The tissue that normally lines the inside of the uterus is called the endometrium. In some women endometrium grows outside the uterus. When this happens a woman has a condition called endometriosis. The most common areas for this abnormal growth of endometrium are the reproductive organs (ovaries, fallopian tubes, uterus). Endometrium may also grow on the intestines, bladder, or even in the rectum.
This misplaced tissue responds to the hormones of the menstrual cycle and bleeds each month in the same way the lining of the uterus responds to hormones. However, if the tissue is not in the uterus, the blood shed from the tissue has no way to leave the body. When the tissue bleeds cysts, adhesions, and scar tissue form and the area around the endometriosis thickens.
How does it occur?
Why some women develop endometriosis is not known. There are many theories, but none of them explains all cases. One theory suggests that in some women endometrial tissue flows backward during menstrual flow into the fallopian tubes and abdomen, where it attaches and grows.
Another theory suggests that all women experience a backup of endometrial tissue in the uterus, but the immune system is able to destroy the misplaced tissue. Women who develop endometriosis, however, may have an immune system that is not able to destroy the misplaced tissue.
What are the symptoms?
Some women have no symptoms. If symptoms occur they may include:
- abnormal or heavy menstrual flow
- back or flank pain before or during the menstrual period
- very painful menstrual cramps
- painful intercourse
- pelvic pain, especially before or during the menstrual period
- painful bowel movements, diarrhea, constipation or other intestinal upsets during the menstrual period
- painful urination or feeling the need to urinate often during the menstrual period
- difficulty becoming pregnant
How is it diagnosed?
First, the doctor will ask you about your symptoms. You will need a pelvic exam to check for cysts or nodules or any abnormal tenderness or thickening in your pelvic area. Usually, the doctor will need to do a one?day surgical procedure in the hospital called a laparoscopy. You are given an anesthetic before the procedure so you will not feel any pain. Then a small cut is made near the navel and your abdomen is filled with a gas (carbon dioxide). The surgeon inserts an instrument called a laparoscope through the cut and into the abdomen to look at the organs and the pelvic cavity.
With laparoscopy the doctor can see the size, location, and number of endometrial growths. Sometimes a piece of tissue is removed (a biopsy) to help make a diagnosis. Before treatment can begin, a definite diagnosis is required.
How is it treated?
Endometriosis is a disease that can get more severe as you grow older. However, there are many ways to lessen the symptoms and complications. The treatment depends on the severity of the symptoms, the location and degree of endometriosis, your age, and your plans for childbearing.
If the only symptom is mild premenstrual pain, the only treatment necessary may be a medication such as aspirin or ibuprofen to relieve the pain. If you have a diagnostic laparoscopy, your doctor may use a laser to remove the abnormal tissue at the time of the laparoscopy, especially if you have a mild case of endometriosis.
The doctor may prescribe birth control pills, progesterone pills, or other drugs to control your hormones. The purpose of these medicines is to control the hormone stimulation of the endometriosis areas. These are usually prescribed for six months, but the length of time varies with individual circumstances.If you take a drug to control your hormones, both the lining of the uterus and the misplaced endometrial tissue will decrease or stop bleeding each month. This should stop the buildup of cysts and scar tissue and should reduce swelling outside the uterus. Drug treatment also allows your body to heal the endometriosis as much as possible.
Some of the drugs used for treatment of endometriosis are very expensive. They are mainly used if you have endometriosis and are also trying to become pregnant.
How long will the effects last?
No treatment has been found yet that is 100 % effective. All current therapy offers at least some relief from the symptoms but not a cure. Endometriosis may recur or progress after hormone therapy or surgery.
In severe cases, possible treatment is to surgically remove the organs containing the growths (such as the fallopian tubes, uterus, or the ovaries). If your uterus is removed, you can never become pregnant. This is often done for severe cases, and usually is effective in removing the endometriosis.
How can I take care of myself?
Keep a careful record of your symptoms. The easiest way to do this is to assign a number to each of the symptoms you have and record them by number on your calendar for three months. Record all symptoms, including any time lost from work and leisure activities. Report the symptoms to your doctor. Take your calendar with you to your appointment. If you have not yet been diagnosed with endometriosis, your doctor may not suspect endometriosis without this information.
Try the following recommendations for easing your pain:
- Take warm baths
- Wear loose clothing
- Use a hot water bottle or heating pad on your abdomen
- Avoid constipation by increasing fiber and water in your diet
- Do relaxation exercises
- Listen to soft music and breathe slow, deep breaths
- ake pain medication as recommended by your doctor
You may want to join a chapter of the Endometriosis Association. This organization is a support group run by women with endometriosis.
Infertility is the failure of a woman to become pregnant after 1 year of having regular, unprotected sexual intercourse. This is called primary infertility, if a woman has never conceived. If a woman has previously had children but now has not conceived for 1 year, it is known as secondary infertility. Infertility is a problem for one out of every six couples.
How does it occur?
50% of infertility is attributed to female factors. The most common reason for female infertility is the failure to release an egg (ovulate). Failure to ovulate may be caused by:
- a hormone imbalance
- Obesity and weight gain
- Prolonged excessive stress
- a tumor or cyst on the ovary and other ovary disorders
- Extreme exercise, i.e. marathoners
- Weight loss for various reasons, including eating disorders such as anorexia and bulimia
- Abuse of alcohol, drugs, tobacco, coffee, tea, or other products containing caffeine.
- A damaged fallopian tube or uterus can also cause infertility.
These organs may be damaged from:
- a previous infection, such as pelvic inflammatory disease or other sexually transmitted diseases
- a birth defect
- a previous surgery to remove a tubal pregnancy resulting in scar tissue
- Other conditions such as endometriosis, fibroids, or an abnormally-shaped or tipped uterus.
In rare cases, the woman's body destroys the sperm because she is allergic to the sperm. Genetic problems causing infertility are also rare.
There is a natural decline in fertility that comes with aging. This decline occurs more quickly after age 30.
How is the problem diagnosed?
The doctor will give you a thorough physical exam to help investigate and find a treatment for infertility. You may have to give the doctor more information to help determine why pregnancy does not occur. The doctor will ask both you and your partner questions during joint and separate interviews.
Some of the questions usually asked are about previous medical conditions such as illnesses and infections, use of drugs and alcohol, sexual intercourse practices, detailed sexual history (including previous pregnancy, miscarriage, or abortions), genital surgery, circumcision, and normal genital development.
In addition to a complete physical and gynecological exam, the doctor may want to do the following tests:
- urine and blood tests to check for infections and a hormone imbalance
- tests on a sample of cervical mucus and a sample of tissue from the lining of your uterus to determine if ovulation is occurring
- a test of your partner's sperm count to see if the cause of infertility is too few sperm.
The doctor may also instruct you on how to take and chart your body temperature each morning. There is a natural rise in body temperature after ovulation. By looking at your temperature chart, the doctor may determine if and when ovulation is occurring.
A doctor may do the following procedures to check if a blockage in the fallopian tubes or uterus is causing the infertility:
- a laparoscopy (a scope is inserted into your abdomen so the doctor may view the organs)
- an insufflation of the fallopian tubes (carbon dioxide gas is blown into the tubes to help the doctor locate a blockage)
- an x-ray of the uterus and fallopian tubes. (Hysthosdepingogane)
How is it treated? If the doctor discovers you have a disorder that is causing the infertility, he or she will recommend treating this problem to try to restore your fertility. Treatment may include medication (usually hormones or antibiotics) or surgery. Sometimes a combination of treatments is necessary to correct the problem.
To restore fertility the doctor may suggest the following:
- Take hormones for a hormone imbalance, endometriosis, or short menstrual cycle. (Multiple births may occur if your ovaries are over-stimulated by hormone treatment.)
- Take drugs to stimulate ovulation.
- Keep a record of your daily temperature to track ovulation. This will help predict when you are most fertile or if the drugs you are taking is stimulating egg production.
- Have surgery to remove blockage or scar tissue from the fallopian tubes or uterus.
If you cannot become pregnant because your partner's sperm count is low, artificial insemination is an option. The sperm is collected and then placed in your body during the most fertile time in your menstrual cycle. This has varying success. If your partner's sperm count is still insufficient, you may become pregnant using sperm donated from another man.
In vitro fertilization is another option. In this procedure, the sperm and egg are fertilized outside of the body and put into your body. This procedure is an option if the man's sperm count is low or if your fallopian tubes are blocked or damaged and cannot be corrected with surgery. In vitro fertilization is expensive and success rates are often low.
The period of investigation and treatment for infertility can be stressful for a couple and put unusual strain on their relationship. Counseling may help the couple get through any difficult times.
What can be done to help prevent infertility?
You may not be able to prevent infertility resulting from genetic abnormalities or an illness. However, you can do the following to reduce your risk of developing disorders that might cause infertility:
- Prevent sexually transmitted diseases by using condoms and making sure both you and your partner only have sex with each other.
- Limit your intake of alcohol, coffee, tea, soda, and other foods and beverages containing caffeine.
- Avoid use of recreational drugs (such as marijuana) and overuse of prescription and over-the-counter drugs.
- Avoid exposure to toxic substances such as industrial chemicals, herbicides, and pesticides.
- Maintain good personal hygiene and health practices.
Contact the doctor about any signs of infection or hormonal change, such as:
- unusual discharge from the vagina
- abdominal pain
- abnormal bleeding
- change in menstrual cycle
- discomfort during intercourse
- sores and itching in the vagina or rectum
Urinary incontinence is a major health problem in the United States and around the world. It affects 15 percent of women younger than 60, 25 percent of women older than 60, and up to 50 percent of all nursing home patients. Many women avoid social and sometimes sexual activities because of incontinence, which can lead to depression and a loss of self worth. Because of what they hear from family and friends, and what they see on TV, they use pads and diapers prematurely. Even when seeing their family doctor for an annual checkup, they rarely bring up their incontinence. Only about 50 percent of incontinence sufferers seek medical attention.
Government statistics show that the cost of untreated incontinence is around $11.2 billion annually for outpatients. About 50 percent of all sanitary napkins and pads purchased are used for the control of urinary leakage instead of menstrual flow. Recent estimates show that an average user of these products will spend around $1000-1500 per year on pads and diapers.
Incontinence is not an inevitable part of aging. Successful treatments are available. You should not let incontinence lower your quality of life. Although the subject may be embarrassing to discuss you must be willing to talk to your caregiver. Incontinence is a common, serious and treatable problem, and cost of not getting treatment is very high, not only financially, but also emotionally.
We all tend to take our bladders for granted until they cause problems, but this is actually how its supposed to work. We have enough going on around us, without having to worry constantly about how our bladder is doing.
Urine is made in the kidney, transported down the ureters, and stored in the bladder until we find a place that is socially acceptable to empty. What is happening most of the time is occurring on a sub-conscious level. Minute by minute, we are not aware that our bladders are slowly filling up. It is not until we reach some amount that we note consciously that our bladder is getting full. Usually, after we reach this amount (which varies widely from person to person), we can continue to "hold" our urine and allow the bladder to continue to fill a little more. Finally we reach a point where no matter how hard we try, we can no longer hold our urine.
Many of us think of the bladder as a balloon that is filling up and if overfull would pop. But, unlike a balloon, as the bladder fills there is no increase in pressure in the bladder. The more air you put into a balloon the harder you have to blow and the greater the pressure. Think of the bladder more as a plastic bag which you can blow into. It fills easily until the bag is full, then suddenly the pressure shoots up and it becomes hard to fill.
It is at capacity when the bladder walls are starting to get stretched, that the bladder starts sending our brain signals that it is getting full. This is mediated through special nerves in the bladder wall called "stretch receptors". When it is appropriate our brains sends a message back to the bladder to empty.