immune system may be involved in the development of Endometriosis. Cell-mediated immunity, in which specific immune cells fight disease; and humoral immunity, in which antibodies are formed to attack antigens." Studies by others suggest that migrating Endometriotic tissue affects women who have "deficient cell mediated immunity." In women without the deficiency, the transplanted cells are destroyed.

      Genetics
      Researchers have discovered that some women's genetic makeup determines their predisposition for contracting the disease.

      Still others believe it is a combination of many different factors that cause some women to have the disease.

      Some women with Endometriosis have no symptoms, others have chronic or debilitating pain and infertility. Some general symptoms of Endometriosis include chronic or intermittent pelvic pain, dysmenorrhea (painful menstruation is not normal!), infertility, miscarriage(s) and ectopic (tubal) pregnancy.

      Location specific symptoms of Endometriosis include:

      Cul-de-Sac ("Pouch of Douglas")
      The Cul-de-Sac is one of the most common (top 5) disease locations. Endometriotic implants express an "irritating focus" of prostaglandins and other chemicals. The Cul-de-Sac is surrounded by the posterior wall of the uterus, the supravaginal cervix, the upper part of the vagina, the rectum and the sacrum, the small intestine and the sacrolateral ligaments. Hence, this "irritating focus" can aggravate all the areas named, including the bowel. This can account for bowel symptoms when there are no implants actually present on the bowels. The same is true for disease located on the appendix. Dyspareunia (pain during intercourse) and pain after intercourse are also commonly reported symptoms by women with Cul-de-Sac Endometriosis.

      Uterosacral/Presacral Nerves
      Backache, leg pain, painful intercourse are often the chief complaints of women with Endometriosis in these common locations.

      Gastrointestinal Tract
      The rectosigmoid colon, rectovaginal septum, small bowel, rectum, cecum, large bowel, appendix, distal ileum, gallbladder and intestines make up the GI tract. GI tract symptoms include nausea, vomiting, constipation, painful bowel movements, blood in stool, rectal bleeding, sharp gas pains, bloating and tailbone pain.

      Bladder, Kidneys, Ureters and Urethra
      Women with Endometriosis of these areas complain of blood in the urine, tenderness around the kidneys, painful or burning urination, flank pain radiating toward the groin, urinary frequency, retention, or urgency, and hypertension. Many women with Endo also have Interstitial Cystitis, Endo's "Evil Twin."

      Pleural (Lung and Diaphragm)
      Coughing up of blood/bloody sputum, particularly coinciding with menses, accumulation of air/gas in the chest cavity, constricting chest pain and/or shoulder pain, shoulder pain associated with menses, shortness of breath, collection of blood and/or pulmonary nodule in chest cavity, deep chest pain.

      Sciatic Nerve
      Pain in the leg and/or hip which radiates down the leg are found in women with this form of disease. This symptom is concurrent with that of inguinal (groin area) Endometriosis as well.

      Subcutaneous/Cutaneous Endometriosis
      Painful nodules, often visible to the naked eye, at the skin's surface. Can bleed during menses and/or appear blue. The vagina is the most common location for this form of disease.

      Fatigue, chronic pain, allergies and other immune system-related problems are also commonly reported complaints of women who have Endometriosis.

      It is quite possible to have some, all or none of these symptoms. Many women with Endometriosis are completely asymptomatic. Endometriosis symptoms are so inconsistent and non-specific that they can easily masquerade as several other conditions. These include adenomyosis ("Endometriosis Interna"), appendicitis, ovarian cysts, bowel obstructions, colon cancer, diverticulitis, ectopic pregnancy, fibroid tumors, gonorrhea, inflammatory bowel disease, irritable bowel syndrome, ovarian cancer and pelvic inflammatory disease.

      Younger women and teens with symptoms are often dismissed and told they have PID or that they are "too young" to have Endometriosis. Once erroneously believed to be a disease of “Caucasian career women who have delayed childbearing,” we know that in fact, Endometriosis affects women of all ages, races and socioeconomic status. Endometriosis also can and does exist in the adolescent female population. Far from the “rare” incidence once believed, studies have found that as many as 70% of teenagers with chronic pelvic pain had Endometriosis proven by laparoscopy. Other reports indicate that as many as 41% of patients experienced Endometriosis pain 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. Sometimes, teens and young women lack support and validation from both the home and the school; told the pain is “in their head,” that they are “faking it,” that their debilitating cramps are “normal” and “a part of womanhood,” that they are merely suffering from “the curse,” or that they should just “grin and bear it.” Their symptoms may also be dismissed as a sexually transmitted disease, which Endometriosis absolutely is not. Failure to acknowledge and address symptoms early in the disease process can lead to significant delays in diagnosis and necessary, subsequent treatments. Lack of support from family and loved ones can also add to the patient’s pain and fear - at any age. Recent studies have also shown that Endometriosis may in fact have an even bigger impact on younger patients than older women. One such study discovered that in patients under 22 years of age, the rate of disease recurrence was double that of older women (35% versus 19%). The study also revealed that the disease behaves differently in younger women; leading some researchers to believe it is a different form of Endometriosis altogether. Surgery, considered necessary to accurately diagnose and effectively treat the disease, is often withheld from younger patients based on the injudicious belief that early surgery somehow negatively influences a young woman’s fertility. Extensive, cumulative research has shown this concern to be unfounded. What can impact fertility, however, is neglecting effective treatment of the disease. Some researchers also feel that symptomatic, adolescent-onset Endometriosis is most often a lifelong problem that will progress to severe fibrotic disease.

      While some larger implants and endometriomas may be seen through ultrasonography, CT Scan, MRI or other diagnostic procedure, such detection rates are limited. Thus, the current gold standard for a positive diagnosis of Endometriosis is via gynecologic surgery like a laparoscopy, or in some cases, open surgery like the laparotomy. Laparoscopy entails visualization of the abdomen and pelvic cavity via an instrument known as the laparoscope - a thin, lighted instrument fitted with a telescopic lens and on occasion, a miniature videocamera. During "the Lap," as it is commonly referred to, your organs will be manipulated for viewing, diagnoses are made, biopsies are taken, and therapeutic measures are usually performed as well.

      While there is no cure for Endometriosis, treatments exist ranging from medical to alternative to surgical. Some, such as surgical excision, confer longer-lasting benefits than others.

      Surgical destruction of the disease can be done in many various ways, according to the surgeon's preference and training. These include:

      Excision
      Cutting out of entire diseased implants, while preserving the healthy portions of the affected organ(s). This meticulous form of removal can only be performed by an advanced endoscopic specialist with a full understanding of modern concepts of treatment. Recurrence rates are less than 10% at 5 years out.

      Vaporization
      Destruction of implants by instant boiling of the cellular water with a high power laser or electrosurgical tool.

      Ablation
      Removal by any surgical means; generally involves laser. This is the most common method utilized by Gyn Surgeons. Recurrence is over 80% within the first 2 years.

      Coagulation
      Desiccation of implants by heating and drying the affected tissue(s).

      Fulguration
      Superficial burning of implants with a spark of electricity from any electrosurgical tool.

      Ultrasonic
      Some surgeons prefer ultrasonic treatment methods; this means sound waves at very high frequency will be used as an energy source. Two devices are currently used by surgeons who practice this method are the Harmonic Scalpel and the CUSA (Cavitational Ultrasonic Surgical Aspirator).

      Hysterectomy
      Endometriosis remains a leading cause of hysterectomy and accounts for nearly half of the 600,000 hysterectomies performed in the U.S. annually. While not a definitive cure for the disease, some women have experienced relief of painful symptoms following a hysterectomy. Certainly, each case of Endometriosis is different and each patient requires a different course of treatment. A hysterectomy is just one of the many surgical options that can be considered in your search for treatment. The old school belief was once that a hysterectomy was the cure for Endometriosis. Today, of course, we know this is untrue and that a hysterectomy is no more curative than "prescribed pregnancy" (another common fallacy). However, some women with Endometriosis who have elected to undergo a hysterectomy have found relief following the procedure.

      Several patients can experience relief through the use of hormonal agents and other medical therapies. These include:

      Aromatase Inhibitors
      Studies have shown that misplaced Endometrial tissues respond to ovarian hormones such as estrogen and go through a menstruation-like process (bleeding, shedding and inflammation) repetitiously in the abdomen of a woman. Estrogen is like fuel to fire for Endometriosis, thus current treatments have been designed to stop estrogen secretions from the ovaries of a woman (gonadotropin releasing hormone agonists). Estrogen, however is made not only in the ovaries but also in adipose tissue [fibrous, insulating tissues packed with fat cells], and most importantly, *within Endometriosis implants themselves.* Thus, Endometriosis tissue acts in a devious manner to make its own estrogen through the abnormal expression of aromatase enzyme, sustaining its own life cycle. This may explain the high numbers of treatment failures and early recurrences after conventional treatments of Endometriosis. Aromatase Inhibitor treatment is in trials, but not yet widely available.

      GnRH (gonadotropin-releasing hormone) Agonists
      These are drugs that are designed to suppress the Endometriosis implants by stimulating the ovaries to produce more estradiol (the most potent form of estrogen) then paradoxically, after 7 to 21 days of constant stimulation, shutting down the "messenger" hormones sent from the pituitary gland to the ovaries. The result is that the ovaries shut down, estradiol levels drop sharply and rapidly and the patient ceases to ovulate or menstruate; a condition similar to that of menopause. Some women experience positive results with GnRH treatments, others do not. As with any treatment, each case will vary. Though the medications can temporarily shrink the lesions of Endometriosis, they will not shrink adhesions or scar tissue, which often play a part in the symptomatic pain of the disease, nor do they treat infertility in any way. Common side effects that have been reported by women undergoing treatment include hot flashes, headaches, insomnia, vaginal dryness, decreased libido, depression, mood swings, fatigue, acne, dizziness, nausea, short term memory loss, diarrhea, hair loss, anxiety, and bruising at injection site. There are several different GnRHs that can be considered for treatment. These include Lupron Depot, Synarel, Zoladex and Suprefact.

      Other medications include synthetic hormones like Danazol. This synthetic testosterone marketed under the names "Danocrine" or "Cyclomen" is usually given in pill form. Danazol was the first medication approved for use in the treatment of Endometriosis and works by suppressing the ovaries. However, expense and side effects have made it a less common approach by physicians today.

      Contraceptives such as Depo-Provera (medroxyprogesterone acetate) and Provera (both progestins, administered by injection or orally) are also used to treat the disease, as are combination estrogen/progesterone oral contraceptive pills like Alesse and Lo-Ovral.

      Pain management options include non-steroidal anti-inflammatories (NSAIDs) such as Anaprox or Toradol. Stronger narcotics and anti-depressants are often used as well.

      Alternative therapies may also be effective and non-invasive for some patients, including:

      Immunotherapy, Diet & Nutrition, Shiatsu, Naturopathy, Biofeedback, Osteopathy, Homeopathic Therapy, Chiropractics, Acupuncture, use of a Transcutaneous Electrical Nerve Stimulation (TENS) unit, Bach Flower Remedies, Exercise, Aromatherapy, Reflexology, Herbs, and Massage Therapy.

      There is no cure for Endometriosis, but there are ways to cope. For more information on Endometriosis, please visit the ERC on the web at http://www.endocenter.org and join the ERC's free online Listservs at http://groups.yahoo.com/group/erc and http://health.groups.yahoo.com/group/EndoDocs."

  17. QUESTION:
    What will happen to me if i surgically remove my ovaries? What changes will there be in my body?

    • ANSWER:
      the medical term for removing your ovaries is called a Oophorectomy.
      Oophorectomy is often necessary when pelvic disease, such as ovarian cancer or severe endometriosis, is present. In the United States, more than 600,000 hysterectomies (the surgical removal of a woman's uterus) are performed each year. About half of these involve removal of the ovaries too.

      Oophorectomy is sometimes recommended when the hormones produced by the ovaries are worsening a disease, such as breast cancer or severe endometriosis.

      In rare cases, the ovaries are removed in an attempt to reduce the possibility of developing a future disease, such as ovarian cancer. This is called a prophylactic oophorectomy.
      If you do not have an increased risk of ovarian cancer or another disease that requires the removal of your ovaries, consider the benefits of not having your ovaries removed. These benefits include:

      Hormones. When an oophorectomy is done before a woman's natural age of menopause, estrogen replacement therapy (ERT) may be prescribed afterward to reduce the risk of osteoporosis, hot flashes, and other menopausal symptoms. Ask your doctor about other problems that may be related to using ERT.
      Fewer fractures. Removal of the ovaries increases the risk for developing weak and brittle bones (osteoporosis), because the body no longer produces a large amount of estrogen. The risk for developing osteoporosis following an oophorectomy is greater in young women.
      Long-term survival benefits. Women younger than age 65 who do not have their ovaries removed have a slight increase in long-term survival. This increase may occur because women who have their ovaries have fewer fractures and are less likely to develop heart disease.1

      From webmd

      For more information..consult your Gynecologist or Obstertician

  18. QUESTION:
    What is endometriosis? Its treatment?How can someone get pregnant when you have this condition?

    • ANSWER:
      The endometrium is the tissue that lines the uterus. During each menstrual cycle, a new endometrium grows, preparing for a possible pregnancy. If you do not become pregnant during that cycle, the endometrium is shed, which you know as your menstrual period. Endometriosis is endometrium tissue that grows outside of the uterus. This usually occurs on the ovaries, the fallopian tubes, the outer surface of the uterus, the bowels, or other abdominal organs. Rarely, it can affect other organs and structures in the body. Endometriosis that does not cause symptoms or causes only mild symptoms usually does not require medical treatment. Treatment of endometriosis that is causing moderate to severe pain includes:
      Identification and removal of endometrial tissue throughlaparoscopy. Endometrial implants may be destroyed by laser beam or electric current (electrocautery), or cut away and removed during the procedure.
      Use of medications that shrink the endometrial implants and control symptoms.
      Surgery to remove the uterus and ovaries (hysterectomy and oophorectomy). Many women with endometriosis can conceive naturally. For those who have difficulty, surgery often provides a "window of opportunity" during which the chances of conception increase. In a study that was done, 172 women underwent laparoscopic treatment of endometriosis. Of those, 50 became pregnant within 36 weeks. The authors attributed a 13% increase in the probability of pregnancy to the surgical treatment.

  19. QUESTION:
    After having my uterus remove because of endometriosis and scar tissue can it continue to spead?
    I had my uterus removed in 2001 because i had endometriosis and scar tissues bad. I had painful periods, heavy bleeding, and painful sex. At first I had a laparoscopy done and within 2 months i had the surgery. My doctor said she didnt want to take out my ovaries because i was too young (21). I had endometriosis all over my adominal wall , matterfact my uterus was stuck to my adominal wall alone with my bladder. Now it been 6 years and i feel like my condition is getting back worse. Do you think i need another scope to clean up my pelvic area? Also i think those monthly cyst and the endo have beaten up my ovaries, because my sexual drive is not there anymore.Please help me i dont think my new dr. understands where iam coming from. He keeps giving me birth controls.

    • ANSWER:
      If your doctor did not truly excise (see http://www.endometriosistreatment.org for info on what excision is and why it is superior in terms of surgical treatment) all disease from all locations, then he or she simply superficially removed some of it from some locations, leaving active disease behind to cause symptoms and continue to thrive. There are many true Endo specialists out there who can offer definitive help, instead of superficial surgeries, medical suppression and unnecessary hysterectomies (hysterectomy is NOT a cure for Endometriosis nor is oophorectomy - look up aromatase enzyme information as it relates to Endo and you'll understand why). I do feel a consult followed by a definitive surgery with a specialist would be your best bet. Good luck and feel better.

  20. QUESTION:
    what is entometriosis cancer?&can a complete hysterectomie really take in all away?
    i am waiting for my sugury date and am very scared,alot of things run threw my mind, like once they remove this will the cancer be gone?&like how will this affect me as a woman?with ur hormones and stuff?will a sex life still extist?

    • ANSWER:
      Endometrial cancer is cancer of the lining of the uterus. According to Medline, it is the most common type of uterine cancer. Although the exact cause of endometrial cancer is unknown, increased levels of estrogen appear to have a role. One of estrogen's normal functions is to stimulate the buildup of the epithelial lining of the uterus. Excess estrogen administered to laboratory animals produces endometrial hyperplasia and cancer. It is also associated with obesity, hypertension and polycystic ovarian disease. Tamoxifen, used to treat breast cancer, may also increase the risk of developing endometrial cancer.

      Endometrial cancer should not be confused the disease Endometriosis, or with the malignant shifts that can and do occur (albeit rarely) in women with Endometriosis.

      Symptoms include abnormal uterine bleeding, abnormal menstrual periods, bleeding between normal periods in premenopausal women, vaginal bleeding or spotting in postmenopausal women, extremely long, heavy, or frequent episodes of bleeding in women over 40, lower abdominal pain or pelvic cramping, and thin white or clear vaginal discharge in postmenopausal women.

      Treatment varies based on the stage. For example, women with the early stage 1 disease may be candidates for treatment with surgical hysterectomy, but removal of the tubes and ovaries (bilateral salpingo-oophorectomy) is also usually recommended for 2 reasons, 1.) tumor cells can spread to the ovaries very early in the disease and 2.) any dormant cancer cells that may be present could possibly be stimulated by estrogen production by the ovaries. Abdominal hysterectomy is recommended over vaginal hysterectomy, because it affords the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of cancer.

      Women with stage 1 disease who are at increased risk for recurrence, and those with stage 2 disease are often offered surgery in combination with radiation therapy. Chemotherapy may be considered in some cases, especially for those with stage 3 and 4 disease.

      The 5-year survival rate for endometrial cancer following appropriate treatment is:

      75 - 95% for stage 1
      50% for stage 2
      30% for stage 3
      Less than 5% for stage 4

      You can find others who understand at http://www.nlm.nih.gov/medlineplus/ency/article/002166.htm.

      Good luck to you.

  21. QUESTION:
    Are there other alternative treatments for Endometriosis other than the Lupron Depot Shot?

    • ANSWER:
      Let me make one thing very clear to you that there is no cure to endometriosis. Treatment for endometriosis is aimed at easing the symptoms so that the condition does not interfere with your daily life.

      Not treating at all is an option if the symptoms are mild and there are no problems with subfertility of infertility. In about a third of cases, endometriosis gets better by itself without treatment. It is also possible to keep an eye on the symptoms and decide to have treatment if they get worse.

      Drug treatments

      Pain killers:

      Non-steroidal anti inflammatory (NSAIDS) are usually the preferred treatment, as they act against the inflammation caused by endometriosis as well as helping ease pain and discomfort. Examples are ibuprofen and naproxen.
      Paracetamol is sometimes used as an alternative. It is not usually as effective as NSAIDS, but may be used if NSAIDS cause any side effects
      Codeine is a stronger pain killer that is sometimes combined with paracetamol or used alone if other pain killers are not suitable. Constipation is a common side-effect

      Hormone treatments:

      Hormone treatments aim to stop egg release (ovulation). This encourages the endometrial tissue to shrink and this helps to reduce the symptoms. In some cases, they may eventually disappear. In effect the treatment stops your periods. There are four broad types of hormone-based treatment:

      Progestogens: these drugs stop egg release and help to shrink endometrial tissue. They sometimes have unpleasant side effects such as bloating, mood changes, irregular bleeding and weight gain. Drug names include medroxyprogesterone acetate, dydrogesterone, and norethisterone.

      Antiprogestogens: these drugs create an effect similar to after the menopause. They can have unpleasant side effects including weight gain, acne, mood changes and the development of masculine features (hair growth and deepening voice). Drug names include danazol and gestrinone; gestrinone is known to have fewer unpleasant side effects

      Combined oral contraceptive pill: Although not officially licensed for the treatment of endometriosis, it can help to relieve symptoms and can be taken indefinitely

      Gonadotrophin-releasing hormone (GnRH) analogues: this is a group of drugs that create an effect similar to after the menopause. They often have unpleasant side effects similar to the menopause such as hot flushes, difficulty sleeping, vaginal dryness, low libido, and headaches and reduced bone mineral density (‘thinning' bones). For this reason they can only be used for relatively short periods of time (6 months). Drug names include buserelin, goserelin, nafarelin, leuprorelin, and triptorelin.

      Surgery

      Surgery can be used to remove areas of endometrial tissue and this can help with the symptoms. This kind of surgery will depend on where the tissue is. Often it is carried out as ‘keyhole’ surgery during a laparoscopy and may include the use of laser surgery techniques. This type of surgery is sometimes called ‘conservative’ surgery as it has a smaller impact on your body and the operations are generally minor.

      If other treatments have not worked and if you have decided not to have any more children, then a hysterectomy is an option. Sometimes this includes removal of the ovaries too (Oophorectomy). Generally, this is considered to be a ‘last resort’ treatment and there is evidence that, even after this operation, endometriosis can come back. Hysterectomy and Oophorectomy are sometimes called ‘radical’ surgery as they are major operations that will have a significant impact on your body.

      Support from self-help groups can be very helpful if you are learning to manage endometriosis.

  22. QUESTION:
    Would a hysterectomy cure PCOS?
    Would a hysterectomy cure a case of PCOS or poly-cystic ovarian syndrome? I am really young, but I have other health problems that I am in treatment for. The treatment isn't working as well due to this. Also does anyone know the youngest patient to have a hysterectomy?

    • ANSWER:
      Not just a hysterectomy, you would have to have your ovaries removed too (an oophorectomy) as the ovaries will continue to release hormones even without the womb there.
      I have just had a big operation for PCOS and endometriosis, I've had ovarian drilling done on both ovaries, this may be an option for you as the surgery has good results.
      There is always the option too of taking the oral contraceptive pill or using a drug called metformin.
      Hysterectomy is a radical step and you will find hardly any Doctor willing to perform such an operation on someone so young. You may not want children now but think of the future, once your uterus is gone, it's gone forever and you will never get the chance to experience having your own children. If in another ten years or so you still feel the same then you can reassess the situation then but you are best off trying other treatments for PCOS in the meantime.
      The youngest patients to have a hysterectomy are usually those who sadly have cancer and there is no alternative but to remove the uterus.
      Have a chat with your Ob/Gynae consultant about ovarian drilling or hormonal treatments and see if you can find something that will help you in the meantime.

  23. QUESTION:
    Can Endemetreosis come back after a Hysterectomy ?
    Hi, Well i suffered with endemetreosis for 14 years, I got through it but had alot of pain and discomfort, during this time I took danazol and various pills to help, but with that failing i had surgery to remove it but within 12 months it was back around my pelvis, ovaries, bowels etc.. during a time of no treatment I amazingly got pregnant and thought this was the best thing this could do the trick, I had my 1st baby which was fantastic, then within 18 months was expecting my 2nd, I am so lucky to have them both, as being told never would happen. Anyway after time the old Capital E returned and as a result I had a hysterectomy which is 3 years ago this month. I have been having HRT for 2 years, but for the last 4 months have been experiencing my old symptoms back ache, servere low abdominal pain and a stomach that looks 6 months pregnant, pelvic congestion, could it be back ???

    • ANSWER:
      Endometriosis has a tendency to recur but you will be need a proper diagnosis of recurrence. Pregnancy isn't always impossible with endometriosis. It can be difficult to very difficult to impossible, depending on the severity of the condition. Pregnancy relieves the symptoms. It inhibits the growth and bleeding of the endometrial implants because ovulation and menstruation are suppressed. The excess endometrial tissue are called implants because they implant themelves on surrounding tissue and structures. This isn't a question of "adhesions or cysts returning" as this was never your problem to begin with.

      It is possible that you may require further cauterization or vaporization of additional implants. If you had a hysterectomy only without the bilateral salpino-oophorectomy, you may need this additional surgical procedure as well. The two most common areas that endometrial tissue implants itself on are the ovaries and the pouch of Douglas (cul-de-sac of Douglas), a pouch formed by the caudal portion of the parietal perineum (the membrane that lines the abdominal wall).

      I trust that you've already reported this to your OB/Gyn. If not, do so right away. Congratulations for defying the odds and having two healthy children!

  24. QUESTION:
    Question about a hysterectomy?
    I had a hysterectomy five years ago, because I have endometriosis. But I still have my ovaries, and for the last two weeks I've been spotting blood off and on. Is that normal? I really don't want to go to my doctor, because I hate doctors and examinations. Does anyone possibly know what this could be?

    • ANSWER:
      http://www.hystersisters.com/vb2/showthread.php?t=270169

      What are the risks of hysterectomy surgery?
      As much as we would like everything to go perfectly, things can go wrong. Luckily, very serious problems are uncommon in hysterectomies.

      There are the usual surgical risks of blood loss, infection and problems with the anesthesia. What is unique about a hysterectomy is that the pelvic organs are packed closely together in a small space, and sometimes they adhere to other abdominal organs. This poses the danger of an inadvertent puncture of the bowel, bladder or ureters, and that risk increases for patients with severe endometriosis or large fibroids. Obviously, the goal is to spot such a puncture during surgery and repair it.

      How can I prepare for the operation?
      You will withstand surgery better and recover more quickly if you are in good physical shape. That means doing aerobic exercise and quitting or at least cutting down on smoking if you are a smoker. You should also stay as close as possible to your ideal weight, since too much extra weight puts you at major risk for complications with the anesthesia as well as the surgery. Take iron to build up your blood, and get plenty of rest so that your immune system is not stressed by fatigue.

      I stop taking my medications?
      It’s important to ask your doctor which medications are safe to take before surgery. Anti-inflammatories Motrin, Naprosyn and other drugs that many people use for arthritis, headaches and other conditions could be hazardous because they can interfere with clotting. You should absolutely not take MAO inhibitors. Also, be sure to talk to your doctor about any allergies you have to medication.

      If you are a woman with serious heart or lung disease, you should meet with your anesthesiologist well before surgery to plan your anesthesia in advance.

      What can I expect from recovery?
      Whether you have an abdominal or a vaginal hysterectomy, you should anticipate a six-week recovery. Abdominal hysterectomy patients must wait for the stitches that hold the skin together to heal. Even vaginal hysterectomy patients may find that they need more time than they anticipated to recover. (It’s a good idea to schedule the time in case the vaginal operation they anticipated turns into an abdominal one.) Keep in mind recuperation time can vary depending in part on your age, your physical shape and other factors that cannot be anticipated.

      When you go home, avoid strenuous activities, especially if they affect your abdominal muscles. Climb stairs slowly and infrequently and don’t drive during the week or two after surgery.

      Ask your doctor about intercourse. I tell my patients to avoid it until I can check to see that everything is healed. Sexual stimulation and orgasmic responses are OK, but you should not have anything in your vagina.

      When can I go back to work?
      I generally recommend waiting six weeks before you go back to work. Even if you are not in pain two weeks after surgery, you may find that you are tired and need to rest in the afternoons. Whether you have a laparoscopically assisted vaginal hysterectomy, an abdominal hysterectomy or a vaginal hysterectomy, you should also avoid lifting for six weeks.

      What symptoms should I watch for after a hysterectomy?
      Keep an eye on bleeding. You will have some staining or discharge from the vagina as stitches dissolve, but call your doctor if it is more than the bleeding of a normal menstrual period. Also, call your doctor about fevers that are higher than 100°F.

      You should feel less pain each day. You may also feel hot flashes related to changes in estrogen levels, whether or not your ovaries have been removed. If you did have an oophorectomy and your ovaries were working well before they were removed, you may need a large dose of estrogen. You may need less estrogen if you were going through menopause at the time of your hysterectomy and oophorectomy. But call your physician if you find you are having hot flashes, sleep problems and other menopausal symptoms.

      Will hysterectomy bring on menopause?
      If you are premenopausal and your ovaries are removed, you can expect to undergo surgical menopause and may experience symptoms such as hot flashes. Because their symptoms will be more severe than they would be in a natural menopause, women whose ovaries are removed usually decide to have estrogen replacement therapy (ERT) postoperatively.

      Some women who keep their ovaries experience temporary hot flashes after a hysterectomy. This is not menopause, but temporary estrogen replacement therapy (ERT) can usually do a good job of alleviating the symptoms.

      How will a hysterectomy affect me emotionally?
      Every woman will have a different reaction to her hysterectomy. Those who have their ovaries as well as their uterus removed can have particularly strong emotions. It can help to address questions of femaleness, sexuality and sexual response before the operation. Some women will have a lot of concern about their hysterectomy even if they have finished childbearing. Others will think of it as a necessary operation, not much different than an appendectomy.

      Call your doctor if something really starts to bother you. If you feel foolish calling your doctor, try your doctor’s nurse. Most nurses have been through hysterectomies with a lot of patients and understand the issues.

      How will a hysterectomy affect my sex life?
      Many women experience some temporary pain during intercourse the first few times after a major operation. Others find permanent changes.

      Obviously, you will not have uterine contractions with orgasms after a hysterectomy. You will have no cervix, so if you are among the women whose pleasure involves pressure against the cervix, the hysterectomy will affect your sexual response. If you had your hysterectomy because of endometriosis or fibroids, this painful tissue will no longer be jabbed and you may be much more comfortable during intercourse.

      Since estrogen keeps the vagina moist, you will have to lubricate your vagina if your ovaries are taken out. You can choose a standard lubricant such as K-Y Jelly or vaginal estrogen if you do not go on ERT postoperatively. Estrogen preparations that also contain small amounts of testosterone may be helpful if you suffer from loss of libido.

      The psychological issues surrounding hysterectomies and sexuality can be complex. If a woman thinks she will have a problem, then she probably will. If her sexual self-image is tied to having a uterus, even if she is past her childbearing years, a hysterectomy may be a problem for her. For this reason, women who are electing to have a hysterectomy should make the decision carefully and even consider talking about it with a counselor before the operation.

      Does hysterectomy have an effect on PMS?
      Many women find their PMS symptoms disappear after a hysterectomy when the ovaries are removed; some find relief even if their ovaries are not removed. In light of our scientific knowledge today, this doesn’t make sense. PMS is related to ovarian function and has little to do with the uterus. But, while it may be hard to explain, physicians do report that patients find relief from PMS after a hysterectomy.

      Mary Jane Minkin, MD, is a clinical professor of obstetrics and gynecology at the Yale University School of Medicine and a partner of Gynecology & Infertility P.C., a private practice in Connecticut. She appears regularly on public radio.

      http://womenshealth.about.com/cs/uterinediseases/a/hysterqa4.htm

      Hysterectomy and sexual wellbeing
      More questions are yet to be answered
      EDITOR—Roovers et al take subjective distress into account in their examination of sexual outcomes after hysterectomy.1 This is a much needed aspect of the research on this topic. I am disappointed that, as so often in this type of research, the method does not include the use of a well validated interview or self report measure to assess sexual function.

      I am concerned about the interpretation of the results for the women who developed new sexual symptoms after their operation. New sexual problems developed in 9 (23%) patients after vaginal hysterectomy, 8 (24%) patients after subtotal abdominal hysterectomy, and 12 (19%) patients after total abdominal hysterectomy. For previously asymptomatic women undergoing hysterectomy the rate of new sexual problems (about one out of five) is troubling and does not imply that sexual symptoms after hysterectomy are rare. Moreover, more women than not (according to the paper, more than 50%) continued to be troubled by existing sexual problems after hysterectomy. I hesitate to accept the authors' conclusion that sexual pleasure is enhanced after hysterectomy, particularly since they did not directly measure sexual enjoyment or satisfaction. Sexual pleasure cannot simply be inferred from the absence or presence of a few symptoms.

      Several elements are curiously absent from prospective studies of hysterectomy and sexual function, including a consideration of the incidence of sexual problems in the general population compared with that among women undergoing hysterectomy. Strong evidence either for or against the hypothesis that hysterectomy may affect sexual function negatively is lacking. Neither the study by Roovers et al nor other research to date has successfully addressed this question.

      The following are actual questions that our readers have written in. As always, no information found here is to be considered a substitute for medical advice. Always consult your physician for personal care and treatment.

      Q: "I recently found out that I have to have a hysterecomy and was told of the ways they do the procedure as far as incisions and a vaginal hysterectomy. Could you tell me about the ways again so I'll know? Thanks."

      A: A hysterectomy can be done either vaginally or abdominally. The risk of one or more post-surgical complications (such as uncontrolled bleeding and fever) is 1.7 times higher for abdominal hysterectomy than for vaginal hysterectomy, according to the Center for Disease Control.

      In a vaginal hysterectomy, the uterus is removed through the vagina. This requires no abdominal incision, so recovery and hospital stays are often shorter. This method, however, can interfere with sexual function because the vagina may be tightened or shortened during the surgery.

      LAVH (laparoscopic assisted vaginal hysterectomy) is similar to the vaginal hysterectomy, but the surgeon is assisted with the aid of the laparoscope (inserted through the belly button). The uterus is then cut and removed in sections through the scope or vaginally. Though the surgery takes longer, hospital stays and recovery time are often shortened.

      In an abdominal hysterectomy, an incision is made in the abdomen either vertically below the belly button or horizontally above the pubic hairline. The incision is generally about 6 to 8 inches long. Organs are then removed through the incision. Approximately 75% of hysterectomies performed in the US are done abdominally.

      It really depends on the patient and the reason for her hysterectomy. Also, there are different "levels" of hysterectomy...

      The uterus is removed, but the cervix remains intact: subtotal (or supracervical) hysterectomy

      The uterus, cervix, and fundus are removed, but the ovaries and fallopian tubes remain intact: total (or complete) hysterectomy

      The uterus, cervix, fallopian tubes, and ovaries are removed: bilateral salphingo-oophorectomy

      If one ovary is left, this procedure is called a unilateral salphingo-oophorectomy.

      The uterus, cervix, fallopian tubes, ovaries, part of the vagina, and sometimes pelvic lymph nodes are removed: radical hysterectomy. Generally, this procedure is reserved to treat widespread cancer.

      Recovery time for a hysterectomy in general can vary from patient to patient. Reported times have been from 6-10 weeks.

      I personally had a total LAVH hysterectomy. My recovery was about 2-4 weeks.

      Q: "Are there different types of surgical alternatives to a complete hysterectomy? Are there partial ones where only the ovaries are taken?"

      A: There is a procedure called oopherectomy, where only the ovaries are taken. If only one ovary is taken, it is called left or right oopherectomy. If both ovaries and tubes are taken, it is called bilateral salpingoopherectomy. Only when the uterus is removed, is it truly a hysterectomy. There are alternatives to hysterectomy, including:

      endometrial ablation - usually an outpatient procedure where electricity is used to burn away the lining of the uterus. This is done via hysteroscope, an instrument placed through the natural opening in the cervix (no incisions are needed).
      thermal balloon endometrial ablation - placement of a plastic balloon into the uterus through the cervix. The balloon is then filled with sterile water and heated to very high temperatures, destroying the lining of the uterus.
      uterine artery embolization - a procedure that uses angiographic techniques to place a catheter into the uterine arteries. Small particles are injected into the arteries, resulting in the blockage of the arteries. Generally used, with success, for the treatment of fibroids.
      medical therapy - in cases of endometriosis or other gynecologic disorders, you may wish to try a course of GnRH or other medical therapy to achieve possible symptomatic relief before undergoing a hysterectomy.

      Q: "I am having both of my ovaries removed surgically. Can you tell me how long it takes to recover from the surgery?"

      A: Good luck with your bilateral oopherectomy. Depending upon what else is done at the time (for example, will the surgeon be removing any Endometriosis or other disease, cutting adhesions, placing adhesion barriers in the pelvis, etc.), your recovery could range from anywhere between 1 to 6 weeks. Some women who have had total hysterectomies are back to the swing of things at the end of the first week, others have had less work done during surgery take weeks to recuperate. I had a total hyst w/a BSO a few years ago; I was up and around after about 8 days but did not feel totally recuperated until 2-4 weeks later. It also depends on how the surgery is done - laparoscopically, vaginally with laparoscopic assist, or laparotomy. A laparotomy will have the longest recovery time because of the incisions made (they are much larger and more painful than the small incisions done during laparoscopic procedures). Everyone is different, and depending on what is being done through what method and how your overall health is already, you can expect at least a week's recuperation time. If you've got children at home, it's a good idea to line up childcare for the first week, at the very least, and if you're working outside the home, I would recommend taking 2 weeks off; you can always change that while you're recovering and take more or less days once you see how you're feeling. If your job requires lifting or labor of any sort, definitely take the full 2 weeks AT LEAST. You don't want to be pulling those pelvic muscles after surgery...ouch! And hopefully you'll have someone with you to help after the surgery, to help you get around if need be and assist with housework/cooking/whatever. Anyway, good luck to you and I hope all goes safely and successfully.

      Q: "I have a slight hormone imbalance and I suffer from IBS. I am in constant discomfort in my lower abdomen and have horrendous periods, my gynecologist is thinking about a full hysterectomy, ovaries as well; I am not sure if it's the hormones or the IBS, I need medical guidance as my GP is not very good. I have had the Minerva coil, no help, I can't use the contraceptive pill due to high blood pressure and I have recently had a hormone injection (can't remember the name) but I had to stop that as it gave me high blood pressure and terrible headaches. I was then put on Provera and HRT to give me a mini menopause, unfortunately I have just had to come off this as I have now had a period for 4 weeks. Please help!"

      A: Hi, before you even think about having a hysterectomy, I suggest seeing an Endometriosis specialist. All of the symptoms you mention are signs of the disease, particularly "horrendous periods," which is a hallmark symptom. I would not advise anyone to have a hysterectomy without first finding the source of their pain, whether it be Endometriosis, fibroids, adenomyosis or something else. A hysterectomy is not a cure for Endometriosis, and if it is another condition, chances are it can be diagnosed and treated successfully through laparoscopic surgery. It sounds as if your doctor is unresponsive to your concerns and not well equipped to treat gynecological ailments. My advice to you is, find another doctor, one who specializes in chronic pelvic pain and/or Endometriosis. If you need help finding a specialist, contact the Endometriosis Research Center at http://www.endocenter.org. Good luck to you, and feel better!

      Q: "I had a hysterectomy about a year ago. My sex drive was excellent before that, now there is nothing. What can I do about this or is there anything safe out there I can take for this?"

      A: Are you on Hormone Replacement Therapy, or have you talked to your doc about some HRT options? If you are not on HRT already, discuss the options with your doc as it may help. Also, sometimes women in surgical menopause do very well with a small amount of testosterone addback in their HRT. Talk to your doc about it.

      In terms of the physical aspects of menopause, i.e. vaginal dryness, etc., use of lubricants can ease the dryness and pain associated with the condition and make the experience more pleasurable.

      You may also want to look into supplements and over the counter aids to assist you. Check out hystersisters.com for more links and info on this.

      Q: "What can I take for hot flashes?"

      A: Hot flashes are usually associated with menopause, whether it be natural (due to age), medical (due to medications like Lupron), or surgical (due to a hysterectomy). They can be treated with hormone replacement therapy (HRT); either a combination of estrogen/progesterone (and in some cases, low doses of testosterone are also added) OR, depending on your personal needs, just estrogen addback. There are several plant-based HRTs you can consider, like Alora, Cenestin, Climara, Estrace, Estraderm, Estratab, Estring, FemPatch, Menest, Ogen, Ortho-est, Vivelle and the Vivelle Dot. Check with your doc for details and additional options. I would NOT recommend Premarin HRT (forms include Prempro, Premphase and Prempac), as they are conjugated equine estrogens...in other words, made from pregnant mare's urine. There are also "natural" remedies you can take if you are against synthetic medications, such as Dong Quai (also known as "Angelica"). Dong Quai helps relieve hot flashes and menstrual difficulties commonly associated with natural menopause. Another one is Black Cohosh, an herb native to North America. This is commonly used by women to resolve such symptoms of menopause as hot flashes, vaginal atrophy, anxiety, menopausal depression, lowered concentration and headaches. You can consult your doc or licensed alternative healthcare practitioner for details and additional uses. Hope that helps!

  25. QUESTION:
    I have a question about my Endometriosis & Polycystic ovary syndrome.?
    I have Endometriosis & Polycystic Ovary syndrome with both ovaries. I want a Unilateral Oophorectomy to help with the pain because one ovary is worse than the other. But I don't want to have kids. What is the percentage of getting pregnant with one ovary? What is the percentage of getting pregnant with one ovary while on Depo Provera? Keep in mind I don't want to have kids, but I don't want a hysterectomy & go through menopause because I am only 20. I would appreciate comments & answers. thank you.

    • ANSWER:
      Your chances of getting pregnant are very slim with one ovary along with endo and pcos. Being on Depo Provera should reduce your chances even further. Talk to your doctor about the chances.

      I have severe endo and it took me over 3 years to get pregnant and I had to use IVF.

  26. QUESTION:
    what is salpingo oophorectomy?
    >what are the indications for salphingo oophorectomy?
    >How is salpingo oophoprectomy done?
    >What are the complications of salpingo oophorectomy?
    >What are the nursing interventions and managemen for salpingo oophorectomy?

    • ANSWER:
      Oophorectomy and Salpingo-Oophorectomy (Removal of the Ovaries and/or Fallopian Tubes)

      Oophorectomy is the surgical removal of the ovary while salpingo-oophorectomy is the removal of the ovary and its adjacent fallopian tube. These two procedures are performed for cancer of the ovary, removal of suspicious ovarian tumors, or Fallopian tube cancer (which is very rare). They may also be performed due to complications of infection, or in combination with hysterectomy for cancer. Occasionally, a women with inherited types of cancer of the ovary or breast will have an oophorectomy as preventative (prophylactic) surgery in order to reduce the risk of future cancer of the ovary or breast. Such familial disorders are very rare.

      The surgical removal of a fallopian tube and an ovary.

      Purpose

      This surgery is performed to treat ovarian or other gynecological cancers, or infections as a result of pelvic inflammatory disease. Occasionally, removal of one or both ovaries may be done to treat endometriosis. If only one tube and ovary are removed, the woman may still be able to conceive and carry a pregnancy to term.

      Description

      If the procedure is performed through a laparoscope, the surgeon can avoid a large abdominal incision and can shorten recovery. With this technique, the surgeon makes a small cut through the abdominal wall just below the navel. When the laparoscope is used, the patient can be given either regional or general anesthesia; if there are no complications, the patient can leave the hospital in a day or two.

      If a laparoscope is not used, the surgery involves an incision 4-6 in (10-long into the abdomen either extending vertically up from the pubic bone toward the navel, or horizontally (the "bikini incision") across the pubic hairline. The scar from a bikini incision is less noticeable, but some surgeons prefer the vertical incision because it provides greater visibility while operating.

      Preparation

      A spinal block or general anesthesia may be given before surgery.

      Aftercare

      If performed through an abdominal incision, salpingo-oophorectomy is major surgery that requires three to six weeks for full recovery. However, if performed laparascopically, the recovery time can be much shorter. There may be some discomfort around the incision for the first few days after surgery, but most women are walking around by the third day. Within a month or so, patients can gradually resume normal activities such as driving, exercising, and working.

      Immediately following the operation, the patient should avoid sharply flexing the thighs or the knees. Persistent back pain or bloody or scanty urine indicates that a ureter may have been injured during surgery.

      If both ovaries are removed in a premenopausal woman as part of the operation, the sudden loss of estrogen will trigger an abrupt premature menopause that may involve severe symptoms of hot flashes, vaginal dryness, painful intercourse, and loss of sex drive. (This is also called "surgical menopause.") In addition to these symptoms, women who lose both ovaries also lose the protection these hormones provide against heart disease and osteoporosis many years earlier than if they had experienced natural menopause. Women who have had their ovaries removed are seven times more likely to develop coronary heart disease and much more likely to develop bone problems at an early age than are premenopausal women whose ovaries are intact.

      For these reasons, some form of estrogen replacement therapy (ERT) may be prescribed to relieve the symptoms of surgical menopause and to help prevent heart and bone disease.

      In addition, to help offset the higher risks of heart and bone disease after loss of the ovaries, women should get plenty of exercise, maintain a low-fat diet, and ensure intake of calcium is adequate.

      Reaction to the removal of fallopian tubes and ovaries depends on a wide variety of factors, including the woman's age, the condition that required the surgery, her reproductive history, how much social support she has, and any previous history of depression. Women who have had many gynecological surgeries or chronic pelvic pain seem to have a higher tendency to develop psychological problems after the surgery.
      http://www.medicinenet.com/hysterectomy/page5.htm
      http://www.healthatoz.com/healthatoz/Atoz/ency/salpingo-oophorectomy.jsp
      http://www.rdoctor.com
      http://www.nlm.nih.gov/medlineplus
      http://www.ncbi.nlm.nih.gov
      http://www.cdc.gov
      http://www.kavokin.com
      http://www.symptomat.com
      http://www.webmd.com
      http://www.nhsdirect.nhs.uk
      Risks

      Major surgery always involves some risk, including infection, reactions to the anesthesia, hemorrhage, and scars at the incision site. Almost all pelvic surgery causes some internal scars, which, in some cases, can cause discomfort years after surgery.

      Key Terms

      Androgens
      Hormones (specifically testosterone) responsible for male sex characteristics.

      Endometriosis
      A painful disease in which cells from the lining of the uterus (endometrium) aren't shed during menstruation, but instead attach themselves to other organs in the pelvic cavity. The condition is hard to diagnose and often causes severe pain as well as infertility.

      Fallopian tubes
      Tubes that extend from either end of the uterus that convey the egg from the ovary to the uterus during each monthly cycle.

      Ureter
      The tube that carries urine from the bladder to the kidneys.
      For Your Information

      Books

      Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. The Harvard Guide to Women's Health. Cambridge, MA: Harvard University Press, 1996.

      Landau, Carol. The Complete Book of Menopause: Every Woman's Guide to Good Health. New York: G. P. Putnam's Sons, 1994.

      Notelovitz, Morris, and Diana Tonnessen. Estrogen: Yes or No? New York: St. Martin's Press, 1993.

      Ryan, Kenneth J., Ross S. Berkowitz,, and Robert L. Barbieri. Kistner's Gynecology. 6th ed. St. Louis: Mosby, 1995.

      Organizations

      Midlife Women's Network. 5129 Logan Ave. S., Minneapolis, MN 55419.(800) 886-4354.

      Source: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group

      The Essay Author is Carol A. Turkington

  27. QUESTION:
    What is edometriosis? How is it treated?
    Sex Questions

    • ANSWER:
      Endometriosis is a noncancerous disorder in which functioning endometrial tissue is implanted outside the uterine cavity. Symptoms depend on location of the implants and may include dysmenorrhea (painful menstruation), dyspareunia (painful or difficult coitus), infertility, dysuria (difficult or painful micturition), and pain during defecation. Diagnosis is by biopsy, usually via laparoscopy. Treatments include anti-inflammatory drugs, drugs to suppress ovarian function and endometrial tissue growth, surgical ablation and excision of endometriotic implants, and, if disease is severe and no childbearing is planned, hysterectomy (surgical removal of the uterus) plus oophorectomy (excision of an ovary).

  28. QUESTION:
    Anyone out there have endometriosis ?
    I think I may have it. My mom had it, and my periods were so bad I was throwing up and missing school. My doctor put me on the depo so I wouldn't have periods anymore. She said that most likely I had it and this will fix it (not cure it).

    I was wondering if any of ya'll had it and got it cured? I don't want to be on birth control for the rest of my life. And I'm only 20 so I'm way too young for a hysterectomy.

    Tell me about your experience

    Thanks!

    • ANSWER:
      Sadly, endo is an incurable (but treatable) condition. There are ways to manage it sometimes, especially if the implantations are caught early and they're not very aggressive or advanced. There is no known absolute cause, but there are a lot of theories floating around. The only known "cure" is a full hysterectomy including oophorectomy (removal of the ovaries) because endo is stimulated by hormone production.

      If yours is manageable right now, good for you. There is a lot of research being done, and maybe somewhere down the road a cure will come along. Good luck.

  29. QUESTION:
    Can endometriosis travel to the Heart?
    http://blog.catamenialpneumothorax.org
    For more info, click on cells beside organs at http://blog.catamenialpneumothorax.org

    • ANSWER:
      Endometriosis is a noncancerous disorder in which functioning endometrial tissue is implanted outside the uterine cavity. Symptoms depend on location of the implants and may include dysmenorrhea, dyspareunia, infertility, dysuria, and pain during defecation. Diagnosis is by biopsy, usually via laparoscopy. Treatment includes anti-inflammatory drugs, drugs to suppress ovarian function and endometrial tissue growth, surgical ablation and excision of endometriotic implants, and, for severe disease if no childbearing is planned, hysterectomy plus oophorectomy.
      Endometriosis has also been found in the skin, the lungs, the diaphragm, and even the brain.
      Consult the Gynecologist.

  30. QUESTION:
    Can Endometriosis go away by itself?

    • ANSWER:
      No. Endometriosis does not go away.

      From the Endo Research Center, a free foundation for Endo, available online at www.endocenter.org:

      "Endometriosis, a leading cause of pelvic pain, hysterectomy and female infertility, is a reproductive and immunological disease affecting nearly 89 million women and teens worldwide. The average delay in diagnosis is a staggering 9 years, and the disease can only be definitively diagnosed through gynecologic surgery.

      With Endometriosis, tissue like the endometrium is found outside the uterus, in other areas of the body. These growths, called "implants" or "lesions," still respond to hormonal commands each month, breaking down and bleeding. However, unlike the endometrium, the tissue has no way of leaving the body. The result is internal bleeding, degeneration of blood and tissue shed from the growths, inflammation of the surrounding areas and formation of scar tissue. Depending on the location of the growths, interference with the bowel, bladder, intestines and other areas of the abdominal cavity can occur. Endometriosis has even been found lodged in the skin, the lungs and even the brain.

      There is currently no definitive cure for Endometriosis, but there are several effective methods of disease management. Many women can and do live well in spite of their Endometriosis.

      Endometriosis staging has been defined by the American Society for Reproductive Medicine, with criteria based on the location, amount, depth and size of disease implants. These factors are graded on a point system based on biopsy samples obtained during surgery. The first classification scheme was developed in 1973, but since then it has been revised and refined 3 times for a more precise method of documentation. As of 1985, the stages are classified as 1 though 4; minimal, mild, moderate, and severe. Stage is not indicative of pain levels, infertility or symptoms. A woman in Stage 4 can be asymptomatic while a Stage 1 patient might be in debilitating pain.

      Malignant transformation of Endometriosis can and does occur. Some researchers even estimate that approximately 0.7-1.0% of patients with Endometriosis have lesions that will ultimately undergo malignant transformation, and urge consideration of performing bilateral oophorectomy at the time of abdominal surgery in patients with significant disease. We have also begun learning of the elevated risks women with the disease have for certain cancers, including non-Hodgkin’s lymphoma. The reasons why remain unclear; however, women with Endometriosis are more likely take certain drugs, such as Progestagins, and are more likely to have had their ovaries or uterus removed, another factor that influences hormone levels and possibly increases cancer risk. One patient undergoing Tamoxifen therapy was discovered to have malignant endometrioid neoplasia arising within her Endometriosis, suggesting to her physicians that the Tamoxifen, as a result of its estrogenic effects, caused proliferative and malignant changes in her disease. In a similar study targeting women who had undergone hysterectomy with oophorectomy because of Endometriosis, authors noted that "Endometriosis can undergo estrogen-dependent changes similar to the endometrium and may carry a risk of developing hyperplasia and carcinoma during unopposed estrogen stimulation." The researchers concluded that unopposed estrogen therapy may lead to premalignant or malignant transformation in the residual foci of Endometriosis and encouraged the addition of progestins to estrogen replacement therapy. It is also possible that women with Endometriosis may be screened more often certain cancers (i.e. breast) and therefore are more likely to be diagnosed.

      While no one is certain exactly what causes Endometriosis, there are several theories, though none are definitive. Common ones include:

      Sampson's Theory of Retrograde Menstruation
      In 1921, Dr. John Sampson contended that "during menstruation, a certain amount of menstrual fluid is regurgitated, or forced backward, from the uterus through the fallopian tubes and showered upon the pelvic organs and pelvic lining." There has been evidence to support Dr. Sampson's theory; however, studies have shown that while many women experience retrograde menstruation and have evidence of a "tipped" uterus, not all women will develop the disease. His theory also fails to explain the presence of Endometriosis in such remote areas as the lungs, skin, lymph nodes, breasts and other areas.

      Transplantation Theory
      Believes that Endometriosis is spread through the lymphatic and circulatory systems. This would explain Endometriosis in most sites, but does not explain the presence of disease to begin with.

      Iatrogenic Transplantation ("Doctor Caused")
      Holds that the accidental transference of diseased tissue occurs from one site to another during surgery. However, this is highly uncommon today due to advanced surgical management. It also does not explain the presence of the disease to begin with.

      Coelomic Metaplasia
      Drs. Ivanoff and Meyer's theory that "certain cells, when stimulated, can transform themselves into a different kind of cell." This would explain the presence of the disease in absence of menstruation, and further, the presence of Endometriosis in the few men who have been diagnosed with it.

      Heredity
      A very popular theory that women with relatives who have the disease may be genetically predisposed to developing it themselves. This theory was suggested as early as 1943, and research is currently underway by Oxegene Study scientists at the University of Oxford in the United Kingdom.

      Immunity
      According to the Institute for the Study and Treatment of Endometriosis in IL, "two different arms of the immune system may be involved in the development of Endometriosis. Cell-mediated immunity, in which specific immune cells fight disease; and humoral immunity, in which antibodies are formed to attack antigens." Studies by others suggest that migrating Endometriotic tissue affects women who have "deficient cell mediated immunity." In women without the deficiency, the transplanted cells are destroyed.

      Genetics
      Researchers have discovered that some women's genetic makeup determines their predisposition for contracting the disease.

      Still others believe it is a combination of many different factors that cause some women to have the disease.

      Some women with Endometriosis have no symptoms, others have chronic or debilitating pain and infertility. Some general symptoms of Endometriosis include chronic or intermittent pelvic pain, dysmenorrhea (painful menstruation is not normal!), infertility, miscarriage(s) and ectopic (tubal) pregnancy.

      Location specific symptoms of Endometriosis include:

      Cul-de-Sac ("Pouch of Douglas")
      The Cul-de-Sac is one of the most common (top 5) disease locations. Endometriotic implants express an "irritating focus" of prostaglandins and other chemicals. The Cul-de-Sac is surrounded by the posterior wall of the uterus, the supravaginal cervix, the upper part of the vagina, the rectum and the sacrum, the small intestine and the sacrolateral ligaments. Hence, this "irritating focus" can aggravate all the areas named, including the bowel. This can account for bowel symptoms when there are no implants actually present on the bowels. The same is true for disease located on the appendix. Dyspareunia (pain during intercourse) and pain after intercourse are also commonly reported symptoms by women with Cul-de-Sac Endometriosis.

      Uterosacral/Presacral Nerves
      Backache, leg pain, painful intercourse are often the chief complaints of women with Endometriosis in these common locations.

      Gastrointestinal Tract
      The rectosigmoid colon, rectovaginal septum, small bowel, rectum, cecum, large bowel, appendix, distal ileum, gallbladder and intestines make up the GI tract. GI tract symptoms include nausea, vomiting, constipation, painful bowel movements, blood in stool, rectal bleeding, sharp gas pains, bloating and tailbone pain.

      Bladder, Kidneys, Ureters and Urethra
      Women with Endometriosis of these areas complain of blood in the urine, tenderness around the kidneys, painful or burning urination, flank pain radiating toward the groin, urinary frequency, retention, or urgency, and hypertension. Many women with Endo also have Interstitial Cystitis, Endo's "Evil Twin."

      Pleural (Lung and Diaphragm)
      Coughing up of blood/bloody sputum, particularly coinciding with menses, accumulation of air/gas in the chest cavity, constricting chest pain and/or shoulder pain, shoulder pain associated with menses, shortness of breath, collection of blood and/or pulmonary nodule in chest cavity, deep chest pain.

      Sciatic Nerve
      Pain in the leg and/or hip which radiates down the leg are found in women with this form of disease. This symptom is concurrent with that of inguinal (groin area) Endometriosis as well.

      Subcutaneous/Cutaneous Endometriosis
      Painful nodules, often visible to the naked eye, at the skin's surface. Can bleed during menses and/or appear blue. The vagina is the most common location for this form of disease.

      Fatigue, chronic pain, allergies and other immune system-related problems are also commonly reported complaints of women who have Endometriosis.

      It is quite possible to have some, all or none of these symptoms. Many women with Endometriosis are completely asymptomatic. Endometriosis symptoms are so inconsistent and non-specific that they can easily masquerade as several other conditions. These include adenomyosis ("Endometriosis Interna"), appendicitis, ovarian cysts, bowel obstructions, colon cancer, diverticulitis, ectopic pregnancy, fibroid tumors, gonorrhea, inflammatory bowel disease, irritable bowel syndrome, ovarian cancer and pelvic inflammatory disease.

      Younger women and teens with symptoms are often dismissed and told they have PID or that they are "too young" to have Endometriosis. Once erroneously believed to be a disease of “Caucasian career women who have delayed childbearing,” we know that in fact, Endometriosis affects women of all ages, races and socioeconomic status. Endometriosis also can and does exist in the adolescent female population. Far from the “rare” incidence once believed, studies have found that as many as 70% of teenagers with chronic pelvic pain had Endometriosis proven by laparoscopy. Other reports indicate that as many as 41% of patients experienced Endometriosis pain 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. Sometimes, teens and young women lack support and validation from both the home and the school; told the pain is “in their head,” that they are “faking it,” that their debilitating cramps are “normal” and “a part of womanhood,” that they are merely suffering from “the curse,” or that they should just “grin and bear it.” Their symptoms may also be dismissed as a sexually transmitted disease, which Endometriosis absolutely is not. Failure to acknowledge and address symptoms early in the disease process can lead to significant delays in diagnosis and necessary, subsequent treatments. Lack of support from family and loved ones can also add to the patient’s pain and fear - at any age. Recent studies have also shown that Endometriosis may in fact have an even bigger impact on younger patients than older women. One such study discovered that in patients under 22 years of age, the rate of disease recurrence was double that of older women (35% versus 19%). The study also revealed that the disease behaves differently in younger women; leading some researchers to believe it is a different form of Endometriosis altogether. Surgery, considered necessary to accurately diagnose and effectively treat the disease, is often withheld from younger patients based on the injudicious belief that early surgery somehow negatively influences a young woman’s fertility. Extensive, cumulative research has shown this concern to be unfounded. What can impact fertility, however, is neglecting effective treatment of the disease. Some researchers also feel that symptomatic, adolescent-onset Endometriosis is most often a lifelong problem that will progress to severe fibrotic disease.

      While some larger implants and endometriomas may be seen through ultrasonography, CT Scan, MRI or other diagnostic procedure, such detection rates are limited. Thus, the current gold standard for a positive diagnosis of Endometriosis is via gynecologic surgery like a laparoscopy, or in some cases, open surgery like the laparotomy. Laparoscopy entails visualization of the abdomen and pelvic cavity via an instrument known as the laparoscope - a thin, lighted instrument fitted with a telescopic lens and on occasion, a miniature videocamera. During "the Lap," as it is commonly referred to, your organs will be manipulated for viewing, diagnoses are made, biopsies are taken, and therapeutic measures are usually performed as well.

      While there is no cure for Endometriosis, treatments exist ranging from medical to alternative to surgical. Some, such as surgical excision, confer longer-lasting benefits than others.

      Surgical destruction of the disease can be done in many various ways, according to the surgeon's preference and training. These include:

      Excision
      Cutting out of entire diseased implants, while preserving the healthy portions of the affected organ(s). This meticulous form of removal can only be performed by an advanced endoscopic specialist with a full understanding of modern concepts of treatment. Recurrence rates are less than 10% at 5 years out.

      Vaporization
      Destruction of implants by instant boiling of the cellular water with a high power laser or electrosurgical tool.

      Ablation
      Removal by any surgical means; generally involves laser. This is the most common method utilized by Gyn Surgeons. Recurrence is over 80% within the first 2 years.

      Coagulation
      Desiccation of implants by heating and drying the affected tissue(s).

      Fulguration
      Superficial burning of implants with a spark of electricity from any electrosurgical tool.

      Ultrasonic
      Some surgeons prefer ultrasonic treatment methods; this means sound waves at very high frequency will be used as an energy source. Two devices are currently used by surgeons who practice this method are the Harmonic Scalpel and the CUSA (Cavitational Ultrasonic Surgical Aspirator).

      Hysterectomy
      Endometriosis remains a leading cause of hysterectomy and accounts for nearly half of the 600,000 hysterectomies performed in the U.S. annually. While not a definitive cure for the disease, some women have experienced relief of painful symptoms following a hysterectomy. Certainly, each case of Endometriosis is different and each patient requires a different course of treatment. A hysterectomy is just one of the many surgical options that can be considered in your search for treatment. The old school belief was once that a hysterectomy was the cure for Endometriosis. Today, of course, we know this is untrue and that a hysterectomy is no more curative than "prescribed pregnancy" (another common fallacy). However, some women with Endometriosis who have elected to undergo a hysterectomy have found relief following the procedure.

      Several patients can experience relief through the use of hormonal agents and other medical therapies. These include:

      Aromatase Inhibitors
      Studies have shown that misplaced Endometrial tissues respond to ovarian hormones such as estrogen and go through a menstruation-like process (bleeding, shedding and inflammation) repetitiously in the abdomen of a woman. Estrogen is like fuel to fire for Endometriosis, thus current treatments have been designed to stop estrogen secretions from the ovaries of a woman (gonadotropin releasing hormone agonists). Estrogen, however is made not only in the ovaries but also in adipose tissue [fibrous, insulating tissues packed with fat cells], and most importantly, *within Endometriosis implants themselves.* Thus, Endometriosis tissue acts in a devious manner to make its own estrogen through the abnormal expression of aromatase enzyme, sustaining its own life cycle. This may explain the high numbers of treatment failures and early recurrences after conventional treatments of Endometriosis. Aromatase Inhibitor treatment is in trials, but not yet widely available.

      GnRH (gonadotropin-releasing hormone) Agonists
      These are drugs that are designed to suppress the Endometriosis implants by stimulating the ovaries to produce more estradiol (the most potent form of estrogen) then paradoxically, after 7 to 21 days of constant stimulation, shutting down the "messenger" hormones sent from the pituitary gland to the ovaries. The result is that the ovaries shut down, estradiol levels drop sharply and rapidly and the patient ceases to ovulate or menstruate; a condition similar to that of menopause. Some women experience positive results with GnRH treatments, others do not. As with any treatment, each case will vary. Though the medications can temporarily shrink the lesions of Endometriosis, they will not shrink adhesions or scar tissue, which often play a part in the symptomatic pain of the disease, nor do they treat infertility in any way. Common side effects that have been reported by women undergoing treatment include hot flashes, headaches, insomnia, vaginal dryness, decreased libido, depression, mood swings, fatigue, acne, dizziness, nausea, short term memory loss, diarrhea, hair loss, anxiety, and bruising at injection site. There are several different GnRHs that can be considered for treatment. These include Lupron Depot, Synarel, Zoladex and Suprefact.

      Other medications include synthetic hormones like Danazol. This synthetic testosterone marketed under the names "Danocrine" or "Cyclomen" is usually given in pill form. Danazol was the first medication approved for use in the treatment of Endometriosis and works by suppressing the ovaries. However, expense and side effects have made it a less common approach by physicians today.

      Contraceptives such as Depo-Provera (medroxyprogesterone acetate) and Provera (both progestins, administered by injection or orally) are also used to treat the disease, as are combination estrogen/progesterone oral contraceptive pills like Alesse and Lo-Ovral.

      Pain management options include non-steroidal anti-inflammatories (NSAIDs) such as Anaprox or Toradol. Stronger narcotics and anti-depressants are often used as well.

      Alternative therapies may also be effective and non-invasive for some patients, including:

      Immunotherapy, Diet & Nutrition, Shiatsu, Naturopathy, Biofeedback, Osteopathy, Homeopathic Therapy, Chiropractics, Acupuncture, use of a Transcutaneous Electrical Nerve Stimulation (TENS) unit, Bach Flower Remedies, Exercise, Aromatherapy, Reflexology, Herbs, and Massage Therapy.

      There is no cure for Endometriosis, but there are ways to cope. For more information on Endometriosis, please visit the ERC on the web at http://www.endocenter.org and join the ERC's free online Listservs at http://groups.yahoo.com/group/erc and http://health.groups.yahoo.com/group/EndoDocs."

  31. QUESTION:
    I have severe pain in my left ovairy. My doc wants to do a hystereomty. Should I do it?

    My doc said i have sist on that ovary

    • ANSWER:
      a total hysterectomy is only needed when something is wrong with the uterus and the ovaries or a condition exists which will infect remaining organs.

      my husband's mom had both of her ovaries removed, but not her uterus, due to cysts. one was sudden, it burst and she nearly bled to death internally. the other was painful and so they took it out to prevent the same thing happening.

      cysts can be painful. but they can be treated when small with hormone therapy. other pains include fibroids, endometriosis, dysmennohria (spelling?)

      sounds like you need second opinions. once it is taken out, it is for the rest of your life, and some women find things a lot worse without them.
      try this site for more help....
      http://women.webmd.com/guide/hysterectomy
      http://women.webmd.com/endometriosis/should-i-have-a-hysterectomy-and-oophorectomy-to-treat-endometriosis
      http://women.webmd.com/tc/hysterectomy-comparison-of-hysterectomy-procedures

  32. QUESTION:
    what are the signs of endometriouis?
    has any one had it and what are the signs and how do u get it?and how do u get rid of it

    • ANSWER:
      What are the symptoms?
      While some women with endometriosis never have symptoms, others develop mild, moderate, or severe pain. Depending on where the endometriosis is growing, pain can be in the lower belly or in the rectum or vagina. Pain can happen only before and during the menstrual period or on a constant basis. For some women, pain is most noticeable during sex, a bowel movement, or ovulation. Abnormal vaginal or rectal bleeding can be a sign of endometriosis.

      Endometriosis can sometimes make it difficult to get pregnant. Some women never know that they have endometriosis until they see a doctor because they are not able to get pregnant (infertility).

      If you have endometriosis, it is likely to be different for you than for another woman who has it. If you have symptoms, they may stay the same, improve, or suddenly get worse. They are likely to improve during pregnancy. For almost all women, endometriosis shrinks away and stops causing symptoms after menopause.

      How is it treated?
      There is no cure for endometriosis. However, you do have options for treating pain and infertility. These include slowing, stopping, or removing endometriosis implants and scar tissue. Your treatment choices depend on whether you plan to get pregnant in the future. You may need to try several different treatments to find one that works best for you.

      Pain. For endometriosis that causes only mild symptoms, you may get enough relief with home treatment such using as a heating pad and taking pain medicine that you can buy without a prescription.

      When pain medicine is not enough, many women get relief by controlling their menstrual cycles with birth control pills. The advantage of birth control pills is that they are the only hormone therapy that most women can take for years with few or no side effects.

      If birth control pills do not help, you may try other hormone therapies that work by lowering the body's estrogen levels. This can cause difficult side effects, however. All hormone therapies relieve endometriosis pain by shrinking endometriosis implants. Overall, they all work well to relieve pain for most women. 2 However, pain often returns several months after treatment ends.

      Removing implants or scar tissue with surgery relieves pain for most women. However, pain usually returns a year or two after surgery. Taking hormone medicine after surgery may help you stay pain-free longer. 3, 4

      As a last resort for pain treatment, some women have the uterus and ovaries removed (hysterectomy and oophorectomy). Having your ovaries removed drops your estrogen levels and starts early menopause. This relieves symptoms in most cases, but up to 15% of women have pain return. 5 Also, removing your uterus and ovaries is a major surgery that has its own risks. It also makes you permanently unable to become pregnant. For more information, see the topic Hysterectomy.

      Infertility. Depending on your age (fertility naturally declines after age 35) and how severe your endometriosis is, you have different options. You can improve your chances of pregnancy by having laparoscopic surgery to remove moderate to severe endometriosis, using intrauterine insemination and fertility drugs such as clomiphene (Clomid, for example), and/or having in vitro fertilization (IVF).

  33. QUESTION:
    What does an Obstrician/Gynecologist do?

    • ANSWER:
      Obstetrician is a medical doctor with a surgical specialty dealing with the care of a woman and her baby during pregnancy, childbirth and the puerperium (the period shortly after birth). Most obstetricians are also gynaecologists.

      In obstetric practice, an obstetrician sees a pregnant woman on a regular basis to check the progress of the pregnancy and to detect possible diseases. A woman's schedule of antenatal appointment varies depending on local resources and her risk factors, such as diabetes.

      Gynaecologist is a medical doctor with a surgical specialty dealing with health of the female reproductive system (uterus, vagina and ovaries). Almost all modern gynaecologists are also obstetricians.

      The main conditions dealt with by a gynaecologist are:

      1. Cancer and pre-cancerous diseases of the reproductive organs including ovaries, fallopian tubes, uterus, vagina, and vulva.
      2. Incontinence of urine.
      3. Amenorrhea (absent menstrual periods).
      4. Dysmenorrhoea (painful menstrual periods).
      5. Infertility.
      6. Menorrhagia (heavy menstrual periods). This is a common indication for hysterectomy.
      7. Prolapse of pelvic organs.

      There is some crossover in these areas. For example a woman with incontinence may be referred to a urologist.

      Some of the more common operations that gynaecologists perform include:

      1. Dilation and curettage (removal of the uterine contents for various reasons, including partial miscarriage and dysfunctional uterine bleeding refractive to medical therapy).
      2. Hysterectomy (removal of the uterus).
      3. Oophorectomy (removal of the ovaries).
      4. Tubal ligation.
      5. Hysteroscopy.
      6. Diagnostic laparoscopy - used to diagnose and treat sources of pelvic and abdominal pain; perhaps most famously used to provide definitive diagnosis of endometriosis.
      7. Exploratory laparotomy - may be used to investigate the level of progression of benign or malignant disease, or to assess and repair damage to the pelvic organs.
      8. Various surgical treatments for urinary incontinence, including cystoscopy and sub-urethral slings.
      9. Surgical treatment of pelvic organ prolapse, including correction of cystocele and rectocele.
      10. Appendectomy - often performed to remove site of painful endometriosis implantation and/or prophylactically (against future acute appendicitis) at the time of hysterectomy or cesearean section. May also be performed as part of a staging operation for ovarian cancer.
      11. Cervical Excision Procedures (including cryosurgery, LLETZ, LEEP) - removal of the surface of the cervix containing pre-cancerous cells which have been previously identified on Pap smear.

      Hope this helps answer your question. :)

  34. QUESTION:
    Pap smear came back abnormal?
    Hi i'm a healthy 25 yearold mother of one. I had my very first pap smear done last month and got the results back saying i have mild dyskaryosis, i was terrified and shocked and quite scared. Calmer now reading the leaflet, i have to have a colocyc ...something done basically like another smear but more in depth ... just wondering if anyone else has had this?

    • ANSWER:
      I've had paps return abnormal results as well, but mine were for dysplasia (which is basically cell change) and further testing put the potential cause as HPV. Not something you really want to hear when you'd only been married a year . . .

      I had to have follow up exams called colposcopies - basically a visual exam of the cervix under magnification. Depending upon what is seen, there may or may not be biopsies (the taking of tissue samples for further testing). I'm not positive how the medical system works where you are, but here in the US any time one has a test/procedure where the potential exists for it to change into another procedure based upon findings of the first one, medical staff tries to cover all of the bases by listing all of the likely possibilities on the consent form before they have you sign it. Plus, that info is also discussed with you by the physician when they recommend treatment.

      A personal example of the above to illustrate: Last year, I was scheduled to have a diagnostic laparoscopy to investigate an apparent cyst on my left ovary. Because of my age (46 at time) and past medical history (endometriosis), the GYN advised that he would be performing a total hysterectomy if he found any evidence of endometrial implants anywhere they should not normally occur. For that reason, my consent for surgery read: Diagnostic Laparoscopy with Possible Hysterectomy and Bi-lateral Oophorectomy. (This way, if something changed mid-procedure, he would not have to stop, wake me up to sign for the new procedure (or have my husband sign off on it), and put me out again before he continued.

      My experience with the abnormal pap tests was that, because of the cause of the abnormality, I had to go to a 3 - 4 times per year testing schedule to check for changes. Any time something weird was seen, a colposcopy w/biopsies was scheduled to check it out. Don't stress too much about the abnormal result, okay?

      Good luck to you.

  35. QUESTION:
    Is shaking a symptom of chemical menopause?
    I had a a radical hysterectomy and Oophorectomy (bilateral) to treat endometriosis on 11/16/2006, and I've been getting some symptoms since then -- especially chills and sweats (not just at night). I was assured that this was common in people with surgical menopause, so I have just been trying to figure out how to deal with the symptoms. The last few weeks I have been getting fits of shaking/ trembling that are most common when I first wake after a long sleep. Sometimes, it is so severe that I can't get up without risking falling. I have asked my doctors about it, but they seem unimpressed, and I'm not sure if I should be either.

    I am taking Premarin for hormone replacement therapy, but I don't notice much difference in my symptoms if I do or do not take it.

    • ANSWER:
      That's weird. See a neurologist. And for gosh's sake, switch from Premarin to something better for your health, like estrogen patches. Transdermal estrogen delivered by patch is much better for you than oral estrogen from horses. Transdermal doesn't have the risks of oral, such as problems with cardiovascular health, potential clotting risks interference with other hormones such as thyroid and testosterone, and fewer headaches.

  36. QUESTION:
    Is it necessary to have smear tests done, after a full hysterectomy????

    • ANSWER:
      I'm not sure what you mean by full hysterectomy? Total hysterectomy is the removal of the uterus AND cervix. Removal of the ovaries/tubes AND uterus is a hysterectomy with bilateral salpingo oophorectomy.
      There are different studies about smears after a hysterectomy; some say it is a must, some say it is unnecessary.
      I asked a doctor (who has some gynecological training) in my town about smears post-hysterectomy, and he said that it would be a vaginal vault smear, and it is not typically necessary, as the rate of vaginal vault cancer is VERY low. However, if your doctor is taking smears for anything else, you could ask him/her to do one of the vaginal vault, too.
      My family doctor told me what is of major consideration is whether or not I had normal pap smears PRIOR to my hysterectomy.
      I had a Total Abdominal Hysterectomy (TAH) at age 22 for endometriosis.

  37. QUESTION:
    Any gynecologists? I had a laparoscopy, hysteroscopy and D&C done last week , plus insertion of a Mirena IUD?
    (My previous one had slipped out of place.) Along with severe & prolonged menstrual bleeding, I was also having terrible pain in the area of my right ovary. It was bad enough to land me in hospital, where they gave me morphine.The next day I had an ultrasound which showed that I have some small fibroids, but no cysts. When the dr did the laparoscopy he couldn't see the right side of the pelvis very well (probably due to the fact that I am overweight) but he what he did see was normal. (no endometriosis.) He said I have a "bulky uterus" which I am assuming is from the fibroids. However, I am still experiencing the same pain in the right ovary as before. It is not constant, but when it does flare up the pain is extreme. I'm at the point where I'm considering a hysterectomy and right oophorectomy which would mean I would not go into early menopause. But before I take this drastic measure does anyone have any other advice? Would a CT scan or MRI show anything more definitive? Thanks.......

    • ANSWER:
      I am no doctor but I certainly would advise you to have a CT scan and even consider (if your insurance will pay for it) and MRI. I would not go for elective total hysterectomy (which means inclusion of ovaries) and early menopause without
      having a good gynecological exam done by these two methods. Only if both the CT and the MRI prove that nothing is wrong with your ovary I would suggest going to another professional physician and try to find out maybe the pain's source is somewhere else, so why have such a huge unnecessary operation? Good luck.

  38. QUESTION:
    endometriosis?
    WHAT IS ENDOMETRiOSIS?

    • ANSWER:
      From the Endo Research Center, a free foundation for Endo, available online at www.endocenter.org:

      "Endometriosis, a leading cause of pelvic pain, hysterectomy and female infertility, is a reproductive and immunological disease affecting nearly 89 million women and teens worldwide. The average delay in diagnosis is a staggering 9 years, and the disease can only be definitively diagnosed through gynecologic surgery.

      With Endometriosis, tissue like the endometrium is found outside the uterus, in other areas of the body. These growths, called "implants" or "lesions," still respond to hormonal commands each month, breaking down and bleeding. However, unlike the endometrium, the tissue has no way of leaving the body. The result is internal bleeding, degeneration of blood and tissue shed from the growths, inflammation of the surrounding areas and formation of scar tissue. Depending on the location of the growths, interference with the bowel, bladder, intestines and other areas of the abdominal cavity can occur. Endometriosis has even been found lodged in the skin, the lungs and even the brain.

      There is currently no definitive cure for Endometriosis, but there are several effective methods of disease management. Many women can and do live well in spite of their Endometriosis.

      Endometriosis staging has been defined by the American Society for Reproductive Medicine, with criteria based on the location, amount, depth and size of disease implants. These factors are graded on a point system based on biopsy samples obtained during surgery. The first classification scheme was developed in 1973, but since then it has been revised and refined 3 times for a more precise method of documentation. As of 1985, the stages are classified as 1 though 4; minimal, mild, moderate, and severe. Stage is not indicative of pain levels, infertility or symptoms. A woman in Stage 4 can be asymptomatic while a Stage 1 patient might be in debilitating pain.

      Malignant transformation of Endometriosis can and does occur. Some researchers even estimate that approximately 0.7-1.0% of patients with Endometriosis have lesions that will ultimately undergo malignant transformation, and urge consideration of performing bilateral oophorectomy at the time of abdominal surgery in patients with significant disease. We have also begun learning of the elevated risks women with the disease have for certain cancers, including non-Hodgkin’s lymphoma. The reasons why remain unclear; however, women with Endometriosis are more likely take certain drugs, such as Progestagins, and are more likely to have had their ovaries or uterus removed, another factor that influences hormone levels and possibly increases cancer risk. One patient undergoing Tamoxifen therapy was discovered to have malignant endometrioid neoplasia arising within her Endometriosis, suggesting to her physicians that the Tamoxifen, as a result of its estrogenic effects, caused proliferative and malignant changes in her disease. In a similar study targeting women who had undergone hysterectomy with oophorectomy because of Endometriosis, authors noted that "Endometriosis can undergo estrogen-dependent changes similar to the endometrium and may carry a risk of developing hyperplasia and carcinoma during unopposed estrogen stimulation." The researchers concluded that unopposed estrogen therapy may lead to premalignant or malignant transformation in the residual foci of Endometriosis and encouraged the addition of progestins to estrogen replacement therapy. It is also possible that women with Endometriosis may be screened more often certain cancers (i.e. breast) and therefore are more likely to be diagnosed.

      While no one is certain exactly what causes Endometriosis, there are several theories, though none are definitive. Common ones include:

      Sampson's Theory of Retrograde Menstruation
      In 1921, Dr. John Sampson contended that "during menstruation, a certain amount of menstrual fluid is regurgitated, or forced backward, from the uterus through the fallopian tubes and showered upon the pelvic organs and pelvic lining." There has been evidence to support Dr. Sampson's theory; however, studies have shown that while many women experience retrograde menstruation and have evidence of a "tipped" uterus, not all women will develop the disease. His theory also fails to explain the presence of Endometriosis in such remote areas as the lungs, skin, lymph nodes, breasts and other areas.

      Transplantation Theory
      Believes that Endometriosis is spread through the lymphatic and circulatory systems. This would explain Endometriosis in most sites, but does not explain the presence of disease to begin with.

      Iatrogenic Transplantation ("Doctor Caused")
      Holds that the accidental transference of diseased tissue occurs from one site to another during surgery. However, this is highly uncommon today due to advanced surgical management. It also does not explain the presence of the disease to begin with.

      Coelomic Metaplasia
      Drs. Ivanoff and Meyer's theory that "certain cells, when stimulated, can transform themselves into a different kind of cell." This would explain the presence of the disease in absence of menstruation, and further, the presence of Endometriosis in the few men who have been diagnosed with it.

      Heredity
      A very popular theory that women with relatives who have the disease may be genetically predisposed to developing it themselves. This theory was suggested as early as 1943, and research is currently underway by Oxegene Study scientists at the University of Oxford in the United Kingdom.

      Immunity
      According to the Institute for the Study and Treatment of Endometriosis in IL, "two different arms of the immune system may be involved in the development of Endometriosis. Cell-mediated immunity, in which specific immune cells fight disease; and humoral immunity, in which antibodies are formed to attack antigens." Studies by others suggest that migrating Endometriotic tissue affects women who have "deficient cell mediated immunity." In women without the deficiency, the transplanted cells are destroyed.

      Genetics
      Researchers have discovered that some women's genetic makeup determines their predisposition for contracting the disease.

      Still others believe it is a combination of many different factors that cause some women to have the disease.

      Some women with Endometriosis have no symptoms, others have chronic or debilitating pain and infertility. Some general symptoms of Endometriosis include chronic or intermittent pelvic pain, dysmenorrhea (painful menstruation is not normal!), infertility, miscarriage(s) and ectopic (tubal) pregnancy.

      Location specific symptoms of Endometriosis include:

      Cul-de-Sac ("Pouch of Douglas")
      The Cul-de-Sac is one of the most common (top 5) disease locations. Endometriotic implants express an "irritating focus" of prostaglandins and other chemicals. The Cul-de-Sac is surrounded by the posterior wall of the uterus, the supravaginal cervix, the upper part of the vagina, the rectum and the sacrum, the small intestine and the sacrolateral ligaments. Hence, this "irritating focus" can aggravate all the areas named, including the bowel. This can account for bowel symptoms when there are no implants actually present on the bowels. The same is true for disease located on the appendix. Dyspareunia (pain during intercourse) and pain after intercourse are also commonly reported symptoms by women with Cul-de-Sac Endometriosis.

      Uterosacral/Presacral Nerves
      Backache, leg pain, painful intercourse are often the chief complaints of women with Endometriosis in these common locations.

      Gastrointestinal Tract
      The rectosigmoid colon, rectovaginal septum, small bowel, rectum, cecum, large bowel, appendix, distal ileum, gallbladder and intestines make up the GI tract. GI tract symptoms include nausea, vomiting, constipation, painful bowel movements, blood in stool, rectal bleeding, sharp gas pains, bloating and tailbone pain.

      Bladder, Kidneys, Ureters and Urethra
      Women with Endometriosis of these areas complain of blood in the urine, tenderness around the kidneys, painful or burning urination, flank pain radiating toward the groin, urinary frequency, retention, or urgency, and hypertension. Many women with Endo also have Interstitial Cystitis, Endo's "Evil Twin."

      Pleural (Lung and Diaphragm)
      Coughing up of blood/bloody sputum, particularly coinciding with menses, accumulation of air/gas in the chest cavity, constricting chest pain and/or shoulder pain, shoulder pain associated with menses, shortness of breath, collection of blood and/or pulmonary nodule in chest cavity, deep chest pain.

      Sciatic Nerve
      Pain in the leg and/or hip which radiates down the leg are found in women with this form of disease. This symptom is concurrent with that of inguinal (groin area) Endometriosis as well.

      Subcutaneous/Cutaneous Endometriosis
      Painful nodules, often visible to the naked eye, at the skin's surface. Can bleed during menses and/or appear blue. The vagina is the most common location for this form of disease.

      Fatigue, chronic pain, allergies and other immune system-related problems are also commonly reported complaints of women who have Endometriosis.

      It is quite possible to have some, all or none of these symptoms. Many women with Endometriosis are completely asymptomatic. Endometriosis symptoms are so inconsistent and non-specific that they can easily masquerade as several other conditions. These include adenomyosis ("Endometriosis Interna"), appendicitis, ovarian cysts, bowel obstructions, colon cancer, diverticulitis, ectopic pregnancy, fibroid tumors, gonorrhea, inflammatory bowel disease, irritable bowel syndrome, ovarian cancer and pelvic inflammatory disease.

      Younger women and teens with symptoms are often dismissed and told they have PID or that they are "too young" to have Endometriosis. Once erroneously believed to be a disease of “Caucasian career women who have delayed childbearing,” we know that in fact, Endometriosis affects women of all ages, races and socioeconomic status. Endometriosis also can and does exist in the adolescent female population. Far from the “rare” incidence once believed, studies have found that as many as 70% of teenagers with chronic pelvic pain had Endometriosis proven by laparoscopy. Other reports indicate that as many as 41% of patients experienced Endometriosis pain 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. Sometimes, teens and young women lack support and validation from both the home and the school; told the pain is “in their head,” that they are “faking it,” that their debilitating cramps are “normal” and “a part of womanhood,” that they are merely suffering from “the curse,” or that they should just “grin and bear it.” Their symptoms may also be dismissed as a sexually transmitted disease, which Endometriosis absolutely is not. Failure to acknowledge and address symptoms early in the disease process can lead to significant delays in diagnosis and necessary, subsequent treatments. Lack of support from family and loved ones can also add to the patient’s pain and fear - at any age. Recent studies have also shown that Endometriosis may in fact have an even bigger impact on younger patients than older women. One such study discovered that in patients under 22 years of age, the rate of disease recurrence was double that of older women (35% versus 19%). The study also revealed that the disease behaves differently in younger women; leading some researchers to believe it is a different form of Endometriosis altogether. Surgery, considered necessary to accurately diagnose and effectively treat the disease, is often withheld from younger patients based on the injudicious belief that early surgery somehow negatively influences a young woman’s fertility. Extensive, cumulative research has shown this concern to be unfounded. What can impact fertility, however, is neglecting effective treatment of the disease. Some researchers also feel that symptomatic, adolescent-onset Endometriosis is most often a lifelong problem that will progress to severe fibrotic disease.

      While some larger implants and endometriomas may be seen through ultrasonography, CT Scan, MRI or other diagnostic procedure, such detection rates are limited. Thus, the current gold standard for a positive diagnosis of Endometriosis is via gynecologic surgery like a laparoscopy, or in some cases, open surgery like the laparotomy. Laparoscopy entails visualization of the abdomen and pelvic cavity via an instrument known as the laparoscope - a thin, lighted instrument fitted with a telescopic lens and on occasion, a miniature videocamera. During "the Lap," as it is commonly referred to, your organs will be manipulated for viewing, diagnoses are made, biopsies are taken, and therapeutic measures are usually performed as well.

      While there is no cure for Endometriosis, treatments exist ranging from medical to alternative to surgical. Some, such as surgical excision, confer longer-lasting benefits than others.

      Surgical destruction of the disease can be done in many various ways, according to the surgeon's preference and training. These include:

      Excision
      Cutting out of entire diseased implants, while preserving the healthy portions of the affected organ(s). This meticulous form of removal can only be performed by an advanced endoscopic specialist with a full understanding of modern concepts of treatment. Recurrence rates are less than 10% at 5 years out.

      Vaporization
      Destruction of implants by instant boiling of the cellular water with a high power laser or electrosurgical tool.

      Ablation
      Removal by any surgical means; generally involves laser. This is the most common method utilized by Gyn Surgeons. Recurrence is over 80% within the first 2 years.

      Coagulation
      Desiccation of implants by heating and drying the affected tissue(s).

      Fulguration
      Superficial burning of implants with a spark of electricity from any electrosurgical tool.

      Ultrasonic
      Some surgeons prefer ultrasonic treatment methods; this means sound waves at very high frequency will be used as an energy source. Two devices are currently used by surgeons who practice this method are the Harmonic Scalpel and the CUSA (Cavitational Ultrasonic Surgical Aspirator).

      Hysterectomy
      Endometriosis remains a leading cause of hysterectomy and accounts for nearly half of the 600,000 hysterectomies performed in the U.S. annually. While not a definitive cure for the disease, some women have experienced relief of painful symptoms following a hysterectomy. Certainly, each case of Endometriosis is different and each patient requires a different course of treatment. A hysterectomy is just one of the many surgical options that can be considered in your search for treatment. The old school belief was once that a hysterectomy was the cure for Endometriosis. Today, of course, we know this is untrue and that a hysterectomy is no more curative than "prescribed pregnancy" (another common fallacy). However, some women with Endometriosis who have elected to undergo a hysterectomy have found relief following the procedure.

      Several patients can experience relief through the use of hormonal agents and other medical therapies. These include:

      Aromatase Inhibitors
      Studies have shown that misplaced Endometrial tissues respond to ovarian hormones such as estrogen and go through a menstruation-like process (bleeding, shedding and inflammation) repetitiously in the abdomen of a woman. Estrogen is like fuel to fire for Endometriosis, thus current treatments have been designed to stop estrogen secretions from the ovaries of a woman (gonadotropin releasing hormone agonists). Estrogen, however is made not only in the ovaries but also in adipose tissue [fibrous, insulating tissues packed with fat cells], and most importantly, *within Endometriosis implants themselves.* Thus, Endometriosis tissue acts in a devious manner to make its own estrogen through the abnormal expression of aromatase enzyme, sustaining its own life cycle. This may explain the high numbers of treatment failures and early recurrences after conventional treatments of Endometriosis. Aromatase Inhibitor treatment is in trials, but not yet widely available.

      GnRH (gonadotropin-releasing hormone) Agonists
      These are drugs that are designed to suppress the Endometriosis implants by stimulating the ovaries to produce more estradiol (the most potent form of estrogen) then paradoxically, after 7 to 21 days of constant stimulation, shutting down the "messenger" hormones sent from the pituitary gland to the ovaries. The result is that the ovaries shut down, estradiol levels drop sharply and rapidly and the patient ceases to ovulate or menstruate; a condition similar to that of menopause. Some women experience positive results with GnRH treatments, others do not. As with any treatment, each case will vary. Though the medications can temporarily shrink the lesions of Endometriosis, they will not shrink adhesions or scar tissue, which often play a part in the symptomatic pain of the disease, nor do they treat infertility in any way. Common side effects that have been reported by women undergoing treatment include hot flashes, headaches, insomnia, vaginal dryness, decreased libido, depression, mood swings, fatigue, acne, dizziness, nausea, short term memory loss, diarrhea, hair loss, anxiety, and bruising at injection site. There are several different GnRHs that can be considered for treatment. These include Lupron Depot, Synarel, Zoladex and Suprefact.

      Other medications include synthetic hormones like Danazol. This synthetic testosterone marketed under the names "Danocrine" or "Cyclomen" is usually given in pill form. Danazol was the first medication approved for use in the treatment of Endometriosis and works by suppressing the ovaries. However, expense and side effects have made it a less common approach by physicians today.

      Contraceptives such as Depo-Provera (medroxyprogesterone acetate) and Provera (both progestins, administered by injection or orally) are also used to treat the disease, as are combination estrogen/progesterone oral contraceptive pills like Alesse and Lo-Ovral.

      Pain management options include non-steroidal anti-inflammatories (NSAIDs) such as Anaprox or Toradol. Stronger narcotics and anti-depressants are often used as well.

      Alternative therapies may also be effective and non-invasive for some patients, including:

      Immunotherapy, Diet & Nutrition, Shiatsu, Naturopathy, Biofeedback, Osteopathy, Homeopathic Therapy, Chiropractics, Acupuncture, use of a Transcutaneous Electrical Nerve Stimulation (TENS) unit, Bach Flower Remedies, Exercise, Aromatherapy, Reflexology, Herbs, and Massage Therapy.

      There is no cure for Endometriosis, but there are ways to cope. For more information on Endometriosis, please visit the ERC on the web at http://www.endocenter.org and join the ERC's free online Listservs at http://groups.yahoo.com/group/erc and http://health.groups.yahoo.com/group/EndoDocs."

  39. QUESTION:
    Does this sound like endometriosis?
    For the past year, I have felt extreme pain in my pelvic region. It seems like it almost always hurts a little but around my period it gets much worse. I have pain when I urinate and when I make a bowel movement. I have also noticed extreme pain during deep penetration sex. I am only 21 years old but children are very important to me. I have an appointment in 3 weeks to see a gynecologist. Does anyone have any suggestions of what this might be and what are my chances of getting pregnant in the near future?

    • ANSWER:
      Endometriosis, a leading cause of pelvic pain, hysterectomy and female infertility, is a reproductive and immunological disease affecting nearly 89 million women and teens worldwide. The average delay in diagnosis is a staggering 9 years, and the disease can only be definitively diagnosed through gynecologic surgery.

      With Endometriosis, tissue like the endometrium is found outside the uterus, in other areas of the body. These growths, called "implants" or "lesions," still respond to hormonal commands each month, breaking down and bleeding. However, unlike the endometrium, the tissue has no way of leaving the body. The result is internal bleeding, degeneration of blood and tissue shed from the growths, inflammation of the surrounding areas and formation of scar tissue. Depending on the location of the growths, interference with the bowel, bladder, intestines and other areas of the abdominal cavity can occur. Endometriosis has even been found lodged in the skin, the lungs and even the brain.

      There is currently no definitive cure for Endometriosis, but there are several effective methods of disease management. Many women can and do live well in spite of their Endometriosis.

      Endometriosis staging has been defined by the American Society for Reproductive Medicine, with criteria based on the location, amount, depth and size of disease implants. These factors are graded on a point system based on biopsy samples obtained during surgery. The first classification scheme was developed in 1973, but since then it has been revised and refined 3 times for a more precise method of documentation. As of 1985, the stages are classified as 1 though 4; minimal, mild, moderate, and severe. Stage is not indicative of pain levels, infertility or symptoms. A woman in Stage 4 can be asymptomatic while a Stage 1 patient might be in debilitating pain.

      Malignant transformation of Endometriosis can and does occur. Some researchers even estimate that approximately 0.7-1.0% of patients with Endometriosis have lesions that will ultimately undergo malignant transformation, and urge consideration of performing bilateral oophorectomy at the time of abdominal surgery in patients with significant disease. We have also begun learning of the elevated risks women with the disease have for certain cancers, including non-Hodgkin’s lymphoma. The reasons why remain unclear; however, women with Endometriosis are more likely take certain drugs, such as Progestagins, and are more likely to have had their ovaries or uterus removed, another factor that influences hormone levels and possibly increases cancer risk. One patient undergoing Tamoxifen therapy was discovered to have malignant endometrioid neoplasia arising within her Endometriosis, suggesting to her physicians that the Tamoxifen, as a result of its estrogenic effects, caused proliferative and malignant changes in her disease. In a similar study targeting women who had undergone hysterectomy with oophorectomy because of Endometriosis, authors noted that "Endometriosis can undergo estrogen-dependent changes similar to the endometrium and may carry a risk of developing hyperplasia and carcinoma during unopposed estrogen stimulation." The researchers concluded that unopposed estrogen therapy may lead to premalignant or malignant transformation in the residual foci of Endometriosis and encouraged the addition of progestins to estrogen replacement therapy. It is also possible that women with Endometriosis may be screened more often certain cancers (i.e. breast) and therefore are more likely to be diagnosed.

      While no one is certain exactly what causes Endometriosis, there are several theories, though none are definitive. Common ones include:

      Sampson's Theory of Retrograde Menstruation
      In 1921, Dr. John Sampson contended that "during menstruation, a certain amount of menstrual fluid is regurgitated, or forced backward, from the uterus through the fallopian tubes and showered upon the pelvic organs and pelvic lining." There has been evidence to support Dr. Sampson's theory; however, studies have shown that while many women experience retrograde menstruation and have evidence of a "tipped" uterus, not all women will develop the disease. His theory also fails to explain the presence of Endometriosis in such remote areas as the lungs, skin, lymph nodes, breasts and other areas.

      Transplantation Theory
      Believes that Endometriosis is spread through the lymphatic and circulatory systems. This would explain Endometriosis in most sites, but does not explain the presence of disease to begin with.

      Iatrogenic Transplantation ("Doctor Caused")
      Holds that the accidental transference of diseased tissue occurs from one site to another during surgery. However, this is highly uncommon today due to advanced surgical management. It also does not explain the presence of the disease to begin with.

      Coelomic Metaplasia
      Drs. Ivanoff and Meyer's theory that "certain cells, when stimulated, can transform themselves into a different kind of cell." This would explain the presence of the disease in absence of menstruation, and further, the presence of Endometriosis in the few men who have been diagnosed with it.

      Heredity
      A very popular theory that women with relatives who have the disease may be genetically predisposed to developing it themselves. This theory was suggested as early as 1943, and research is currently underway by Oxegene Study scientists at the University of Oxford in the United Kingdom.

      Immunity
      According to the Institute for the Study and Treatment of Endometriosis in IL, "two different arms of the immune system may be involved in the development of Endometriosis. Cell-mediated immunity, in which specific immune cells fight disease; and humoral immunity, in which antibodies are formed to attack antigens." Studies by others suggest that migrating Endometriotic tissue affects women who have "deficient cell mediated immunity." In women without the deficiency, the transplanted cells are destroyed.

      Genetics
      Researchers have discovered that some women's genetic makeup determines their predisposition for contracting the disease.

      Still others believe it is a combination of many different factors that cause some women to have the disease.

      Some women with Endometriosis have no symptoms, others have chronic or debilitating pain and infertility. Some general symptoms of Endometriosis include chronic or intermittent pelvic pain, dysmenorrhea (painful menstruation is not normal!), infertility, miscarriage(s) and ectopic (tubal) pregnancy.

      Location specific symptoms of Endometriosis include:

      Cul-de-Sac ("Pouch of Douglas")
      The Cul-de-Sac is one of the most common (top 5) disease locations. Endometriotic implants express an "irritating focus" of prostaglandins and other chemicals. The Cul-de-Sac is surrounded by the posterior wall of the uterus, the supravaginal cervix, the upper part of the vagina, the rectum and the sacrum, the small intestine and the sacrolateral ligaments. Hence, this "irritating focus" can aggravate all the areas named, including the bowel. This can account for bowel symptoms when there are no implants actually present on the bowels. The same is true for disease located on the appendix. Dyspareunia (pain during intercourse) and pain after intercourse are also commonly reported symptoms by women with Cul-de-Sac Endometriosis.

      Uterosacral/Presacral Nerves
      Backache, leg pain, painful intercourse are often the chief complaints of women with Endometriosis in these common locations.

      Gastrointestinal Tract
      The rectosigmoid colon, rectovaginal septum, small bowel, rectum, cecum, large bowel, appendix, distal ileum, gallbladder and intestines make up the GI tract. GI tract symptoms include nausea, vomiting, constipation, painful bowel movements, blood in stool, rectal bleeding, sharp gas pains, bloating and tailbone pain.

      Bladder, Kidneys, Ureters and Urethra
      Women with Endometriosis of these areas complain of blood in the urine, tenderness around the kidneys, painful or burning urination, flank pain radiating toward the groin, urinary frequency, retention, or urgency, and hypertension. Many women with Endo also have Interstitial Cystitis, Endo's "Evil Twin."

      Pleural (Lung and Diaphragm)
      Coughing up of blood/bloody sputum, particularly coinciding with menses, accumulation of air/gas in the chest cavity, constricting chest pain and/or shoulder pain, shoulder pain associated with menses, shortness of breath, collection of blood and/or pulmonary nodule in chest cavity, deep chest pain.

      Sciatic Nerve
      Pain in the leg and/or hip which radiates down the leg are found in women with this form of disease. This symptom is concurrent with that of inguinal (groin area) Endometriosis as well.

      Subcutaneous/Cutaneous Endometriosis
      Painful nodules, often visible to the naked eye, at the skin's surface. Can bleed during menses and/or appear blue. The vagina is the most common location for this form of disease.

      Fatigue, chronic pain, allergies and other immune system-related problems are also commonly reported complaints of women who have Endometriosis.

      It is quite possible to have some, all or none of these symptoms. Many women with Endometriosis are completely asymptomatic. Endometriosis symptoms are so inconsistent and non-specific that they can easily masquerade as several other conditions. These include adenomyosis ("Endometriosis Interna"), appendicitis, ovarian cysts, bowel obstructions, colon cancer, diverticulitis, ectopic pregnancy, fibroid tumors, gonorrhea, inflammatory bowel disease, irritable bowel syndrome, ovarian cancer and pelvic inflammatory disease.

      Younger women and teens with symptoms are often dismissed and told they have PID or that they are "too young" to have Endometriosis. Once erroneously believed to be a disease of “Caucasian career women who have delayed childbearing,” we know that in fact, Endometriosis affects women of all ages, races and socioeconomic status. Endometriosis also can and does exist in the adolescent female population. Far from the “rare” incidence once believed, studies have found that as many as 70% of teenagers with chronic pelvic pain had Endometriosis proven by laparoscopy. Other reports indicate that as many as 41% of patients experienced Endometriosis pain 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. Sometimes, teens and young women lack support and validation from both the home and the school; told the pain is “in their head,” that they are “faking it,” that their debilitating cramps are “normal” and “a part of womanhood,” that they are merely suffering from “the curse,” or that they should just “grin and bear it.” Their symptoms may also be dismissed as a sexually transmitted disease, which Endometriosis absolutely is not. Failure to acknowledge and address symptoms early in the disease process can lead to significant delays in diagnosis and necessary, subsequent treatments. Lack of support from family and loved ones can also add to the patient’s pain and fear - at any age. Recent studies have also shown that Endometriosis may in fact have an even bigger impact on younger patients than older women. One such study discovered that in patients under 22 years of age, the rate of disease recurrence was double that of older women (35% versus 19%). The study also revealed that the disease behaves differently in younger women; leading some researchers to believe it is a different form of Endometriosis altogether. Surgery, considered necessary to accurately diagnose and effectively treat the disease, is often withheld from younger patients based on the injudicious belief that early surgery somehow negatively influences a young woman’s fertility. Extensive, cumulative research has shown this concern to be unfounded. What can impact fertility, however, is neglecting effective treatment of the disease. Some researchers also feel that symptomatic, adolescent-onset Endometriosis is most often a lifelong problem that will progress to severe fibrotic disease.

      While some larger implants and endometriomas may be seen through ultrasonography, CT Scan, MRI or other diagnostic procedure, such detection rates are limited. Thus, the current gold standard for a positive diagnosis of Endometriosis is via gynecologic surgery like a laparoscopy, or in some cases, open surgery like the laparotomy. Laparoscopy entails visualization of the abdomen and pelvic cavity via an instrument known as the laparoscope - a thin, lighted instrument fitted with a telescopic lens and on occasion, a miniature videocamera. During "the Lap," as it is commonly referred to, your organs will be manipulated for viewing, diagnoses are made, biopsies are taken, and therapeutic measures are usually performed as well.

      While there is no cure for Endometriosis, treatments exist ranging from medical to alternative to surgical. Some, such as surgical excision, confer longer-lasting benefits than others.

      Surgical destruction of the disease can be done in many various ways, according to the surgeon's preference and training. These include:

      Excision
      Cutting out of entire diseased implants, while preserving the healthy portions of the affected organ(s). This meticulous form of removal can only be performed by an advanced endoscopic specialist with a full understanding of modern concepts of treatment. Recurrence rates are less than 10% at 5 years out.

      Vaporization
      Destruction of implants by instant boiling of the cellular water with a high power laser or electrosurgical tool.

      Ablation
      Removal by any surgical means; generally involves laser. This is the most common method utilized by Gyn Surgeons. Recurrence is over 80% within the first 2 years.

      Coagulation
      Desiccation of implants by heating and drying the affected tissue(s).

      Fulguration
      Superficial burning of implants with a spark of electricity from any electrosurgical tool.

      Ultrasonic
      Some surgeons prefer ultrasonic treatment methods; this means sound waves at very high frequency will be used as an energy source. Two devices are currently used by surgeons who practice this method are the Harmonic Scalpel and the CUSA (Cavitational Ultrasonic Surgical Aspirator).

      Hysterectomy
      Endometriosis remains a leading cause of hysterectomy and accounts for nearly half of the 600,000 hysterectomies performed in the U.S. annually. While not a definitive cure for the disease, some women have experienced relief of painful symptoms following a hysterectomy. Certainly, each case of Endometriosis is different and each patient requires a different course of treatment. A hysterectomy is just one of the many surgical options that can be considered in your search for treatment. The old school belief was once that a hysterectomy was the cure for Endometriosis. Today, of course, we know this is untrue and that a hysterectomy is no more curative than "prescribed pregnancy" (another common fallacy). However, some women with Endometriosis who have elected to undergo a hysterectomy have found relief following the procedure.

      Several patients can experience relief through the use of hormonal agents and other medical therapies. These include:

      Aromatase Inhibitors
      Studies have shown that misplaced Endometrial tissues respond to ovarian hormones such as estrogen and go through a menstruation-like process (bleeding, shedding and inflammation) repetitiously in the abdomen of a woman. Estrogen is like fuel to fire for Endometriosis, thus current treatments have been designed to stop estrogen secretions from the ovaries of a woman (gonadotropin releasing hormone agonists). Estrogen, however is made not only in the ovaries but also in adipose tissue [fibrous, insulating tissues packed with fat cells], and most importantly, *within Endometriosis implants themselves.* Thus, Endometriosis tissue acts in a devious manner to make its own estrogen through the abnormal expression of aromatase enzyme, sustaining its own life cycle. This may explain the high numbers of treatment failures and early recurrences after conventional treatments of Endometriosis. Aromatase Inhibitor treatment is in trials, but not yet widely available.

      GnRH (gonadotropin-releasing hormone) Agonists
      These are drugs that are designed to suppress the Endometriosis implants by stimulating the ovaries to produce more estradiol (the most potent form of estrogen) then paradoxically, after 7 to 21 days of constant stimulation, shutting down the "messenger" hormones sent from the pituitary gland to the ovaries. The result is that the ovaries shut down, estradiol levels drop sharply and rapidly and the patient ceases to ovulate or menstruate; a condition similar to that of menopause. Some women experience positive results with GnRH treatments, others do not. As with any treatment, each case will vary. Though the medications can temporarily shrink the lesions of Endometriosis, they will not shrink adhesions or scar tissue, which often play a part in the symptomatic pain of the disease, nor do they treat infertility in any way. Common side effects that have been reported by women undergoing treatment include hot flashes, headaches, insomnia, vaginal dryness, decreased libido, depression, mood swings, fatigue, acne, dizziness, nausea, short term memory loss, diarrhea, hair loss, anxiety, and bruising at injection site. There are several different GnRHs that can be considered for treatment. These include Lupron Depot, Synarel, Zoladex and Suprefact. Please read the following before considering GnRH therapy:

      http://www.endocenter.org/pdf/surgery%20...
      Surgery versus the Use of Lupron Depot as Treatment

      http://www.endocenter.org/pdf/prediagnos...
      Use of Lupron Depot Prior to Surgical Diagnosis

      Other medications include synthetic hormones like Danazol. This synthetic testosterone marketed under the names "Danocrine" or "Cyclomen" is usually given in pill form. Danazol was the first medication approved for use in the treatment of Endometriosis and works by suppressing the ovaries. However, expense and side effects have made it a less common approach by physicians today.

      Contraceptives such as Depo-Provera (medroxyprogesterone acetate) and Provera (both progestins, administered by injection or orally) are also used to treat the disease, as are combination estrogen/progesterone oral contraceptive pills like Alesse and Lo-Ovral.

      Pain management options include non-steroidal anti-inflammatories (NSAIDs) such as Anaprox or Toradol. Stronger narcotics and anti-depressants are often used as well.

      Alternative therapies may also be effective and non-invasive for some patients, including:

      Immunotherapy, Diet & Nutrition, Shiatsu, Naturopathy, Biofeedback, Osteopathy, Homeopathic Therapy, Chiropractics, Acupuncture, use of a Transcutaneous Electrical Nerve Stimulation (TENS) unit, Bach Flower Remedies, Exercise, Aromatherapy, Reflexology, Herbs, and Massage Therapy.

      There is no cure for Endometriosis, but there are ways to cope. For more information on Endometriosis, please visit the ERC on the web at http://www.endocenter.org [there is a self-test there as well] and join the ERC's free online Listserv at http://groups.yahoo.com/group/erc.

  40. QUESTION:
    endometriosis?
    i have SEVERE pains every month during menses and for a few days after its over there is a dark brown discharge that is nothing like my period. i was just wondering if anyone out there has endometriosis and could tell me about the symptoms. please be specific. and the pain is sometimes so bad i throw up and pass out

    • ANSWER:
      Dark brown discharge is typically "old blood." It's not harmful, but I can understand your pain and frustration. Here's some additional info including symptoms copied from the Endo Research Center @ www.endocenter.org. Hope it helps.

      About Endo -

      Endometriosis, a leading cause of pelvic pain, hysterectomy and female infertility, is a reproductive and immunological disease affecting nearly 89 million women and teens worldwide. The average delay in diagnosis is a staggering 9 years, and the disease can only be definitively diagnosed through gynecologic surgery.

      With Endometriosis, tissue like the endometrium is found outside the uterus, in other areas of the body. These growths, called "implants" or "lesions," still respond to hormonal commands each month, breaking down and bleeding. However, unlike the endometrium, the tissue has no way of leaving the body. The result is internal bleeding, degeneration of blood and tissue shed from the growths, inflammation of the surrounding areas and formation of scar tissue. Depending on the location of the growths, interference with the bowel, bladder, intestines and other areas of the abdominal cavity can occur. Endometriosis has even been found lodged in the skin, the lungs and even the brain.

      There is currently no definitive cure for Endometriosis, but there are several effective methods of disease management. Many women can and do live well in spite of their Endometriosis.

      Endometriosis staging has been defined by the American Society for Reproductive Medicine, with criteria based on the location, amount, depth and size of disease implants. These factors are graded on a point system based on biopsy samples obtained during surgery. The first classification scheme was developed in 1973, but since then it has been revised and refined 3 times for a more precise method of documentation. As of 1985, the stages are classified as 1 though 4; minimal, mild, moderate, and severe. Stage is not indicative of pain levels, infertility or symptoms. A woman in Stage 4 can be asymptomatic while a Stage 1 patient might be in debilitating pain.

      Malignant transformation of Endometriosis can and does occur. Some researchers even estimate that approximately 0.7-1.0% of patients with Endometriosis have lesions that will ultimately undergo malignant transformation, and urge consideration of performing bilateral oophorectomy at the time of abdominal surgery in patients with significant disease. We have also begun learning of the elevated risks women with the disease have for certain cancers, including non-Hodgkin’s lymphoma. The reasons why remain unclear; however, women with Endometriosis are more likely take certain drugs, such as Progestagins, and are more likely to have had their ovaries or uterus removed, another factor that influences hormone levels and possibly increases cancer risk. One patient undergoing Tamoxifen therapy was discovered to have malignant endometrioid neoplasia arising within her Endometriosis, suggesting to her physicians that the Tamoxifen, as a result of its estrogenic effects, caused proliferative and malignant changes in her disease. In a similar study targeting women who had undergone hysterectomy with oophorectomy because of Endometriosis, authors noted that "Endometriosis can undergo estrogen-dependent changes similar to the endometrium and may carry a risk of developing hyperplasia and carcinoma during unopposed estrogen stimulation." The researchers concluded that unopposed estrogen therapy may lead to premalignant or malignant transformation in the residual foci of Endometriosis and encouraged the addition of progestins to estrogen replacement therapy. It is also possible that women with Endometriosis may be screened more often certain cancers (i.e. breast) and therefore are more likely to be diagnosed.

      While no one is certain exactly what causes Endometriosis, there are several theories, though none are definitive. Common ones include:

      Sampson's Theory of Retrograde Menstruation
      In 1921, Dr. John Sampson contended that "during menstruation, a certain amount of menstrual fluid is regurgitated, or forced backward, from the uterus through the fallopian tubes and showered upon the pelvic organs and pelvic lining." There has been evidence to support Dr. Sampson's theory; however, studies have shown that while many women experience retrograde menstruation and have evidence of a "tipped" uterus, not all women will develop the disease. His theory also fails to explain the presence of Endometriosis in such remote areas as the lungs, skin, lymph nodes, breasts and other areas.

      Transplantation Theory
      Believes that Endometriosis is spread through the lymphatic and circulatory systems. This would explain Endometriosis in most sites, but does not explain the presence of disease to begin with.

      Iatrogenic Transplantation ("Doctor Caused")
      Holds that the accidental transference of diseased tissue occurs from one site to another during surgery. However, this is highly uncommon today due to advanced surgical management. It also does not explain the presence of the disease to begin with.

      Coelomic Metaplasia
      Drs. Ivanoff and Meyer's theory that "certain cells, when stimulated, can transform themselves into a different kind of cell." This would explain the presence of the disease in absence of menstruation, and further, the presence of Endometriosis in the few men who have been diagnosed with it.

      Heredity
      A very popular theory that women with relatives who have the disease may be genetically predisposed to developing it themselves. This theory was suggested as early as 1943, and research is currently underway by Oxegene Study scientists at the University of Oxford in the United Kingdom.

      Immunity
      According to the Institute for the Study and Treatment of Endometriosis in IL, "two different arms of the immune system may be involved in the development of Endometriosis. Cell-mediated immunity, in which specific immune cells fight disease; and humoral immunity, in which antibodies are formed to attack antigens." Studies by others suggest that migrating Endometriotic tissue affects women who have "deficient cell mediated immunity." In women without the deficiency, the transplanted cells are destroyed.

      Genetics
      Researchers have discovered that some women's genetic makeup determines their predisposition for contracting the disease.

      Still others believe it is a combination of many different factors that cause some women to have the disease.

      Some women with Endometriosis have no symptoms, others have chronic or debilitating pain and infertility. Some general symptoms of Endometriosis include chronic or intermittent pelvic pain, dysmenorrhea (painful menstruation is not normal!), infertility, miscarriage(s) and ectopic (tubal) pregnancy.

      Location specific symptoms of Endometriosis include:

      Cul-de-Sac ("Pouch of Douglas")
      The Cul-de-Sac is one of the most common (top 5) disease locations. Endometriotic implants express an "irritating focus" of prostaglandins and other chemicals. The Cul-de-Sac is surrounded by the posterior wall of the uterus, the supravaginal cervix, the upper part of the vagina, the rectum and the sacrum, the small intestine and the sacrolateral ligaments. Hence, this "irritating focus" can aggravate all the areas named, including the bowel. This can account for bowel symptoms when there are no implants actually present on the bowels. The same is true for disease located on the appendix. Dyspareunia (pain during intercourse) and pain after intercourse are also commonly reported symptoms by women with Cul-de-Sac Endometriosis.

      Uterosacral/Presacral Nerves
      Backache, leg pain, painful intercourse are often the chief complaints of women with Endometriosis in these common locations.

      Gastrointestinal Tract
      The rectosigmoid colon, rectovaginal septum, small bowel, rectum, cecum, large bowel, appendix, distal ileum, gallbladder and intestines make up the GI tract. GI tract symptoms include nausea, vomiting, constipation, painful bowel movements, blood in stool, rectal bleeding, sharp gas pains, bloating and tailbone pain.

      Bladder, Kidneys, Ureters and Urethra
      Women with Endometriosis of these areas complain of blood in the urine, tenderness around the kidneys, painful or burning urination, flank pain radiating toward the groin, urinary frequency, retention, or urgency, and hypertension. Many women with Endo also have Interstitial Cystitis, Endo's "Evil Twin."

      Pleural (Lung and Diaphragm)
      Coughing up of blood/bloody sputum, particularly coinciding with menses, accumulation of air/gas in the chest cavity, constricting chest pain and/or shoulder pain, shoulder pain associated with menses, shortness of breath, collection of blood and/or pulmonary nodule in chest cavity, deep chest pain.

      Sciatic Nerve
      Pain in the leg and/or hip which radiates down the leg are found in women with this form of disease. This symptom is concurrent with that of inguinal (groin area) Endometriosis as well.

      Subcutaneous/Cutaneous Endometriosis
      Painful nodules, often visible to the naked eye, at the skin's surface. Can bleed during menses and/or appear blue. The vagina is the most common location for this form of disease.

      Fatigue, chronic pain, allergies and other immune system-related problems are also commonly reported complaints of women who have Endometriosis.

      It is quite possible to have some, all or none of these symptoms. Many women with Endometriosis are completely asymptomatic. Endometriosis symptoms are so inconsistent and non-specific that they can easily masquerade as several other conditions. These include adenomyosis ("Endometriosis Interna"), appendicitis, ovarian cysts, bowel obstructions, colon cancer, diverticulitis, ectopic pregnancy, fibroid tumors, gonorrhea, inflammatory bowel disease, irritable bowel syndrome, ovarian cancer and pelvic inflammatory disease.

      Younger women and teens with symptoms are often dismissed and told they have PID or that they are "too young" to have Endometriosis. Once erroneously believed to be a disease of “Caucasian career women who have delayed childbearing,” we know that in fact, Endometriosis affects women of all ages, races and socioeconomic status. Endometriosis also can and does exist in the adolescent female population. Far from the “rare” incidence once believed, studies have found that as many as 70% of teenagers with chronic pelvic pain had Endometriosis proven by laparoscopy. Other reports indicate that as many as 41% of patients experienced Endometriosis pain 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. Sometimes, teens and young women lack support and validation from both the home and the school; told the pain is “in their head,” that they are “faking it,” that their debilitating cramps are “normal” and “a part of womanhood,” that they are merely suffering from “the curse,” or that they should just “grin and bear it.” Their symptoms may also be dismissed as a sexually transmitted disease, which Endometriosis absolutely is not. Failure to acknowledge and address symptoms early in the disease process can lead to significant delays in diagnosis and necessary, subsequent treatments. Lack of support from family and loved ones can also add to the patient’s pain and fear - at any age. Recent studies have also shown that Endometriosis may in fact have an even bigger impact on younger patients than older women. One such study discovered that in patients under 22 years of age, the rate of disease recurrence was double that of older women (35% versus 19%). The study also revealed that the disease behaves differently in younger women; leading some researchers to believe it is a different form of Endometriosis altogether. Surgery, considered necessary to accurately diagnose and effectively treat the disease, is often withheld from younger patients based on the injudicious belief that early surgery somehow negatively influences a young woman’s fertility. Extensive, cumulative research has shown this concern to be unfounded. What can impact fertility, however, is neglecting effective treatment of the disease. Some researchers also feel that symptomatic, adolescent-onset Endometriosis is most often a lifelong problem that will progress to severe fibrotic disease.

      While some larger implants and endometriomas may be seen through ultrasonography, CT Scan, MRI or other diagnostic procedure, such detection rates are limited. Thus, the current gold standard for a positive diagnosis of Endometriosis is via gynecologic surgery like a laparoscopy, or in some cases, open surgery like the laparotomy. Laparoscopy entails visualization of the abdomen and pelvic cavity via an instrument known as the laparoscope - a thin, lighted instrument fitted with a telescopic lens and on occasion, a miniature videocamera. During "the Lap," as it is commonly referred to, your organs will be manipulated for viewing, diagnoses are made, biopsies are taken, and therapeutic measures are usually performed as well.

      While there is no cure for Endometriosis, treatments exist ranging from medical to alternative to surgical. Some, such as surgical excision, confer longer-lasting benefits than others.

      Surgical destruction of the disease can be done in many various ways, according to the surgeon's preference and training. These include:

      Excision
      Cutting out of entire diseased implants, while preserving the healthy portions of the affected organ(s). This meticulous form of removal can only be performed by an advanced endoscopic specialist with a full understanding of modern concepts of treatment. Recurrence rates are less than 10% at 5 years out.

      Vaporization
      Destruction of implants by instant boiling of the cellular water with a high power laser or electrosurgical tool.

      Ablation
      Removal by any surgical means; generally involves laser. This is the most common method utilized by Gyn Surgeons. Recurrence is over 80% within the first 2 years.

      Coagulation
      Desiccation of implants by heating and drying the affected tissue(s).

      Fulguration
      Superficial burning of implants with a spark of electricity from any electrosurgical tool.

      Ultrasonic
      Some surgeons prefer ultrasonic treatment methods; this means sound waves at very high frequency will be used as an energy source. Two devices are currently used by surgeons who practice this method are the Harmonic Scalpel and the CUSA (Cavitational Ultrasonic Surgical Aspirator).

      Hysterectomy
      Endometriosis remains a leading cause of hysterectomy and accounts for nearly half of the 600,000 hysterectomies performed in the U.S. annually. While not a definitive cure for the disease, some women have experienced relief of painful symptoms following a hysterectomy. Certainly, each case of Endometriosis is different and each patient requires a different course of treatment. A hysterectomy is just one of the many surgical options that can be considered in your search for treatment. The old school belief was once that a hysterectomy was the cure for Endometriosis. Today, of course, we know this is untrue and that a hysterectomy is no more curative than "prescribed pregnancy" (another common fallacy). However, some women with Endometriosis who have elected to undergo a hysterectomy have found relief following the procedure.

      Several patients can experience relief through the use of hormonal agents and other medical therapies. These include:

      Aromatase Inhibitors
      Studies have shown that misplaced Endometrial tissues respond to ovarian hormones such as estrogen and go through a menstruation-like process (bleeding, shedding and inflammation) repetitiously in the abdomen of a woman. Estrogen is like fuel to fire for Endometriosis, thus current treatments have been designed to stop estrogen secretions from the ovaries of a woman (gonadotropin releasing hormone agonists). Estrogen, however is made not only in the ovaries but also in adipose tissue [fibrous, insulating tissues packed with fat cells], and most importantly, *within Endometriosis implants themselves.* Thus, Endometriosis tissue acts in a devious manner to make its own estrogen through the abnormal expression of aromatase enzyme, sustaining its own life cycle. This may explain the high numbers of treatment failures and early recurrences after conventional treatments of Endometriosis. Aromatase Inhibitor treatment is in trials, but not yet widely available.

      GnRH (gonadotropin-releasing hormone) Agonists
      These are drugs that are designed to suppress the Endometriosis implants by stimulating the ovaries to produce more estradiol (the most potent form of estrogen) then paradoxically, after 7 to 21 days of constant stimulation, shutting down the "messenger" hormones sent from the pituitary gland to the ovaries. The result is that the ovaries shut down, estradiol levels drop sharply and rapidly and the patient ceases to ovulate or menstruate; a condition similar to that of menopause. Some women experience positive results with GnRH treatments, others do not. As with any treatment, each case will vary. Though the medications can temporarily shrink the lesions of Endometriosis, they will not shrink adhesions or scar tissue, which often play a part in the symptomatic pain of the disease, nor do they treat infertility in any way. Common side effects that have been reported by women undergoing treatment include hot flashes, headaches, insomnia, vaginal dryness, decreased libido, depression, mood swings, fatigue, acne, dizziness, nausea, short term memory loss, diarrhea, hair loss, anxiety, and bruising at injection site. There are several different GnRHs that can be considered for treatment. These include Lupron Depot, Synarel, Zoladex and Suprefact.

      Other medications include synthetic hormones like Danazol. This synthetic testosterone marketed under the names "Danocrine" or "Cyclomen" is usually given in pill form. Danazol was the first medication approved for use in the treatment of Endometriosis and works by suppressing the ovaries. However, expense and side effects have made it a less common approach by physicians today.

      Contraceptives such as Depo-Provera (medroxyprogesterone acetate) and Provera (both progestins, administered by injection or orally) are also used to treat the disease, as are combination estrogen/progesterone oral contraceptive pills like Alesse and Lo-Ovral.

      Pain management options include non-steroidal anti-inflammatories (NSAIDs) such as Anaprox or Toradol. Stronger narcotics and anti-depressants are often used as well.

      Alternative therapies may also be effective and non-invasive for some patients, including:

      Immunotherapy, Diet & Nutrition, Shiatsu, Naturopathy, Biofeedback, Osteopathy, Homeopathic Therapy, Chiropractics, Acupuncture, use of a Transcutaneous Electrical Nerve Stimulation (TENS) unit, Bach Flower Remedies, Exercise, Aromatherapy, Reflexology, Herbs, and Massage Therapy.

      There is no cure for Endometriosis, but there are ways to cope. For more information on Endometriosis, please visit the ERC on the web at http://www.endocenter.org and join the ERC's free online Listserv at http://groups.yahoo.com/group/erc ~ Endometriosis Research Center

  41. QUESTION:
    Endometriosis?
    I have had so many tests, swabs, examinations, ultrasound etc the last 2 months and the doctors just can't seem to find out exactly what is wrong with me. I have this sharp pain in my left side where my ovary is located. I had an 4.5cm haemorragic ovarian cyst which resolved/ruptured 3 weeks ago but I still have this pain. I also have Dysmenorrhea (really painful periods), Dyspareunia (painful sexual intercourse). The doctors are now referring me to a specialist at the hospital and recommending a laparoscopy be done to diagnose whether I might possibly have endometriosis? I have had this really bad nausea feeling since last week and it seems to be getting better, but the pain seems to stay. Does this really mean that I could have endometriosis? Has anyone experienced some similar symptoms etc? I don't know when I would see the specialist at the hospital as I have no health insurance and have to go to a public hospital as an outpatient which means waiting lists etc.

    • ANSWER:
      It sounds like you could very well have endo based on your symptoms. However you cannot know for sure until you have a laparoscopy done. The doctors have to actually see the endo and then excise the endo lesions and they will also remove the cyst and possibly do a biopsy. From their findings with the lap they can better inform you of your options.

      I have been suffering with endo for 7+ years now and I am only 30. In that time I have had 10 major surgeries including a complete abdominal hysterectomy and bilateral salpingo-oophorectomy and appendectomy and had countless procedures, tests, and organs removed. I am a member of the endometriosis association and the erc.

      If you do in fact have endo then your best medicine is research. You have to be well informed and be proactive in your treatment process. I do understand that you cannot financially afford the surgery. I know many women who have major debt because of their endo due to medical bills. Ask your PCP or OBGYN what your options are for someone who doesn't have health insurance. As stated above you may be able to find a teaching hospital or woman's wellness center who could refer you, or you could find a doctor who has a payment plan.

      I have talked to many women who were told they "may" have endo, or that they do have endo. Until you have the exploratory lap and the surgeons say for sure that you do have endo and you see the pictures for yourself don't get too concerned yet. You could have another gynecological problem all together. Something that is far more treatable. There is no cure for endo and the only major medical treatments are treat the symptoms itself not the disease- pain management through drugs etc. or surgical excision of endo implants. I have turned away from the medical profession and found alternative methods to be far less invasive and there are little to no side effects. Acupuncture, as well as diet and hormone treatments are becoming very helpful to women who are tired of the countless pills and procedures.

      The most important thing is to find emotional support and a competent and caring specialist, that is half of the battle.

      Start here
      http://www.endometriosassn.org
      http://www.endocenter.org
      http://www.endometriosis.org
      also look for the largest endmetriosis support group online at yahoo groups.

      Good luck!

      Health, Happiness, and HOPE

  42. QUESTION:
    Major Cramps Even After Hysterectomy?
    I had a hysterectomy in June of 2006 due to endometriosis and the procedures I had done to treat it causing severe hemorahagging in my utereus. They took everything but the ovaries. Could the endometriosis still be bothering me this bad? Its bad pains in my lower back and stomach like when I would get my monthly which i dont get anymore. Has anyone else had this happen? What did u do to have it taken care of? I am only 22 so i dont want my ovaries removed unless absoultely needed
    I had the parts that the endo was affecting removed-my uterus and cervix. I only get the cramps really bad and its only once a month. My dr is certified in treatment and removal of endo, just need some ideas on why its happening so long after the surgery was done

    • ANSWER:
      Hysterectomy is not a cure for Endometriosis, regardless of whether or not the ovaries are removed as well, and/or whether HRT is given or not. The implants, if not meticulously excised from all locations, will remain behind to thrive following the hysterectomy and/or oophorectomy; they produce their own estrogen-synthesizing enzyme known as aromatase and thereby support their own vicious life cycle. The key to dealing effectively with Endo is to remove disease, not necessarily organs.

      You need to see an Endo specialist who can perform the advanced excision surgery necessary to truly eradicate the disease from the bowels, bladder, etc. etc. etc.. Check out the following centers for info and possible help:

      http://www.centerforendo.com
      http://www.endometriosistreatment.org
      http://www.endoexcision.com

      Good luck to you...hope the links help you find someone who truly understands the disease and can effectively remove it.

  43. QUESTION:
    Needing help about endometriosis please?
    When i was about 1 week pregnant my doctor told me i have about a 90% of having endometriosis due to all of my symptoms. And i went to one of the special doctors to find out more and then i found out i was pregnant so they couldn't take it further to find out what stage i was. And i have been trying to fall pregnant for years so i was very excited! I was told with endometriosis its only a 5% chance of falling pregnant. So now my son is 4 months old and i know it hasn't gone as i am still having the pains i was before. They are getting worse as the days go by, first i was hoping its still the contractions of after birth but im almost sure its not now as its been 4 months. I am going to my doctor tomorrow, i would just like to hear a few things if other woman have/had this. What stage were/are you? Any signs of what stage you were in? Anything you can tell me about it would be great. Thank you!

    • ANSWER:
      First off, the site listed below will have a lot of good info - You may want to bookmark it on your computer.

      I did not find out that I had endometriosis until almost 2 years after the C-section birth of my youngest child when I found a lump in my stomach to the right of my navel, which turned out to be an endometrioma attached to my abdominal wall. I had tried telling the staff at the OB's office that something was wrong with my periods following his birth because each month, my cramps went along my incision line (it felt like someone had taken a sword and sliced me open hip to hip). Every. Freaking. Month. I kept getting blown off with "Every woman's cycle changes following the birth of a child," which I already knew because I'd experienced it after my first child was born, but this was off the chain.

      The doctor changed her tune once I found the lump and the pathology report following its removal named it an endometrioma. Her best guess on how it occurred is that endometrial cells may have gotten washed out into my abdominal cavity when she flushed my uterus after the C-section. Regardless, she did not remain my OB/GYN for long - Something about my symptoms being ignored/discredited for as long as they were, being kept in pain while trying to take care of two children under the age of 4 did it for me. I got some recommendations for both friends and my insurance company and found a doc who knew his butt from a hole in the ground and did not play when it came to endometriosis, And so, my journey with endo began.

      I can't tell you what stage mine was at when it was discovered, because findings were not discussed with me in terms of "stages," but I can give you a general time-line if that will help you.

      6/2000 - C-section birth, first child
      11/2001 - C-section birth, second child
      8/2003 - Surgical removal of endometrioma attached to abdominal wall
      4/2004 - Lupron therapy after abdominal/pelvic CT scan showed abnormal endometrial thickness (I had started to have periods longer than 10 days, roughly 3 weeks apart)
      6/2007 - D & C with ablation, tubal ligation to stop last period that went 10 weeks long
      4/2011 - Hospitalized with severe abdominal pain - diagnostic tests showed 4 cm cyst on L ovary. I elected to have a diagnostic laparoscopy. My current GYN did inform me that, given my history with endo, if he found implants anywhere, he would be doing a total hysterectomy including the removal of both ovaries, because endo is fueled by estrogen.
      5/2011 - Laparoscopy became the hysterectomy/oophorectomy with finding of endo implants on the outside of my uterus and on both sets of fallopian tubes. And the suspected ovarian cyst was actually a fibroid inside my left ovary. I was shown the diagnostic photos taken of both ovaries prior to their removal and the right one was the size of a walnut - The left was almost the size of a tennis ball.

      Having had the experiences I have with endo, I wish that I would have known about the existence of web site a lot sooner - It would have helped me a great deal. I mean, just having a resource at hand with the ability to chat with other women who had this would have been reassuring. The abdominal pain I had been experiencing on a daily basis in the two months leading up to the hysterectomy is gone. I have recovered and am beginning a new chapter in my life, adjusting to hot flashes, sweats and the occasional crabbies, but relatively pain free at 46 years old. Because of the endo and an unrelated experience with blood clots (DVT), I cannot do the hormone replacement therapy for the menopausal symptoms - But it is a small price to pay for the absence of my pain.

      Check out the site listed below for the information that you need. Know that every woman's experience with endo is just as unique as she herself is - My experience won't be the same as yours. Good luck.

  44. QUESTION:
    Treatment options for Endometriosis?
    Doctors have thought i might have endometriosis since i was 16, I am now 22. Since the only way to find out was through a laparoscopy i have pushed it off for years. The pain when i was younger was extremely random and rare, but now it is a every day thing and is interfering with my daily life. So i am having the laparoscopy done in two weeks. I havnt discussed treatment options yet, because i need to wait after the procedure to see if i even have endom. If any one knows the treatment options please let me know, i cant wait to weeks! I found online that most treatments depend on wether you have future plans for children or not, which i do want children. The pain is almost unbarable now so something needs to be done. Thanks for anyones help and input
    And i also i have been on Birth Control for six years... which i know they say can help with the pain, but not in my case i guess

    • ANSWER:
      Endometriosis is a noncancerous disorder in which functioning endometrial tissue is implanted outside the uterine cavity. Symptoms depend on location of the implants and may include dysmenorrhea, dyspareunia, infertility, dysuria, and pain during defecation. Diagnosis is by biopsy, usually via laparoscopy. Treatments include anti-inflammatory drugs, drugs to suppress ovarian function and endometrial tissue growth, surgical ablation and excision of endometriotic implants, and, if disease is severe and no childbearing is planned, hysterectomy plus oophorectomy.

  45. QUESTION:
    Elective hysterectomy in 23 year old?
    I am 23 and looking into the possibility of an elective hysterectomy.
    I gave birth at 20 with my husbands child. My husband and I are still together [soon celebrating 5 years of marriage]
    I do not wish to have any more children.
    Last year I was diagnosed with a cyst on my ovary. It went naturally within 4 weeks of it being diagnosed. I have had issues with pelvic pain for the last two years. I have been told that some months, my egg bursts from the ovary faster than a normal release [I hope this makes sense] but the pain is excruciating. My husband has to help me walk short distances from the sofa to the bathroom as I can't walk it. I am unable to walk the dog because of the pain. I take tramadol and have taken codridamol, co-codamol and diclofenic for this, and it only eases the pain for the first hour after taking it. I have had a conversation with my husband, and we both agree that due to lack of funds, we wouldn't be able to offer another child a secure future. The pain at the moment is agonising. I was referred to a gynaecologist last year, who is the one who diagnosed the cyst and the ovary issue. I have now had enough of spending every other month in pain, even when I am not menstruating, [like now]. My periods themselves are very painful also.

    As for contraceptive, I can only take the mini pill. I have something called Factor V Lieden which basically means the pregnancy hormone is present in my bloodstream, my blood thickens and clots, leaving me liable to stroke, DVT and even more illnesses. Therefore I am unable to use things such as the pill, the inplant, and the injection. I had the IUD fitted [copper, not marina] and that did nothing to help the issues. I have had Pelvic Inflammatory disease in the past also. My husband and I are both clean of and STI's or STD's and are both faithful [100%] so we know there are no diseases present causing this issues.

    Do you think an elective hysterectomy is a good option? If not, what other alternatives are there?

    Thanks

    • ANSWER:
      Ugh, I'm so sorry. That's really rough. But it's not clear from what you've said if your pain is all the time or just some of the time. And you haven't explained why you have pain, beyond the cyst and the ovulation. Ovulation should only hurt for an hour at most, and cysts do go away or can be surgically removed but shouldn't be every month. It's hard to judge what will fix the pain without that information. However, it sounds like an elective hysterectomy would be a very bad option. If you had a hysterectomy--and incidentally, what you're talking about here isn't a hysterectomy, it's a total abdominal hysterectomy with bilateral salpingo-oophorectomy--then you'd have problems 24/7/365, while maybe you only have pain some of the time now? But without ovaries then you'd go into surgical menopause, which is much worse than natural menopause, and the worst of the symptoms would last until you were 50. And you couldn't take estrogen to ease those problems because of the Factor V Leiden. And you couldn't undo the surgery, either--it would be permanent. So if you found the situation to be worse, then you'd be stuck. If you had the surgery, then you'd almost certainly suffer from sexual side effects--loss of sexuality, because you'd be castrated. And you'd get osteoporosis. And your lifespan would be shortened by more than 10 years, on average, due to ongoing damage to your heart, blood vessels, colon, and brain, that would be progressive, since your body needs those hormones, hence the shortening of lifespan and increased risk of Parkinson's Disease and Alzheimer's.

      Question: do you currently take the mini pill? because it can usually stop ovulation, though it doesn't do it as well as the combined pill. Can you use Mirena IUD? Also, have you been checked for endometriosis? That might be a possible diagnosis, and they can only tell that by surgery. If you do have endometriosis, then getting your uterus removed would actually be a good option, because it would take away at least some of the pain and the doc could also remove endometrial implants, taking away more of the pain. You'd still get endometrial changes every month, which could be a problem, but it would do a lot towards making it not be as bad and not get worse, to do a hysterectomy. You'd still keep the ovaries, though. Often what they do in these situations is remove the uterus and then give you Lupron, which shuts your ovaries down for like 6 months or so. As a result, all of the endometrial implants die off. Then your ovaries start working again but without a uterus, there are no new implants and the pain is gone or at least lessened. Getting Lupron simulates what it would be like to not have your ovaries. You'll feel quite miserable, and you'll be glad that your ovaries will still be there to start working again.

  46. QUESTION:
    Endometriosis or Ovarian Cancer ahhhhh?
    Finally going to get diagnosis. Ive been horribly painfully sick for so long. Doctor came to a conclusion its either endometriosis or ovarian cancer. Unlikely cancer being that im only 24 but ive also develope diabetes and im skinny not overweight. He doesnt want to do surgery if he doesnt have to so after I get my sugar under control he is going to treat me for endometriosis. If the treament doesnt work then he is doin the surgery and I might get the dreaded ovarian cancer news....Im scared but I know im going to be ok...God is on my side. Anyways does anyone know any other young women who have developed this horrible silent killer? Last think I want is to go through cancer treatments....but I have come to terms that im sick and it could get even worse. Im a mommy I dont wanna die...what kind of supplements should I be taking.....any info is helpful.
    Yea and i have everyone of those symptoms but my symptoms could be of something else either way at least im on the path now to find whats seriously wrong. Ive been sick for so long and now I have this diabetes and im only 24 and im very thin so the diabetes is obviously being caused by an even bigger problem
    Ive decided to do the surgery if I have cancer I need to know now.

    • ANSWER:
      my grandma had ovarian cancer. there are some symptoms but can be vague and increase over time. early detection increases the survival rate. and a pap test DOES NOT detect ovarian cancer. if you've used birth control pills for several years it can help reduce the risk of ovarian cancer. a tubal ligation can reduce the relative risk of ovarian cancer. a hysterectomy can also reduce the risk of ovarian cancer. if you have a family history of ovarian, breast or colon cancer your chances of getting it are much higher. a prophylactic oophorectomy can also reduce your risk for ovarian cancer. some symptoms of ovarian cancer are:
      pelvic or abdominal pain or discomfort
      vague but persistent gastrointestinal upsets such as gas, nausea and indigestion
      frequency and/or urgency of urination in the absence of an infection
      unexplained weight gain or weight loss
      pelvic and/or abdominal swelling, bloating and/or feeling of fullness
      ongoing unusual fatigue
      unexplained changes in bowel habits
      IF SYMPTOMS PERSIST FOR MORE THAN 2 WEEKS, CONSULT YOUR PHYSICIAN!!!
      other symptoms:
      upset stomach or heartburn
      back pain
      pain during sex
      constipation
      menstrual changes

      OVARIAN CANCER...IT WHISPERS, SO LISTEN

  47. QUESTION:
    Anyone else with PCOS get pain from it?
    I've been having right sided lower abdominal pain off and on for the past 18 months. I was admitted to hospital in September with severe pain and ended up having my appendix out (which turned out to be normal, and I was diagnosed as having had a ruptured ovarian cyst). About six weeks later I was readmitted with similar pain, and eventually had an exploratory laparoscopy, which found nothing to explain the pain, but confirmed a diagnosis of PCOS (which had already been diagnosed based on clinical signs and symptoms). Anyway, all the literature says that PCOS doesn't cause pain, but I'm sure the pain I'm experiencing is coming from my right ovary (I'm a junior doctor by the way, so I do know where my ovaries are etc!).

    Does anyone else with PCOS suffer from chronic lower abdominal pain? It's like a twisting pain, comes and goes, sometimes lasts a few hours, sometimes a few days, happening at least once a week. Any ideas?

    • ANSWER:
      Have you been tested for endometriosis? Endo isn't usually uni-lateral, but it is incredibly variable from woman to woman.

      The pain can literally drive women mad, and until laparoscopies and so forth, it used to be dismissed, as 'in your head'.

      My hunch would be that if you have a tendency toward cystic ovaries, you probably have a tendency toward scarring, adhesions, and other painful functions of endometriosis. Catch this before it spreads!

      I had to have a partial hysterectomy, at 28, because the endometriosis was so bad. 17 years of excruciating lower abdominal pain, and scar tissue, adhesions. My left ovary came out when I was 39, because there was a massive adhesion to my bowel. The ovary was fine, but the adhesion cause pain on the toilet.

      I've been in support-groups for pain, and information, on gynaecological problems. I've facilitated same. When you've had as much wrong with your body as I have, you learn about it -- and I had medical training too.

      Feel free to contact me for support, or just to talk, because I know how gruelling it is, getting on with life, with so much PAIN there.

      If it's endo, it should correlate with your menstrual cycles. Some oral contraceptives help reduce the pain. Since you are a medical professional, get a thorough laparoscopy, and have them laser out all the cysts, scars, and adhesions (and stray endometrial/other cells) while they're at it!

      Best of luck, sister!

      BTW, ovarian cysts do come back. You may need an oophorectomy.

  48. QUESTION:
    Anybody had a hysterectomy?
    Okay so I may have to get a complete hysterectomy. Does anyone out here have any advice? What is it like after wards? Anything to watch out for after the procedure?
    Well for starters I'm only 29 almost 30 years old. I had a tubal ligation after the birth of my daughter. It seems like all these problems started after my tubal. I wasn't told about this when I signed the papers. They just said that it was a form of sterilization and that it is 99% effective. Then later I find out that after like 10 years the failure rate is 15%. I made an appointment to see a specialist because my PCP didn't even want to look at the option of hysterectomy even though cancer runs in my family. My 3 sisters had cervical cancer and Gma did also. I have been told that the healing process can take as long as 8 weeks but that's okay. I would rather go ahead and have it done than to be sorry years down the road and realize I had cancer.

    • ANSWER:
      I have, in 2008 when I was 43. I had an abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy, which means they took out everything but my cervix (I now call it the "Bridge to Nowhere" ... LOL)

      Go to www.hystersisters.com and you will find a wealth of information. It depends on which type of surgery you need--abdominal, vaginal, or laparoscopic vaginal--to say how long it will take you to heal, but you should plan on at least eight weeks away from work.

      EDITED TO ADDRESS YOUR ADDITIONAL DETAILS: Okay, in that case the truth is that most gynecologists will not remove your uterus if it is otherwise healthy, even with a family history of cancer. It is best to keep your lady-parts for as long as you can, especially your ovaries. In my case, I had severe endometriosis, PCOS, and uterine fibroids. I had been on hormones and birth control pills before that for over twenty years to attempt to alleviate the symptoms (gushing periods, severe pain, etc.) In the event that you do find a doctor willing to do the hysterectomy, since it is elective, your insurance will not cover it. Mine cost fourteen thousand dollars. Ouch on the wallet. :(

      My advice to you is to get a referral to an oncologist with whom you can discuss your concerns, and allow that oncologist and your PCP to confer about possible other courses of action that could be taken. I know it is frustrating--I begged my doctors for a hysterectomy for years before I finally got one, and only then because I had been on every hormone there was and all of them had eventually failed to work.

      Good luck, honey. I hope you will get some help. Feel free to message me if you have more questions.

  49. QUESTION:
    i suffer serious stomach pain during period please advise?

    • ANSWER:
      You may have Endometriosis.

      From the Endo Research Center, a free foundation for Endo, available online at www.endocenter.org:

      "Endometriosis, a leading cause of pelvic pain, hysterectomy and female infertility, is a reproductive and immunological disease affecting nearly 89 million women and teens worldwide. The average delay in diagnosis is a staggering 9 years, and the disease can only be definitively diagnosed through gynecologic surgery.

      With Endometriosis, tissue like the endometrium is found outside the uterus, in other areas of the body. These growths, called "implants" or "lesions," still respond to hormonal commands each month, breaking down and bleeding. However, unlike the endometrium, the tissue has no way of leaving the body. The result is internal bleeding, degeneration of blood and tissue shed from the growths, inflammation of the surrounding areas and formation of scar tissue. Depending on the location of the growths, interference with the bowel, bladder, intestines and other areas of the abdominal cavity can occur. Endometriosis has even been found lodged in the skin, the lungs and even the brain.

      There is currently no definitive cure for Endometriosis, but there are several effective methods of disease management. Many women can and do live well in spite of their Endometriosis.

      Endometriosis staging has been defined by the American Society for Reproductive Medicine, with criteria based on the location, amount, depth and size of disease implants. These factors are graded on a point system based on biopsy samples obtained during surgery. The first classification scheme was developed in 1973, but since then it has been revised and refined 3 times for a more precise method of documentation. As of 1985, the stages are classified as 1 though 4; minimal, mild, moderate, and severe. Stage is not indicative of pain levels, infertility or symptoms. A woman in Stage 4 can be asymptomatic while a Stage 1 patient might be in debilitating pain.

      Malignant transformation of Endometriosis can and does occur. Some researchers even estimate that approximately 0.7-1.0% of patients with Endometriosis have lesions that will ultimately undergo malignant transformation, and urge consideration of performing bilateral oophorectomy at the time of abdominal surgery in patients with significant disease. We have also begun learning of the elevated risks women with the disease have for certain cancers, including non-Hodgkin’s lymphoma. The reasons why remain unclear; however, women with Endometriosis are more likely take certain drugs, such as Progestagins, and are more likely to have had their ovaries or uterus removed, another factor that influences hormone levels and possibly increases cancer risk. One patient undergoing Tamoxifen therapy was discovered to have malignant endometrioid neoplasia arising within her Endometriosis, suggesting to her physicians that the Tamoxifen, as a result of its estrogenic effects, caused proliferative and malignant changes in her disease. In a similar study targeting women who had undergone hysterectomy with oophorectomy because of Endometriosis, authors noted that "Endometriosis can undergo estrogen-dependent changes similar to the endometrium and may carry a risk of developing hyperplasia and carcinoma during unopposed estrogen stimulation." The researchers concluded that unopposed estrogen therapy may lead to premalignant or malignant transformation in the residual foci of Endometriosis and encouraged the addition of progestins to estrogen replacement therapy. It is also possible that women with Endometriosis may be screened more often certain cancers (i.e. breast) and therefore are more likely to be diagnosed.

      While no one is certain exactly what causes Endometriosis, there are several theories, though none are definitive. Common ones include:

      Sampson's Theory of Retrograde Menstruation
      In 1921, Dr. John Sampson contended that "during menstruation, a certain amount of menstrual fluid is regurgitated, or forced backward, from the uterus through the fallopian tubes and showered upon the pelvic organs and pelvic lining." There has been evidence to support Dr. Sampson's theory; however, studies have shown that while many women experience retrograde menstruation and have evidence of a "tipped" uterus, not all women will develop the disease. His theory also fails to explain the presence of Endometriosis in such remote areas as the lungs, skin, lymph nodes, breasts and other areas.

      Transplantation Theory
      Believes that Endometriosis is spread through the lymphatic and circulatory systems. This would explain Endometriosis in most sites, but does not explain the presence of disease to begin with.

      Iatrogenic Transplantation ("Doctor Caused")
      Holds that the accidental transference of diseased tissue occurs from one site to another during surgery. However, this is highly uncommon today due to advanced surgical management. It also does not explain the presence of the disease to begin with.

      Coelomic Metaplasia
      Drs. Ivanoff and Meyer's theory that "certain cells, when stimulated, can transform themselves into a different kind of cell." This would explain the presence of the disease in absence of menstruation, and further, the presence of Endometriosis in the few men who have been diagnosed with it.

      Heredity
      A very popular theory that women with relatives who have the disease may be genetically predisposed to developing it themselves. This theory was suggested as early as 1943, and research is currently underway by Oxegene Study scientists at the University of Oxford in the United Kingdom.

      Immunity
      According to the Institute for the Study and Treatment of Endometriosis in IL, "two different arms of the immune system may be involved in the development of Endometriosis. Cell-mediated immunity, in which specific immune cells fight disease; and humoral immunity, in which antibodies are formed to attack antigens." Studies by others suggest that migrating Endometriotic tissue affects women who have "deficient cell mediated immunity." In women without the deficiency, the transplanted cells are destroyed.

      Genetics
      Researchers have discovered that some women's genetic makeup determines their predisposition for contracting the disease.

      Still others believe it is a combination of many different factors that cause some women to have the disease.

      Some women with Endometriosis have no symptoms, others have chronic or debilitating pain and infertility. Some general symptoms of Endometriosis include chronic or intermittent pelvic pain, dysmenorrhea (painful menstruation is not normal!), infertility, miscarriage(s) and ectopic (tubal) pregnancy.

      Location specific symptoms of Endometriosis include:

      Cul-de-Sac ("Pouch of Douglas")
      The Cul-de-Sac is one of the most common (top 5) disease locations. Endometriotic implants express an "irritating focus" of prostaglandins and other chemicals. The Cul-de-Sac is surrounded by the posterior wall of the uterus, the supravaginal cervix, the upper part of the vagina, the rectum and the sacrum, the small intestine and the sacrolateral ligaments. Hence, this "irritating focus" can aggravate all the areas named, including the bowel. This can account for bowel symptoms when there are no implants actually present on the bowels. The same is true for disease located on the appendix. Dyspareunia (pain during intercourse) and pain after intercourse are also commonly reported symptoms by women with Cul-de-Sac Endometriosis.

      Uterosacral/Presacral Nerves
      Backache, leg pain, painful intercourse are often the chief complaints of women with Endometriosis in these common locations.

      Gastrointestinal Tract
      The rectosigmoid colon, rectovaginal septum, small bowel, rectum, cecum, large bowel, appendix, distal ileum, gallbladder and intestines make up the GI tract. GI tract symptoms include nausea, vomiting, constipation, painful bowel movements, blood in stool, rectal bleeding, sharp gas pains, bloating and tailbone pain.

      Bladder, Kidneys, Ureters and Urethra
      Women with Endometriosis of these areas complain of blood in the urine, tenderness around the kidneys, painful or burning urination, flank pain radiating toward the groin, urinary frequency, retention, or urgency, and hypertension. Many women with Endo also have Interstitial Cystitis, Endo's "Evil Twin."

      Pleural (Lung and Diaphragm)
      Coughing up of blood/bloody sputum, particularly coinciding with menses, accumulation of air/gas in the chest cavity, constricting chest pain and/or shoulder pain, shoulder pain associated with menses, shortness of breath, collection of blood and/or pulmonary nodule in chest cavity, deep chest pain.

      Sciatic Nerve
      Pain in the leg and/or hip which radiates down the leg are found in women with this form of disease. This symptom is concurrent with that of inguinal (groin area) Endometriosis as well.

      Subcutaneous/Cutaneous Endometriosis
      Painful nodules, often visible to the naked eye, at the skin's surface. Can bleed during menses and/or appear blue. The vagina is the most common location for this form of disease.

      Fatigue, chronic pain, allergies and other immune system-related problems are also commonly reported complaints of women who have Endometriosis.

      It is quite possible to have some, all or none of these symptoms. Many women with Endometriosis are completely asymptomatic. Endometriosis symptoms are so inconsistent and non-specific that they can easily masquerade as several other conditions. These include adenomyosis ("Endometriosis Interna"), appendicitis, ovarian cysts, bowel obstructions, colon cancer, diverticulitis, ectopic pregnancy, fibroid tumors, gonorrhea, inflammatory bowel disease, irritable bowel syndrome, ovarian cancer and pelvic inflammatory disease.

      Younger women and teens with symptoms are often dismissed and told they have PID or that they are "too young" to have Endometriosis. Once erroneously believed to be a disease of “Caucasian career women who have delayed childbearing,” we know that in fact, Endometriosis affects women of all ages, races and socioeconomic status. Endometriosis also can and does exist in the adolescent female population. Far from the “rare” incidence once believed, studies have found that as many as 70% of teenagers with chronic pelvic pain had Endometriosis proven by laparoscopy. Other reports indicate that as many as 41% of patients experienced Endometriosis pain 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. Sometimes, teens and young women lack support and validation from both the home and the school; told the pain is “in their head,” that they are “faking it,” that their debilitating cramps are “normal” and “a part of womanhood,” that they are merely suffering from “the curse,” or that they should just “grin and bear it.” Their symptoms may also be dismissed as a sexually transmitted disease, which Endometriosis absolutely is not. Failure to acknowledge and address symptoms early in the disease process can lead to significant delays in diagnosis and necessary, subsequent treatments. Lack of support from family and loved ones can also add to the patient’s pain and fear - at any age. Recent studies have also shown that Endometriosis may in fact have an even bigger impact on younger patients than older women. One such study discovered that in patients under 22 years of age, the rate of disease recurrence was double that of older women (35% versus 19%). The study also revealed that the disease behaves differently in younger women; leading some researchers to believe it is a different form of Endometriosis altogether. Surgery, considered necessary to accurately diagnose and effectively treat the disease, is often withheld from younger patients based on the injudicious belief that early surgery somehow negatively influences a young woman’s fertility. Extensive, cumulative research has shown this concern to be unfounded. What can impact fertility, however, is neglecting effective treatment of the disease. Some researchers also feel that symptomatic, adolescent-onset Endometriosis is most often a lifelong problem that will progress to severe fibrotic disease.

      While some larger implants and endometriomas may be seen through ultrasonography, CT Scan, MRI or other diagnostic procedure, such detection rates are limited. Thus, the current gold standard for a positive diagnosis of Endometriosis is via gynecologic surgery like a laparoscopy, or in some cases, open surgery like the laparotomy. Laparoscopy entails visualization of the abdomen and pelvic cavity via an instrument known as the laparoscope - a thin, lighted instrument fitted with a telescopic lens and on occasion, a miniature videocamera. During "the Lap," as it is commonly referred to, your organs will be manipulated for viewing, diagnoses are made, biopsies are taken, and therapeutic measures are usually performed as well.

      While there is no cure for Endometriosis, treatments exist ranging from medical to alternative to surgical. Some, such as surgical excision, confer longer-lasting benefits than others.

      Surgical destruction of the disease can be done in many various ways, according to the surgeon's preference and training. These include:

      Excision
      Cutting out of entire diseased implants, while preserving the healthy portions of the affected organ(s). This meticulous form of removal can only be performed by an advanced endoscopic specialist with a full understanding of modern concepts of treatment. Recurrence rates are less than 10% at 5 years out.

      Vaporization
      Destruction of implants by instant boiling of the cellular water with a high power laser or electrosurgical tool.

      Ablation
      Removal by any surgical means; generally involves laser. This is the most common method utilized by Gyn Surgeons. Recurrence is over 80% within the first 2 years.

      Coagulation
      Desiccation of implants by heating and drying the affected tissue(s).

      Fulguration
      Superficial burning of implants with a spark of electricity from any electrosurgical tool.

      Ultrasonic
      Some surgeons prefer ultrasonic treatment methods; this means sound waves at very high frequency will be used as an energy source. Two devices are currently used by surgeons who practice this method are the Harmonic Scalpel and the CUSA (Cavitational Ultrasonic Surgical Aspirator).

      Hysterectomy
      Endometriosis remains a leading cause of hysterectomy and accounts for nearly half of the 600,000 hysterectomies performed in the U.S. annually. While not a definitive cure for the disease, some women have experienced relief of painful symptoms following a hysterectomy. Certainly, each case of Endometriosis is different and each patient requires a different course of treatment. A hysterectomy is just one of the many surgical options that can be considered in your search for treatment. The old school belief was once that a hysterectomy was the cure for Endometriosis. Today, of course, we know this is untrue and that a hysterectomy is no more curative than "prescribed pregnancy" (another common fallacy). However, some women with Endometriosis who have elected to undergo a hysterectomy have found relief following the procedure.

      Several patients can experience relief through the use of hormonal agents and other medical therapies. These include:

      Aromatase Inhibitors
      Studies have shown that misplaced Endometrial tissues respond to ovarian hormones such as estrogen and go through a menstruation-like process (bleeding, shedding and inflammation) repetitiously in the abdomen of a woman. Estrogen is like fuel to fire for Endometriosis, thus current treatments have been designed to stop estrogen secretions from the ovaries of a woman (gonadotropin releasing hormone agonists). Estrogen, however is made not only in the ovaries but also in adipose tissue [fibrous, insulating tissues packed with fat cells], and most importantly, *within Endometriosis implants themselves.* Thus, Endometriosis tissue acts in a devious manner to make its own estrogen through the abnormal expression of aromatase enzyme, sustaining its own life cycle. This may explain the high numbers of treatment failures and early recurrences after conventional treatments of Endometriosis. Aromatase Inhibitor treatment is in trials, but not yet widely available.

      GnRH (gonadotropin-releasing hormone) Agonists
      These are drugs that are designed to suppress the Endometriosis implants by stimulating the ovaries to produce more estradiol (the most potent form of estrogen) then paradoxically, after 7 to 21 days of constant stimulation, shutting down the "messenger" hormones sent from the pituitary gland to the ovaries. The result is that the ovaries shut down, estradiol levels drop sharply and rapidly and the patient ceases to ovulate or menstruate; a condition similar to that of menopause. Some women experience positive results with GnRH treatments, others do not. As with any treatment, each case will vary. Though the medications can temporarily shrink the lesions of Endometriosis, they will not shrink adhesions or scar tissue, which often play a part in the symptomatic pain of the disease, nor do they treat infertility in any way. Common side effects that have been reported by women undergoing treatment include hot flashes, headaches, insomnia, vaginal dryness, decreased libido, depression, mood swings, fatigue, acne, dizziness, nausea, short term memory loss, diarrhea, hair loss, anxiety, and bruising at injection site. There are several different GnRHs that can be considered for treatment. These include Lupron Depot, Synarel, Zoladex and Suprefact.

      Other medications include synthetic hormones like Danazol. This synthetic testosterone marketed under the names "Danocrine" or "Cyclomen" is usually given in pill form. Danazol was the first medication approved for use in the treatment of Endometriosis and works by suppressing the ovaries. However, expense and side effects have made it a less common approach by physicians today.

      Contraceptives such as Depo-Provera (medroxyprogesterone acetate) and Provera (both progestins, administered by injection or orally) are also used to treat the disease, as are combination estrogen/progesterone oral contraceptive pills like Alesse and Lo-Ovral.

      Pain management options include non-steroidal anti-inflammatories (NSAIDs) such as Anaprox or Toradol. Stronger narcotics and anti-depressants are often used as well.

      Alternative therapies may also be effective and non-invasive for some patients, including:

      Immunotherapy, Diet & Nutrition, Shiatsu, Naturopathy, Biofeedback, Osteopathy, Homeopathic Therapy, Chiropractics, Acupuncture, use of a Transcutaneous Electrical Nerve Stimulation (TENS) unit, Bach Flower Remedies, Exercise, Aromatherapy, Reflexology, Herbs, and Massage Therapy.

      There is no cure for Endometriosis, but there are ways to cope. For more information on Endometriosis, please visit the ERC on the web at http://www.endocenter.org and join the ERC's free online Listservs at http://groups.yahoo.com/group/erc and http://health.groups.yahoo.com/group/EndoDocs."

  50. QUESTION:
    Post-menopausal changes in orgasms?
    Okay, so I am a 30-something post-menopausal woman (surgery induced menopause). I had an abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy, for severe endometriosis, about 8 years ago.
    I have noticed a significant change in the quality and duration of my orgasms over the last several years. Where once the pleasure would build and build to a creschendo at the top and then go back down (like going up and over a mountain top), now it just builds and builds, gets to the top and stays there.
    The "pleasure waves" don't really come, and it feels like a let down.
    I've tried viagra, I've tried excitement gel. Nothing really seems to help get it back to what it once was. I miss it.
    Anybody have any experience with this problem or any advice?

    • ANSWER:
      try this, (it may be easier doing it to yourself then getting your guy to do it)

      masturbate until you feel your building up the mountain just before you get to the top stop for 30 secs and start again, do it 4 or 5 times before trying to "reach the top" and over the otherside.

      i really hope this helps

endometriosis after hysterectomy and oophorectomy

Comments are closed.