Home Cure for Endometriosis

51 Tips for Dealing with Endometriosis

51 Tips for Dealing with Endometriosis

Do you have Endometriosis? Do you think you do, but aren’t sure? Are you having a hard time learning to cope? 51 Tips for Dealing with Endometriosis can help.

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Endometriosis and Infertility Solution

Treating Your Endometriosis is written by Shelley Ross. It is an ebook explaining a safe, simple method to treat endometriosis naturally. Endometriosis is a condition where the uterus lining actually develops on the outside of the uterus. This abnormal growth is not just a nuisance it can be potentially dangerous if not treated properly. In her Treating Your Endometriosis eBook Shelly talks about the endometriosis diet that is a key factor in addressing endometriosis pain and symptoms. Endometriosis is not something to be taken lightly. If you suspect that you may have endometriosis you should immediately seek medical advice for a diagnosis. While there is no cure for the disease, it is possible to treat it through a variety of treatments.

Treating Your Endometriosis Overview

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Endometriosis Oh the Tangled Webs We Weave

Endometriosis involves the growth of cells from the endometrium (the uterus lining) in other areas of your abdomen. About 12 million American women report having this condition that's 10-20 percent of the female population. Endometriosis begins with a backup of endometrial tissue that builds up throughout the month during a regular menstrual cycle. The cause of this tissue backup is still unknown. Instead of flowing out of the uterus, some of the tissue moves back up through the fallopian tubes (which transport ovulated eggs) and falls out into the abdominal cavity. These living cells are often called implants, and they continue to respond to cyclical hormonal changes. They grow, build up, and bleed, just like they did before in the uterus, except there's nowhere for the blood to go. The blood can be absorbed slowly by the lining of the abdomen, but the remaining build-up of weblike tissue and blood clots causes the scarring and adhesions that can affect your fallopian tubes, ovaries,...

Oxidative Stress and the Endometriosis

Researches did not report a definitive conclusion about the association between OS and endometriosis. Endometriosis may result in infertility due to mechanical blockage of the sperm-egg union by endometriomata, or adhesions, or pelvic anatomy malformations. Peritoneal fluid of women with endometriosis has been found to be increased in size and contains high concentration of activated macrophages, cytokines, and pros-taglandins. Activated macrophage may be responsible for increased production of ROS. Alpay et al. 204 suggest that ROS may enhance growth and adhesion of endometrial cells in the peritoneal cavity, promoting endometriosis adhesions and infertility. In addition, Murphy et al. 205 reported a correlation between high level of ROS produced by peritoneal macrophages and LPO in endometriosis patients, whereas Jackson et al. 206 reported a weak association between LPO and endometriosis, and other researchers reported no association 175 .

Pelvic Pain Infection and Adhesions

Today's potent antibiotics can cure almost every pelvic infection, and so hysterectomy is rarely recommended as a treatment and usually only in cases of severe infection. Chronic pelvic pain or pelvic adhesions may sometimes be appropriately treated with hysterectomy. Adenomyosis, a condition that is often very painful, is best treated with hysterectomy. This chapter is about these conditions. Chronic pelvic pain is a symptom, not a disease. To determine the best treatment, we need first to determine the underlying reason for the pain. Pelvic pain is considered chronic when it is experienced as Chronic pelvic pain is a very common symptom. In fact, 10 percent of all women who visit a gynecologist do so because of pelvic pain. Persistent or recurring pelvic pain may be caused by a variety of gynecologic conditions, including untreated or incompletely treated pelvic infection, recurrent pelvic infection, endometriosis, adenomyosis, and postoperative pelvic adhesions. In addition, a...

Endometriosis

After several years, Beverly decided to switch doctors. Her new gynecologist suggested doing exploratory surgery to diagnose her problem. At age 30, after laparoscopic surgery revealed endometrial tissue on her uterus, tubes, and ovaries, she was diagnosed with endometriosis. The doctor destroyed much of the overgrown endometrial tissue using a laser through the laparoscope and also had to make a larger abdominal incision to remove her enlarged and overgrown left ovary. Jessica's two sisters and her mother all had endometriosis, and they'd all had hysterectomies before they were 40. Jessica also had endometriosis and had had multiple surgeries herself, both laparoscopies and laparotomies (in which a large abdominal incision is made). She gave birth to her daughter at age 28, but she had had no luck conceiving again. She desperately wanted another child and sought infertility treatment, but she knew that the in tractable endometriosis was preventing pregnancy. She decided to have a...

Position Of Instruments

Endoscopy can be used for surgical treatments, often referred to as minimally invasive surgery. These treatments may even occur at the same time as the endoscopy is being used to make a diagnosis. The surgery is performed by using instruments passed down the endoscope. Endoscopic treatments include removal of intestinal polyps or diseased tissue (such as an inflamed gallbladder) and laser surgery to treat endometriosis. The doctor uses the endoscopic view as a guide during the procedure. Such operations are usually better for the patient than conventional surgery because the patient recovers faster and spends less time in hospital. In some (investigation of the abdomen), endometriosis gas may be pumped into the abdomen to create more space Uterus and provide a better view. View of endometriosis Endometriosis, in which tissue from the uterus lining grows outside the uterus, can be treated endoscopic ally. In this view through the endoscope, a probe holds tissues out of the way in...

Burden of Disease

Although 75 of genital chlamydial infections in women are asymptomatic, C. trachomatis is a major cause of ure-thritis and cervicitis in women. Additionally, up to 40 of untreated cases of C. trachomatis may progress to pelvic inflammatory disease (PID). PID may result in ectopic pregnancy, infertility, and chronic pelvic pain. About 95 of men with C. trachomatis infection are asymptomatic. Genital infection in men occasionally results in acute urethritis or epididymitis and rarely in chronic complications such as prostatitis and reactive arthritis (Meyers et al., 2007).

Ureteral Reconstruction

The ureter has been opened, repaired, or reconstructed predominately utilizing sutured techniques (39). Nezhat probably was the first to report a clinical application of intracor-poreal-sutured reconstruction of a ureter obstructed by endometriosis. Excision of the involved segment and ureteroureterostomy was performed over 7 French catheter with four interrupted 4-0 absorbable sutures. A CO2 laser was utilized for the bloodless dissection prior to reconstruction with an estimated surgical time of 117 minutes (40). Wichham explored and performed a laparoscopic ureterolithotomy without repair of the ureter in 1978 (41). Closure of the ureteral wall following ureterolithotomy was described utilizing a running 4-0 absorbable sutures anchored on each end with absorbable clips (42). The procedure lasted approximately 180 minutes. We have recently resected a stenotic segment of ureter with an eroded proximal calculus and performed a Heinike-Mikulitz type of ureteroureterostomy with...

Neisseria gonorrhoeae

Neisseria gonorrhoeae infection may be asymptomatic in both men and women. The current USPSTF recommendation is for screening women at risk. Men with penile gonorrhea typically present with purulent penile discharge and dys-uria with N. gonorrhoeae infection. Mucopurulent discharge, dysuria, pelvic pain, and dyspareunia are typical symptoms in women. In patients who engage in anal intercourse, anal discharge, rectal pain, and bleeding can be presenting symptoms. Gonococcal pharyngitis is within the differential of exudative pharyngitis in sexually active patients. When symptomatic, throat pain, tonsillar exudates, and anterior cervical adenopathy may be present.

Pelvic Inflammatory Disease

Pelvic inflammatory disease can be caused by a number of organisms, including Chlamydia, and presents with pelvic pain and discharge. Findings that contribute to the diagnosis of PID include fever greater than 101 F, cervical or vaginal mucopurulent discharge, abundant WBCs on saline preparation of vaginal discharge, elevated erythrocyte sedimentation rate (ESR), elevated C-reactive protein (CRP), and evidence of N. gonorrhoeae or C. trachomatis infection. Hospitaliza-tion with parenteral antibiotics may be necessary in pregnant patients, patients in whom surgical emergency cannot be ruled out, those who do not respond to oral treatment, those who cannot tolerate oral treatment, and patients who have severe illness or tubo-ovarian abscess. When treating PID parenter-ally, improvement of symptoms for 24 hours may prompt a change to oral therapy (Table 16-12). Conversely, if oral therapy is not producing significant improvement within 2 to 3 days, admission for parenteral therapy may be...

Finding the Right Doctor

T I don't know why I trusted my doctor, but I did, said Julie, who had been to a number of doctors whom she didn't trust in her years of dealing with pelvic pain and abnormal bleeding. With this doctor, there was something about her her demeanor, her confidence, her patience with my husband. It all came together.

Unique Oral Contraceptives

Tion, endometriosis-related menstrual pain may be relieved by providing a continuous pill-free interval. The major advantage of this product is elimination of menstrual periods, resulting in improvement in or elimination of menstrual-related symptoms (e.g., headaches, menorrhagia, anemia, and endometriosis-related menstrual pain). The most bothersome side effect associated with Lybrel is a high incidence of spotting and breakthrough bleeding during the initial months of use. It appears as though the incidence of breakthrough bleeding with Lybrel decreases with continued use.3

Epidemiology and etiology

Rates of dysmenorrhea range from 20 to 90 . ' Dysmenorrhea can be associated with significant interference in attendance at work and school for 15 of women affected by the most severe form.25 Risk factors for dysmenorrhea include young age, heavy menses, and nulliparity.11 Causes of secondary dysmenorrhea may include cervical stenosis, endometriosis, pelvic infections, pelvic congestion syndrome, uterine or cervical polyps, and uterine fibroids.26

Detrimental Effects of ROS in Patients with Prostatitis

Seminal oxidative stress has been observed in patients with prostatitis categories NIH I, NIH II, NIH IIIA and NIH IV 111, 112 . However, even in prostatitis categories NIH III (chronic abacterial prostatitis) and NIH IIIB (non-inflammatory chronic pelvic pain syndrome), elevated ROS concentrations accompanied by decreased anti-oxidant levels are present in the semen causing oxidative stress irrespective of the presence of leukocytes 113 . This oxidative stress could be triggered by cytokines 26 and is thought to prompt acrosomal dysfunction in terms of significantly reduced inducibility of the acrosome reaction 59 , possibly via destabilization of the sperm plasma membrane by LPO.

Consequences Of Sexual Violence In Intimate Relationships

Survivors of sexual violence perpetrated by a cohabitating partner or spouse often experience more severe forms of physical injuries, as compared with stranger or acquaintance sexual violence.53,54 Physical effects may include vaginal and anal injuries, cuts, bruises, soreness, broken bones, black eyes, stabbings, and torn muscles.32,46 Many of these physical consequences often result in chronic physical ailments and gynecological problems such as pelvic pain, miscarriages, and increased risk for sexually transmitted dis-eases.55,56 Often the gynecological-related health consequences for survivors relate back to power issues with an abusive partner. For example, a survi

Gonadotropinreleasing Hormone

Prostate cancer, breast cancer, and endometriosis are all conditions that are dependent on the presence of sex steroids (Kettel and Hummel, 1997 Schally, 1999). Gonadotropin-releasing hormone (GnRH) is a critical peptide involved in the signaling cascade for gonadotropin synthesis, and the production of leute-nizing hormone (LH) and follicle-stimulating hormone (FSH) (Conn and Crow-ley, 1994) and therefore inhibition of GnRH may provide a therapeutic option for treating the above diseases. After 12 rounds of selection using a DNA library, a truncated 67-mer spiegelmer called NOX 1255 was identified with a Kd of 20nmol L (Wlotzka et al., 2002). Inhibition of GnRH by NOX 1255 and a 5'-PEG-modified version, NOX 1257, was measured in a CHO cell line, resulting in an IC50 of 20 nmol L for both compounds. In vivo activity of the aptamers was evaluated in a rat model of GnRH. As previously mentioned, GnRH controls LH release, which subsequently regulates testosterone production. Rats that...

Aromatherapy Practice

Many aromatherapists offer to treat any illness, as they are convinced that essential oils have great powers. They embark on the treatment of endometriosis, infertility, asthma, diabetes, and arthritis, even cancer, as they are convinced of the therapeutic nature of essential oils, but are often without the necessary scientific and medical knowledge. Psychoneuroimmunology treatment is the current buzzword.

Female Infertility The Obstruction to Reproduction

Getting pregnant isn't as easy as it looks. Indeed, there are a host of intricate processes that must be completed during ovulation, fertilization, and implantation of eggs into the uterus. Most of the couples I see have already been through a battery of tests to determine the possible causes of infertility. These conditions range from failure to ovulate properly to polycystic ovaries, blocked fallopian tubes, endometriosis, uterine fibroids, sexually transmitted disease, and pituitary, thyroid, or adrenal disorders. Emotions such as fear, anxiety, anger, and resentment are often by-products of this stressful time in a couple's inability to conceive.

Pathology and Clinical Manifestations

Herpes genitalis also has the incubation period of several days following exposure to infection. It may be subclinical, especially in women having lesions only in the vagina or the cervix rather than on the vulva. Herpetic infection is more obvious in men with localized pain, erythema, and the development of one or a group of vesicles on the glans, prepuce, or elsewhere on the penis. The inguinal lymph nodes may be swollen and tender. Urethral involvement in both sexes is manifested by dysuria (painful or difficult urination), and a discharge may be noted in male patients. Pelvic pain accompanying the dysuria is common in women. (The virus can be isolated from the urethra of both sexes. Primary infection with HSV-2 virus often is accompanied by systemic symptoms during the first several days (see Figure VIII.64.3). Complications of primary infection reveal a generalized infection, especially as aseptic meningitis and other indications of viral invasion of the central nervous system.

Critique of Selected Clinical Trials

A scientifically unacceptable study of the effect of aromatherapy on endometriosis, reported only at an aromatherapy conference (Worwood, 1996), involved 22 aromatherapists who treated a total of 17 women in two groups over 24 weeks. One group was initially given massage with essential oils and then not touched for the second period, while the second group had the two treatments reversed. Among the many parameters measured were constipation, vaginal discharge, fluid retention, abdominal and pelvic pain, degree of feeling well, renewed vigor, depression, and tiredness. The data were presented as means (or averages, possibly, as this was not stated) but without standard errors of mean (SEM) and lacked any statistical analyses. Unfortunately, the study has been accepted by many aromatherapists as being a conclusive proof of the value in treating endometriosis using aromatherapy.

Oxidative Stress and Female Fertility

Many events related to infertility may occur due to OS in the female reproductive tract, such as endometriosis, hydrosalpinx, polycystic ovarian disease, unexplained infertility, and recurrent pregnancy loss 129 . In addition, apoptosis may cause embryo fragmentation, implantation failure, abortion, or congenital abnormalities in offspring.

Endo Risks and Symptoms Could This Be

While the causes of endometriosis are still unclear, here is a valuable list of the current medical thoughts on the condition > Family history of endometriosis The symptoms of endometriosis can be difficult to evaluate. In the beginning, many women do not have any symptoms. Others who have severe buildup of tissue have no pain, while some women with only small adhesions have disabling discomfort. Although endometriosis is usually diagnosed between the ages of 2b and '5b, the condition could begin about the same time that menstruation starts. Many of these symptoms are frequently ignored or thought of as a normal part of the cycle. Have a conversation with your healthcare provider if you experience any of these symptoms A laparoscopy is an outpatient surgical procedure most commonly used to diagnose endometriosis. A tiny, lighted tube is inserted through a small incision in the navel, so that your surgeon can look inside the abdominal cavity. > Infertility (approximately 25-50...

Oxidative Stress in Female Reproductive System and ART Outcomes

Other OS markers include homocysteine that found to have negative correlation with embryo quality in women with endometriosis 174 . Also, 8-Hydroxy-2-deoxyguanosine (8-OHdG) is an indicator of DNA damage induced by OS. It was reported that high concentrations of 8-OHdG were inversely correlated with fertilization rates and embryo quality 175 . In addition, thiobarbituric acid-reactive substances, conjugated dienes, and lipid hydroperoxides in preovulatory follicular fluid are oxidative stress markers they found to have no correlation with IVF outcomes 144 . Smoking, a good oxidative stress inducer, has negative effect on ovarian function 176 .

Strategies to Overcome OS in Assisted Reproduction

Enzymatic and nonenzymatic antioxidant culture media supplementation Higher implantation and clinical pregnancy rates are reported when antioxidant-supple-mented media is used rather than standard media without antioxidants. Various nonenzymatic antioxidants including beta-mercaptoethano 220 , protein 219 , vitamin E 149 , vitamin C 221 , cysteamine 222 , cysteine 223 , taurine and hypotaurine 224 , and thiols are added to the culture media with the purpose of improving the developmental ability of the embryos by reducing the effects of ROS. Also, the addition of the enzymatic antioxidant, for example SOD, to the culture media prevented the deleterious effects of OS on sperm viability and on the embryo development both in vivo and in vitro. This was demonstrated by increased development of the two-cell stage embryos to the expanded blastocyst stage in the SOD-supplemented media. Mechanical removal of ROS in IVF ET has been studied as a method to improve IVF outcome 225 . The rinsing...

Superior Hypogastric Plexus

Pelvic pain states can be modified by neurolysis of the superior hypogastric plexus.143 Afferent nociceptive fibers originate in various pelvic viscera form a midline plexus in the retroperitoneum, extending from the lower third of the fifth lumbar vertebral body to the upper third of the first sacral vertebral body. These afferent fibers then pass centrally via the sympathetic nerves, trunks, ganglia, and rami. Previously, surgical presacral neurectomy was performed for some pelvic pain states. Current approaches to this plexus affect neurolysis by the spread of neurolytic solution, in a fashion analogous to blocks of the celiac plexus (Fig. 33-5 (Figure Not Available) ).

Interstitial Cystitis

Interstitial cystitis is a chronic, noninfectious bladder disorder predominantly diagnosed in women. Symptoms mimic those of a UTI (urgency, frequency) with the addition of chronic pelvic pain, dyspareunia, or both and varying with bladder filling. Although not associated with cellular change, epithelial inflammation and prolonged symptoms can lead to epithelial damage (Kahn et al., 2005). Two forms are identified classic interstitial cystitis, demonstrating inflammatory bladder wall changes identifiable on cystoscopy, and painful bladder syndrome, defined by the symptoms of interstitial cystitis in the absence of any objective cystoscopic findings (Marinkovic et al., 2009). The main impact of interstitial cystitis is on quality of life. Patients often express somatization and depression or anxiety as with other somatic pain syndromes, its pathogenesis is unclear. Differential diagnosis includes other somatic syndromes such as fibromyalgia, irritable bowel, and chronic pelvic pain, as...

Laparoscopic Hysterectomy

Surgeons began using laparoscopy to assist in vaginal hysterectomy in the late 1980s. In performing laparoscope-assisted vaginal hysterectomy, your doctor can combine the advantages of vaginal hysterectomy with the enhanced visualization of the pelvic organs that the laparoscope provides. LAVH is done today to treat many conditions that would have required an abdominal hysterectomy in the past, including uterine fibroids and endometriosis. Type 2 The laparoscope finds pelvic pathology such as adhesions or endometriosis. Your surgeon will treat these conditions through the laparoscopic incisions and then perform a vaginal hysterectomy.

Oxidative Stress and Chronic Bacterial Prostatitis

Shahed and Shoskes 36 showed that sperm OS in symptomatic patients with chronic bacterial prostatitis related to both ROS overproduction (especially with positive cultures) and reduced antioxidant capacity in men with category III prosta-titis. Furthermore, the observed increased levels of OS markers and their decrease after treatment with antimicrobials (category II) or with the antioxidant dietary supplement (category III) suggested that Gram-positive bacteria in the EPS of some men with chronic pelvic pain syndrome may represent true pathogens on the basis of the clinical response to antibiotics. Zhou et al. 37 showed a significant increase of OS markers (plasma nitric oxide and erythrocyte MDA) in patients with chronic bacterial prostatitis compared to healthy normal volunteers, whereas plasma vitamin C, vitamin E, and P-carotene as well as erythrocyte superoxide dismutase, cata-lase, and glutathione peroxidase activities were significantly lower in patients with chronic bacterial...

Bioactive Spiegelmers

Another peptide hormone that had been addressed by a selection-reflection approach is gonadotropin-releasing hormone I (GnRH synonyms gonadoliberin, luteinizing hormone-releasing hormone, LHRH) (Leva et al., 2002). GnRH is a key peptide hormone in the regulation of mammalian reproduction. It is a deca-peptide that is released from hypothalamic neurons in a pulsatile manner, binding to receptors on gonadotrophic cells on the pituitary. Here, GnRH stimulates the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which in turn trigger the production of sexual steroids. Therefore, GnRH and its receptor have been identified as therapeutic targets for sex steroid-dependent conditions such as prostate and breast cancer, endometriosis, as well as in assisted-reproduction techniques.

Epidural Steroid Injections

The list of indications is quite extensive and includes several well-described conditions such as lumbar-cervical radiculopathy, spinal stenosis, postlaminectomy syndrome, failed back syndrome, postherpetic neuralgia, complex regional pain syndrome, pelvic pain syndromes, phantom limb pain, and periaxial malignancies.13 Conversely, the list of contraindications is relatively short and includes sepsis, local infection, anticoagulation or coagulopathy, and hypovolemia (relative contraindication). 3 White and coworkers, in a study of 304 patients, found that the response to epidural steroid injections was most closely related to onset of symptoms, presence of nerve root compression, and the lack of any associated psychological issues.13 Many others 3 13 113 113 113 have identified some of the primary positive and negative predictive factors of the response to epidural steroid injections. Factors associated with the patient's history that correlate with a favorable response to the...

Superior Hypogastric Plexus Block

Superior hypogastric plexus blockade was first described in 1990 as a treatment for cancer-related pelvic pain.173 This nerve block was performed using a fluoroscopically guided posterior approach, very similar to the posterior approach to the blockade of the celiac plexus or lumbar sympathetic trunk. Because the iliac crests of the pelvic bone can be an anatomic barrier to proper needle placement, computed tomography (CT) has been used to guide superior hypogastric plexus blocks.173 123 153 CT-guided superior hypogastric plexus blocks can be performed using either an anterior or a posterior approach. Because of the small numbers of patients described in each case series, it is not clear that any one method is preferable based on technical ease, outcome, or complications.

Outcome Studies For Superior Hypogastric Plexus Block

Presacral neurectomy has been performed for years as a treatment for chronic pelvic pain. 82 Presacral neurectomy involves a surgical resection of the superior hypogastric plexus by either an open or a laparoscopic approach. Large retrospective series and case reports describe successful relief of pain in approximately 60 to 80 of patients with chronic noncancerous pelvic pain. 82 83 84 More recently, a randomized, controlled study compared a conservative surgical approach with presacral neurectomy in 71 patients with pain from endometriosis. There was no significant difference in relief of dysmenorrhea, pelvic pain, or dyspareunia. 85 These findings emphasize the potential discrepancies in reported outcomes between retrospective case series and controlled prospective studies. Since the original report of superior hypogastric plexus block for pelvic pain, there have been six additional studies describing the pain relief after superior hypogastric plexus block ( Table 51-2 ). 8811 86...

Accreditation Commission for Acupuncture and Oriental Medicine AGAOM

Medical Acupuncture), 263 abdomen, 17, 27. See also hara endometriosis, 175-176 exams, Japanese acupuncture, 27 endometriosis, 177-179 eight directions, 55-56 pulse, 13-15 tongue, 12-13 dianhea, 189-190 dysmenonhea, 167-170 ear infections, 142-144 eczema, 195-197 electro-acupuncture, treatments, 104 endometriosis, 177-179 facelifts, 197-199 fibromyalgia, 65-66 headaches, 59-61 healthful lifestyle tips, 251-252 herbal medicine, 47-49 HIV AIDS, 218-219 hypertension, 220-221 IBS, 186-187 indigestion, 191-193 infertility, 156-158 injuries, 101 insomnia, 225-227 jumper's knee, 88-89 knee pain, 87-88 licenses, 244 magnets, 45-46 Margaret Naeset, 75 medical histories, 14-15 menopause, 170-172 moxibustion, 41-42 nasal congestion, 126-127 acupressure, 4, 9-10, 19, 21-24, 27-29, 74, 86, 128-131, 239-241 acu-points, 5-7, 63-64, 238 allergies, 116-117 anxiety 210-211 arthritis, 78-79 asthma, 118-120 back pain, 82-85 bladder infections, 182-184 bronchitis, 121 bursitis, shoulders, 70-71 cancer,...

Effect of Oxidative Stress on ART Outcome

Abstract Oxidative stress is a condition that causes cellular damage including destruction of all cellular components including lipids, proteins, nucleic acids, and sugars. It affects negatively the quality of oocytes, sperm oocyte interaction, implantation, and early embryo development which influence the success of pregnancy. Many events related to infertility may occur due to OS in the female reproductive tract, such as endometriosis, hydrosalpinx, polycystic ovarian disease, unexplained infertility, and recurrent pregnancy loss.

Psychosocial and Spiritual History

Although many women who are victims of abuse do not volunteer any information, they often discuss the incidents if asked simple, direct questions in a nonjudgmental way and in a confidential setting. Be aware of the possibility of domestic violence in any woman with multiple medical visits for sexual dysfunction, chronic pelvic pain, fatigue, chest pain, gastrointestinal disturbances, headaches, depression, anxiety, panic attacks, eating disorders, substance abuse, suicidal attempts, and abdominal pain.

Ovarian Cysts and Uterine Fibroids Double Trouble

Both of these are unwanted guests in your abdominal cavity. Ovarian cysts are caused by growing cells in the uterus (see the discussion on endometriosis earlier in this chapter), which attach to and penetrate the tough covering of the ovary and begin to multiply. These cells form a cyst a closed pocket of tissue and can collect a large amount of blood, growing to the size of an egg or grapefruit. They are often called chocolate q sts because the blood darkens as it collects, giving it the appearance of a piece of chocolate attached to the ovary. Some women do not even know they have cysts, while others feel the characteristic lower abdominal achiness and discomfort. Sudden or sharp pain may point to a rupture of the cyst. Twisted ovarian q sts produce intermittent pain and are usually removed if pain becomes persistent.

Decompression Sickness

Clinical Features and Associated Disorders. DCS, which can occur after diving to a depth of more than 25 feet, usually appears within a few minutes to a few hours after the end of a dive. Mild DCS (type I) is defined by pain usually in the joints (bends) and or itching of the skin. Serious DCS (type II) is characterized by neurological problems. Involvement of the thoracic spinal cord, the most commonly affected area, leads to low back or pelvic pain and dysesthesias, which may be accompanied by sensory loss, weakness, and incontinence. Less often, the brain may be involved, resulting in various symptoms and signs such as headache, confusion, lethargy, vertigo, speech disturbance, hemiparesis, visual impairment, and seizures, depending upon the site of the insult. y

Edging Out Endo Acu Points Plus

When I first met Anne, she was 37 years of age and had already undergone laser surgery for infertility due to endometriosis. She had still not been able to conceive, had adopted two little girls, and found her old endo symptoms returning. With two small children to care for, her downtime from abdominal pain, constipation, and nausea was more than she could bear. We began with acupuncture and herbs, such as Dang Gui, Mu Dan Pi, and Chi Shao that significantly reduced her symptoms after one month of treatment. After three cycles, she felt greatly improved, acupuncture treatments were reduced to the times just before and after ovulation, and she uses herbs, biomagnets, acupressure, and nutrition to stay feeling good. It takes time, but positive results can be on the way.

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Classification of endometriosis (rear view). The stage is determined by the severity of the endometriosis. Stage I (minimal) Stage II (mild) with peritoneal implants Stage III (moderate) with peritoneal implants and endo-metriotic cysts (endometriomas) Stage IV (severe) with extensive peritoneal implants, large endometriomas, and dense adhesions (a chocolate cyst is pictured on the right ovary). All these hormonal compounds decrease or counteract the estrogen produced in the body and prevent the progression of endometriosis. (As noted in Chapter 3, GnRH agonists may also be used to treat fibroids, but once the treatment is stopped, the fibroids will recur promptly. En-dometriosis likewise recurs after stopping GnRH agonists.) Other drug treatments are in various stages of development. These include progesterone receptor modulators (PRMs), which act in a way similar to progesterone, and aromatase inhibitors, which block an enzyme called aro-matase from converting other...

Prostatitis

A common complication of UTI in men is prostatitis. Bacterial prostatitis is usually caused by the same gram-negative bacilli that cause UTI in female patients 80 or more of such infections are caused by Escherichia coli. The pathogenesis of this condition is poorly understood. Antibacterial substances in prostatic secretions probably protect against such infections. A National Institutes of Health (NIH) expert consensus panel has recommended classifying prostatitis into three syndromes acute bacterial prostatitis, chronic bacterial pros-tatitis, and chronic pelvic pain syndrome (CPPS). Acute bacterial prostatitis is a febrile illness characterized by chills, dysuria,

Gender

There is one condition that is absolutely gender-specific pregnancy. Many women have temporary back pain during the later stages of pregnancy, possibly related to altered posture and hormonal changes in soft tissues. However, this does not appear to have any lasting effect. Several early reports suggested that women with multiple pregnancies might continue to have more back pain. More careful studies do not seem to confirm this. Ostgaard et al (1996) suggested there might have been confusion between posterior pelvic pain and lumbosacral pain. The main problem in pregnancy may be pelvic pain, which usually settles after delivery. When they distinguished this, pregnancy did not appear to influence future back pain. As epidurals became more common during labor, there were many claims that they caused chronic low back pain. However, long-term follow-up of a randomized controlled trial of epidural pain relief in labor showed no significant difference in spinal movements, back pain, or...

Ureteroneocystostomy

Attesting to the feasibility of laparoscopic ureteroneocystostomy, other investigators have reported excellent results in the treatment of secondary ureteral stricture due to perforations from ureteroscopy as well as in gynecologic cases where infiltrative ureteral endometriosis or inadvertent ureteral injuries necessitate distal ureteral resection and reimplantation (21-25). Attesting to the feasibility of laparoscopic ureteroneocystostomy, other investigators have reported excellent results in the treatment of secondary ureteral stricture due to perforations from ureteroscopy as well as in gynecologic cases where infiltrative ureteral endometriosis or inadvertent ureteral injuries necessitate distal ureteral resection and reimplantation.

Prevention

Based on a study on mongrel dogs by Cogan et al. (9), cystotomy induced by electrosurgery during laparoscopic hysterectomy, can be a risk factor for formation of vesicovaginal fistula. Caution should be exercised when using electrosurgery in the vicinity of the bladder. The benefit of electrosurgical burn margin excision or omental flap interposition remains unclear, but both are accomplished easily with little risk and may play a role in fistula prevention. In another study on mongrel dogs, Sokol et al. (17) concluded that double-layer bladder closure appeared to be superior to single-layer repair for prevention of vesicovaginal fistula after monopolar cystotomy. Meticulous suture placement and avoidance of tissue strangulation are also essential for prevention of vesicovaginal fistula. During operative laparoscopy performed to treat extensive endometriosis, intentional or unintentional bladder lacerations, or ureteral injury are recognized complications. Repair of a resected ureter...

Uterine Fibroids

Uterine fibroids are present in approximately one third of reproductive-age women (Viswanathan et al., 2007). Although often asymptomatic, fibroids may cause pelvic pain, pressure, and heavy or irregular vaginal bleeding and are the most common reason for hysterectomy in the United States. Treatment options for fibroids include watchful waiting, since most fibroids will decrease in size after menopause. Although hysterectomy is definitive treatment, it carries the risks of major surgery. Myomectomy and other uterine-sparing procedures have a high rate of symptom recurrence (up to 50 within 5 years) and may be more effective for symptom control in perimenopausal women. Women with fibroids are more likely to be infertile, although it is not clear if the association is causative. Removal of fibroids has not been shown to improve fertility (Grifiths et al., 2009). Medical treatments such as NSAIDs and OCs have not been well studied. The levonorgestrel intrauterine system (Mirena) has been...

Endometrial Biopsy

Once the preparation is complete, the aspirator is inserted into the cervical os using the tenaculum to straighten the cervical canal as needed. It is advanced to the fundus, and then the central plunger is retracted to create intrauterine negative pressure for suction of endometrial contents. The aspirator catheter is then withdrawn to the lower uterine segment and advanced again repetitively to the fundus and rotated to sample all aspects of the uterine body cavity. The catheter is then removed from the uterus. Endometrial cells and blood will have entered the aspirator catheter and can be sent for pathologic examination. The tenaculum and speculum are then removed and withdrawn. The patient may experience uterine cramping and bleeding for a few days and should refrain from intercourse until this resolves. Excessive bleeding, fever, or pelvic pain warrants immediate evaluation in the postoperative period. Pathology results are discussed with the patient when available and any...

Background

Several principles and lessons emerge from the existing experience. First, little data address the application of laparoscopy to the removal of solid organs harboring tumor. The majority of minimally invasive procedures involved either the uterus or spleen, where malignant diseases were excluded. In most cases, simple morcellation without an entrapment sac was performed. Second, previous studies raise significant concerns regarding cellular seeding or spillage. Cases of endometriosis and retained tissue fragments, as well as splenosis, have been reported after intraperitoneal morcella-tion of the uterus and spleen, respectively (14-16). In addition, dissemination of uterine cancer has been reported after morcellation of a specimen with unsuspected adenocar-cinoma (17). Third, one must be cautious and adhere to basic oncologic principles. Although laparoscopic hysterectomy is increasingly applied for lower stage endometrial, cervical, and ovarian carcinoma, additional studies are...

Part

You're riot wearing bandages, a plaster cast, or a sling, so you must not be hurt too bad. Without a reminder, your friends and family might forget you're dealing with a real health challenge. Sometimes other people don't understand that pain can be covered up as you try to live a normal life. Your pain doesn't always show. Most of the patients I've seen with the following conditions such as endometriosis, ovarian cysts, and chronic bladder infections have either a hard time finding the words for what is going on, or have given up reminding those around them. They often suffer in silence. Well, I'm going to speak up about these conditions and the treatments that Oriental Medicine has waiting for you. > Vhether you're dealing with cysts, eczema, endometriosis, irritable bowel syndrome (IBS), or anxiety, get the help you need from these time-tested treatments. I know it's not always been easy. I encourage you to continue through the upcoming pages to discover a way to smile for real....

Pelvic Adhesions

Pelvic adhesions may result from previous surgery, inflammatory disorders, pelvic infection, or endometriosis. The pathogenesis involves creating a deperi-tonealized surface. When damage occurs to this surface, the repair process is rapid and essentially in place by eight days. The first process involves primitive mesothe-lial cells that repair serosal defects from the underlying mesenchyme. The second healing process occurs when fibrin deposits are laid down after three days (9). This results in adhesion formation. There is a long held belief that adhesions cause chronic pelvic pain. Good evidence exists showing that adhesiolysis does not improve chronic pain. In 2003, Swank et al. reported 100 patients with continuous or intermittent abdominal pain thought to be due to adhesions from previous surgery of at least six months' duration (10). These patients were randomized to diagnostic laparoscopy versus diagnostic laparoscopy and lysis of adhesions. The authors found there was...

Ovarian Remnant

Ovarian remnant syndrome is a condition of continued pelvic pain, ovarian follicle formation, and premenopausal levels of pituitary hormones. It is a complication of oophorectomy, where pieces of ovarian cortex are left behind. This tissue is responsive to pituitary hormones and can retain the ability to produce estradiol (20). It is often suspected in a patient with continued pelvic pain and a persistent adnexal mass after a bilateral oophorectomy. An increased risk of ovarian remnant is associated with performing oophorectomy, when the ovaries are adherent to the pelvic sidewall, rec-tosigmoid, and or the cul-de-sac. This may occur in cases of endometriosis, pelvic adhesions, or pelvic inflammatory disease (21). The risk may also increase risk with misapplication or improper use of pretied surgical loops, staplers, or bipolar elec-trodessication (22). This results in the remaining ovarian tissue being scarred along the pelvic sidewall frequently involving the peritoneum adjacent to...

S ex and S exuality

On the other hand, the uterine disorder that prompted hysterectomy may have interfered with your normal sexual relations. Many women tell us that their sexual relations improve after hysterectomy. Hysterectomy often relieves pelvic pain or discomfort or pressure, and sexual experiences after surgery are often less inhibited and more satisfying and pleasurable.

Sciatic Neuropathy

The sciatic nerve arises from the sacral portion of the plexus. It leaves the pelvis through the sciatic notch and divides into the tibial and peroneal nerves at the popliteal fossa. The sciatic nerve provides sensation to the perineum, posterior thigh, lateral calf, and foot. It innervates the thigh extensors, hamstrings, and all the muscles of the lower leg and foot. Pain, weakness, and sensory changes caused by injury of the sciatic nerve or one of its two branches can be caused by trauma from gunshots, hip fracture or dislocation, compression from surgery or prolonged sitting on a hard edge, tumor, endometriosis, lipoma, aneurysm of the gluteal artery, or improper intramuscular injection into the gluteus. Symptoms of sciatic nerve compression can mimic L5-S1 radiculopathy. Again, EMG is helpful in these clinical situations.

Reproductive Options

Often, although hysterectomy is the best treatment available to alleviate many gynecologic conditions, it can be deferred when a woman wishes to bear children. Clearly, if hysterectomy is performed as treatment for a gynecologic malignancy, waiting is not an option. When pelvic pain from endometriosis persists despite previous conservative surgeries, when abnormal bleeding continues even though medical treatments have been tried, when the alternative treatments to hysterectomy are not well tolerated, or when a woman is simply worn down by her gynecologic problem, she may want the definitive treatment of hysterectomy.

Health Effects

Intimate partner violence leads to significant morbidity and mortality and contributes to high health care costs. Victims of IPV experience similar problems as patients with general crisis or trauma (Box 45-1). Abused U.S. women show increased rates of poor general health, digestive problems, abdominal pain, urinary and vaginal infections, pelvic pain, sexual dysfunction, headache, and chronic pain (Campbell, 2002). In particular, these women suffer from gynecologic, central nervous system (CNS), and stress-related problems at an increased rate of 50 to 70 (Wathen and MacMil-lan, 2003). The largest difference between sexually abused and non-sexually abused women is in gynecologic complaints. In addition to direct harm caused by trauma, perinatal complications include low birth weight, antepartum

Incidence

Pregnancies may have risen over the years, considering that the risk factors such as ectopic pregnancy, infertility from tuberculosis and endometriosis, pelvic infections and infertility treatments are more common today. Regardless, an obstetrician practicing alone may never come across an abdominal pregnancy in a career spanning decades. In the singular instance where he she does have the need to treat such a patient, it may be in circumstances far from ideal. Although unusual, obstetricians should be aware of this potentially fatal condition, a circumstance amply illustrated by the first two cases described above.

Urologic Injury

Less common injuries have been reported to the ureter, the urachus, and the kidney (87). The urachal report was noted to occur during placement of an access trocar and patency of the normally obliterated connection to the bladder. Ureteral injuries are most common during laparoscopic-assisted vaginal hysterectomy when taking down the vascular ovarian pedicles. Additional injuries have been reported from thermal coagulation with electrocautery and laser ablation of endometriosis. Nezhat and Nezhat (83) has described the laparoscopic correction of ureteral transection with the performance of a laparoscopic ureteroneocystomy (Lych-Gregoir type). Injuries have also been published with laparoscopic colon resections, pelvic lymph node dissections, and laparoscopic radical prostatectomy series. These injuries are always rare, and their incidence appears to be not rising (49,88-94). A final rare reported complication has been noted during a laparoscopic nephrectomy in a patient with an...

Defining Outcomes

Explanatory trials usually rely on a single clinical outcome. For example, in a trial comparing drug treatments for menorrhagia, menstrual blood loss in millilitres may well be an appropriate primary outcome. Other physiological or biochemical outcomes such as haemoglobin level, volume urinary loss, extent of endometriosis visualised by laparoscopy, number of ovarian follicles seen on ultrasound scan and serum estradiol levels following ovarian stimulation may also be used in different situations. Unfortunately, they may not always correlate well with the clinically relevant outcomes-certainly from the patients' perspective. In certain cases, costs and a need to opt for a modest and realistic sample size dictate the need for surrogate outcomes in preference to more robust but less common substantive outcomes. Thus bone mineral density rather than the

HRT and Cancer

Cervical cancer is a non-hormone-dependent cancer, and using hormone replacement therapy after treatment for cervical cancer does not seem to be a problem. If endometriosis is your problem, the decision about HRT is an individual one that you must make in consultation with your doctor. Since endometriosis seems to be influenced by hormones, especially estrogen, HRT may increases your risk for recurrent en-dometriosis. However, since many women who are treated for en-dometriosis with a hysterectomy and bilateral salpingo-oophorectomy are young, the overall benefits of hormone replacement may outweigh these risks of recurrence. And some 10 to 15 percent of women who have had hysterectomy and removal of both ovaries experience recurrence of endometriosis symptoms even when they do not use hormone replacement following the surgery.

T Conclusion

Heavy uterine bleeding, pelvic pain, or pelvic pressure may be symptoms of any of a number of gynecologic conditions. For nearly all these conditions, hysterectomy is one option for treatment, but, as we have discussed in this book, there are other options as well. In fact, there are only a few instances in which hysterectomy is done in an emergency situation (such as when a woman hemorrhages after childbirth) or as a lifesaving procedure (as a treatment for cancer, for example). A recent editorial in the New England Journal of Medicine was titled Hysterectomy Still a Useful Operation.* In this editorial, Drs. Joseph I. Schaffer and Ann Word summarize the results of a study involving 1,299 women, which showed that 88 percent of the women who had moderate to severe pelvic pain before surgery had significant improvement in this symptom two years after surgery. It is because we

Turners Syndrome

Infertility is defined as failure of conception after 1 year of unprotected intercourse. From 15 to 20 of all couples are infertile. In women, fertility peaks between ages 20 and 24. After this, there is progressive decline in fertility until about age 32, followed by a steep decline after 40. Causes of infertility in couples tend to be one-third male factors, one-third female factors, and one-third combination. Female causes of infertility include ovarian dysfunction (40 ), tubal factors (20 ), cervical factors (infection, stenosis), uterine factors (infection, fibroids), and other (endometriosis, adhesions). The course of investigation for infertility should be based on a couple's wishes for fertility, their age, duration of infertility, and unique features in the history and physical examination. Treatment should be directed toward the underlying cause. For tubal disease, surgery and in vitro fertilization are options. Endometriosis can be managed with conservative surgery based on...