Sulit Hamil Akibat Nyeri Haid

GATRA.com - Dokter spesialis kandungan, dr Aswin W. Sastrowardoyo,SpOG mengatakan, nyeri haid yang menyertai menstruasi akibat kelainan endometriosis yang dapat menyebabkan kesulitan hamil dapat disembuhkan dengan `laparoskopi` atau operasi menggunakan teropong dan pembakaran `kauter` atau listrik.

Aswin di Samarinda, Selasa mengatakan, nyeri seperti tusukan pada perut yang dirasakan wanita sebelum dan setelah masa menstruasi berlangsung, terjadi akibat letak lapisan endometriosis atau lapisan haid yang seharusnya berada di dinding terdalam rahim berada di luar rahim.

"Endometriosis yang seharusnya berada di dinding rahim justru berada di tempat yang salah, yaitu pada otot rahim, indung telur, dinding panggul, bahkan lebih jauh lagi bisa mencapai paru-paru dan otak," katanya.

Ia menjelaskan, pada saat menstruasi, lapisan endometriosis di rahim akan ke luar menjadi darah, kelenjar dan pembuluh darah atau disebut darah kotor, demikian juga endometriosis yang berada di tempat yang salah.

Endometriosis yang berada di rahim, lanjutnya, dapat dikeluarkan langsung dari rahim, sedangkan darah, kelenjar dan pembuluh darah yang dikeluarkan oleh endometriosis di luar rahim, misalnya di indung telur, akan menyebabkan darah mengumpul di tempat yang salah, bahkan membentuk benjolan berisi cairan darah haid atau `kista coklat`.

Ia mencontohkan, darah haid yang dikeluarkan endometriosis yang terdapat di paru-paru menyebabkan batuk disertai darah, di otak menyebabkan sakit kepala, di usus menyebabkan darah ke luar bersama kotoran sisa makanan dan endometriosis di otak menyebabkan pasien akan sering mengalami sakit kepala.

Aswin mengatakan, tubuh akan merespon darah haid tersebut sebagai zat asing dan membentuk antibodi yang terdiri atas sel darah putih untuk memerangi dan melindungi tubuh dari zat asing yang direspon sebagai kuman tersebut.

Akibatnya, tambahnya, akan terjadi pelengketan kuat, terjadi bercak coklat akibat darah haid, bahkan akan terbentuk kista coklat pada indung telur yang dapat menyebabkan saluran telur buntu sehingga sperma tidak bisa masuk.

Laparotomi

"Selain `laparoskopi` dengan membakar mengunakan listrik atau mengangkat kista coklat, cara lain yang dapat dilakukan untuk membuang selaput akibat pelengketan sel darah putih ke indung telur atau menghilangkan kista coklat adalah `laparotomi` atau operasi dengan pembedahan di perut," kata dr Aswin.

Guna mengantisipasi tumbuhnya endometriosis di tempat yang salah, katanya, setelah operasi, dokter akan merekomdasikan sejumlah obat berupa pil atau tablet untuk dikonsumsi dan obat berupa cairan yang harus disuntikkan yang diberikan selama tiga sampai enam bulan.

Ia menambahkan, selama masa pengobatan tersebut pasien jangan panik karena masa haid pasien akan berkurang bahkan berhenti.

Sering ditemukan

Menurut dr Aswin, kasus nyeri haid endometriosis sudah ada sejak dulu, namun saat ini kasus tersebut lebih sering ditemukan. Angka kejadian sulit dipastikan karena awalnya penyakit ini terjadi tanpa gejala atau umumnya pasien mengira nyeri haid yang dialaminya adalah sesuatu yang wajar.

"Mungkin kencederungan menunda kelahiran atau gaya hidup yang semakin modern justru menyebabkan kasus nyeri haid endometriosis sering ditemukan," katanya.

Dengan adanya kehamilan, katanya, wanita tidak mengalami masa menstruasi karena pada rahim tidak terbentuk endometriosis sehingga kasus tersebut dapat berkurang bahkan hilang.

Dikemukakan, keluarga yang memiliki bakat endometriosis kemungkinan besar akan terjadi pada anak perempuan generasi berikutnya.

"Sedangkan endometriosis yang menyerang salah seorang anak `kembar indung telur` atau memiliki wajah sama persis, maka saudara kembarnya yang lain akan mengalami kemungkinan terserang gejala yang sama sekitar 75 persen," demikian dr Aswin.

Perempuan dan Kemiskinan di Bangladesh

Bangladesh adalah negara dengan 132 juta penduduk dan merupakan negara berpenduduk terpadat nomor 8 di dunia. Negara yang baru 33 tahun merdeka ini memiliki pendapatan 380 US$ pertahun. Bangladesh juga disebut sebagai ‘simbol kemiskinan Asia’ sehingga pakar kemiskinan di seluruh dunia mungkin tidak akan dapat disebut pakar jika belum mempelajari masalah kemiskinan di Bangsladesh.

Sejak abad ke-12 hingga 13, Bangladesh berada di bawah kekuasaan kerajaan Hindu atau Budha. Kemudian, pada abad ke-13, pengaruh Islam masuk ke wilayah ini, sehingga mayoritas penduduknya memeluk agama Islam. Pada tahun 1757, Inggris menjajah anak benua India, termasuk Bangladesh. Ketika Inggris angkat kaki dari kawasan itu, pada tahun 1947 berdirilah negara Islam Pakistan, yang wilayahnya juga meliputi Bangladesh. Namun, pada tahun 1971, Bangladesh memisahkan diri dan menjadi negara yang independen.

Dari 132 juta penduduk, 90% populasi Bangladesh beragama Islam, dan sisanya Hindu, Budha, dan Kristen. Kondisi penduduk Bangladesh yang sebagian besarnya miskin dan perekonomian negara yang lemah, membuat negara ini menjadi wilayah yang rentan konflik dan rentan akan masalah kemiskinan. Apalagi dengan melihat penduduk Bangladesh yang kebanyakan berada di daerah pegunungan dan bersuku-suku yang membuat komunikasi dan akses informasi menjadi lebih sulit.

Di sebagian masyarakat Bangladesh, perempuan sering dianjurkan untuk memulai keluarga pada usia muda (pernikahan dini), sehingga proporsi perempuan yang melahirkan anak pada usia 18 tahun di Bangladesh adalah 50% dari total jumlah perempuan produktif di Bangladesh. Jika dibandingkan dengan negara di Amerika Latin dan Karibia, jumlah perempuan yang melahirkan di dua negara tersebut hanya sekitar 12-28% perempuan dari total jumlah perempuan. Anjuran ini pula yang membuat perempuan Bangladesh sering terhimpit pada masalah keluarga, masalah nafkah dan kemiskinan.

Berawal dari kepercayaan kepada orang miskin

Apakah orang miskin dapat dipercaya? Bukankah akibat terdesak akan kemiskinannya, mereka akan mudah “tergelincir” melakukan hal yang menguntungkan mereka sendiri dan bersifat jangka pendek? Benarkah pertanyaan itu?

Pertanyaan yang seperti meragukan orang miskin ini mungkin tidak patut dipertanyakan kepada orang miskin di Bangladesh. Bangladesh adalah sebuah negara yang miskin, tapi menyimpan “mutiara”. Kepercayaan pada orang miskin itulah cikal bakal munculnya “mutiara” itu.

Pemerintah Bangladesh mencoba memberikan kepercayaan besar kepada orang miskin untuk mengelola pinjaman dari pemerintah, pinjaman tersebut dikelola oleh bank pemerintah. Padahal di penjuru dunia, lembaga keuangan hanya melayani mereka yang dianggap memenuhi syarat bank. Misalnya mereka yang memiliki (jaminan fisik), dll. Seandainya mempunyai usaha, mereka pun harus memiliki badan hukum, laporan keuangan, mampu membuat proposal dan rencana bisnis.

Dijamin, meski orang miskin mempunyai usaha yang berpotensi di masa akan datang, mereka tentunya akan segera tercoret akibat berbagai kriteria tadi. Orang miskin, lalu dianggap tak layak dilayani bank. Oleh karena itu tak mengherankan, rakyat miskin selalu tersingkir dan semakin tersingkir.

Menggambarkan situasi yang ada, ilustrasi dari CGAP (Consultative Group to Assist the Poorest) dari Bank Dunia sangatlah tepat. Water, water everywhere but no drop for a drink, artinya meski uang (capital) begitu banyak (di bank), namun tak mampu dijangkau orang miskin. Teriris benar hati ini bila tiba-tiba mengingat situasi Indonesia, dimana kredit bank saja harus dibayar secara mahal oleh rakyat sebanyak Rp 650 trilyun, namun mereka tak menikmati apa yang dibayar mahal itu.

Realitas rakyat miskin seperti di Indonesia tadi tidaklah terjadi di Bangladesh. Negara tersebut merupakan satu-satunya di dunia, dimana 75% penduduk miskinnya mendapat pelayanan keuangan dari lembaga keuangan, baik bank maupun non bank. Tingkat pengembalian pinjaman sekitar 14 juta keluarga miskin itu juga menakjubkan, meski dengan bunga komersial dan tanpa jaminan atau pun berbagai persyaratan rumit lain. Untuk lembaga keuangan kecil sekitar 98% dan lembaga keuangan besar sebesar 99,5% dikembalikan pada waktunya (bank di Indonesia pun sulit menyamainya).

Melalui proses tersebut di atas, hal yang impossible menjadi possible. Setelah mendapat pelayanan keuangan, berbagai usaha rakyat miskin yang kecil-kecil namun massif menjadi berkembang. Grameen Bank yang mulai merintis pelayanan keuangan pada rakyat miskin itu, terutama kepada para perempuan miskin, kini kliennya mencapai 3,2 juta keluarga miskin. Dari penelitian yang dilakukan, dilaporkan 42% keluarga yang dilayani telah keluar dari kemiskinan (2001).

Akibat pengalaman keberhasilan dalam pelayanan keuangan pada rakyat miskin itu, Bangladesh lalu dikenal sebagai motherland of microfinance (ibu dari usaha kecil) yang sering juga disebut banking the unbankable (bank yang tidak memberlakukan syarat-syarat bank). Berbagai model pelayanan keuangan pada masyarakat miskin dari Bangladesh ini, telah direplikasikan pada sekitar 40 negara (Asia Pasifik, Afrika, Amerika Latin dan Eropa).

Keberhasilan Bangladesh mengembangkan pelayanan keuangan bagi masyarakat miskin tak bisa dilepaskan dari peran seorang intelektual, yaitu Profesor Muhammad Yunus. Beliau adalah seorang guru besar ekonomi yang tergoncang hatinya menyaksikan kelaparan yang menelan jutaan korban meninggal di Bangladesh pada tahun 1974.

Tentu apa yang didapatkan Profesor Yunus tidaklah datang dari langit begitu saja. Beliau terjun ke bawah, terlibat dan mencoba memahami karakteristik masyarakat. Melalui action research, tokoh intelektual tersebut lalu merumuskan konsep-konsep pengembangan masyarakat. Tak sampai di situ saja, beliau juga meyakinkan pihak pemerintah, lembaga keuangan, dan lembaga (donor) internasional.

Usaha dari Profesor Yunus tidaklah sia-sia, lalu berdirilah Grameen Bank. Lembaga keuangan tersebut khusus melayani rakyat miskin (perempuan) dan sangat terkenal di dunia. Bahkan, akhirnya didirikan pula semacam wholesale fund yang dinamakan Grameen Trust, untuk mendukung Grameen Bank di seluruh dunia. Hingga kini 113 organisasi di berbagai negara telah didukung, total pinjaman yang diberikan untuk masyarakat miskin, telah mencapai US $ 374 juta (Rp 3,2 trilyun).

Kepercayaan Pemerintah kepada perempuan

Titik tolak yang menjadi paradigma berpikir pelayanan keuangan kepada perempuan miskin di Bangladesh adalah kepercayaan pemerintah kepada perempuan miskin itu sendiri. Pemerintah juga tidak pernah membedakan apakah yang mengajukan permohonan ke bank adalah perempuan atau laki-laki. Dengan kepercayaan tersebut dan dengan memahami kelebihan berikut kekurangannya, masyarakat miskin Bangladesh, terutama para perempuan miskin dilayani sesuai karakteristiknya sehingga mereka dapat berkembang. Peran pemerintah yang utama dalam hal ini adalah mengakui keberadaan lembaga keuangan mikro yang dikelola oleh perempuan dan memberikan keleluasaan pada lembaga tersebut untuk beraktivitas.

Dari pengalaman di Bangladesh tersebut, Indonesia sesungguhnya dapat meniru cara pemerataan kesejahteraan ekonomi yang dilakukan pemerintah Bangladesh melalui sistem bank rakyat dan usaha mikro kreditnya. Di samping itu pemerintah pun harus menyadari bahwa kemiskinan dan pengangguran tidak seharusnya menjadi momok, akan tetapi menjadi tantangan untuk dapat semakin mengembangkan diri dan mengentaskan kemiskina secara bersama-sama.

Perbincangan Kecil

MENYOAL ENDOMETRIOSIS

Beberapa waktu lalu saya ketemu dengan seorang teman lama. Kami berbincang tentang berbagai macam hal, sebelum kemudian sampai pada topik yang bernama 'endometriosis'.

Tanpa kuminta, ia kemudian bercerita panjang-lebar tentang pengalaman pribadinya tentang bawaan menyebalkan yang satu itu. Aku sendiri sempat kaget. Aku sama sekali tidak menyangka bahwa ia yang selama ini kuanggap sebagai perempuan yang 'baik-baik' saja itu ternyata mengidap salah satu kelainan yang pada dasarnya menjadi kelainan banyak perempuan usia subur di muka bumi ini plus berbagai macam ekses yang ditimbulkannya.

Maka kamipun berbincang tentang kelainan hormonal tersebut. Perbincangan lebih fokus pada bagaimana membuat banyak orang lebih mengenal bawaan tersebut dan mampu melakukan tindakan-tindakan minimal yang mampu menekan berbagai macam ekses yang ditimbulkannya. Karena, konon, bawaan tersebut telah membuat tidak sedikit perempuan di berbagai belahan bumi diperlakukan secara tidak adil bahkan kejam tanpa sempat melakukan pembelaan.

Perbincangan sempat mentok pada tidak cukup adanya sumberdaya yang memungkinkan kami bisa melakukan tindakan seminimal apapun. Termasuk di dalamnya adalah bagaimana membuat blog ini bisa lebih manfaat bagi siapapun yang membacanya.

Adakah sampeyan memiliki gagasan yang bisa membantu kami (dan tentu saja perempuan pengidap kelainan hormonal itu di manapun mereka berada)?

media-indonesia-online kista

Tidak Semua Kista Ganggu Kesuburan Wanita Masalah kesuburan pada perempuan sering dikaitkan dengan kista. Bahkan, ada anggapan seseorang yang terkena kista di ovarium (indung telur) akan sulit hamil. Pendapat itu ternyata tidak sepenuhnya benar karena pada umumnya kista bersifat jinak, berukuran kecil, dan tidak berpengaruh terhadap kesuburan. Tetapi, kista bisa berbahaya manakala sudah berukuran besar. "Kista merupakan neoplasma atau pertumbuhan sel baru yang liar. Kista bisa dikatakan berisiko jika neoplasmanya ganas dan bisa mengakibatkan kanker ovarium," kata spesialis kebidanan dan kandungan dr Indra Anwar kepada Media di Jakarta beberapa waktu lalu. Menurut Indra, seseorang bisa saja hamil dengan kista. Lagi pula ovarium seorang perempuan ada sepasang. Jika salah satunya terganggu dan tidak berfungsi, masih ada satu lagi sehingga kehamilan masih dapat terjadi. "Jadi, kista berukuran besar dapat mengganggu kehamilan, bukan kesuburannya," kata dokter dari Rumah Sakit Bunda Jakarta ini lagi. Lebih lanjut, Indra menjelaskan kista yang memiliki diameter lebih dari 5 cm dapat melintir pada saat terjadi kehamilan. Akibatnya, kista pecah dan menimbulkan nyeri sangat hebat. Bila hal itu terjadi, lanjutnya, dapat menjadi nekrotik dan bisa mengakibatkan emboli hingga kematian. Itulah sebabnya kista berukuran besar harus diangkat agar tidak mengganggu dan dapat didiagnosis secara petologi. Dengan diagnosis dapat diketahui apakah kista itu jinak atau ganas. Jenis kista Indra menjelaskan, kista berupa selaput. Ada yang berisi cairan kental, dan bukan kental, yaitu dermoid. Kista dermoid berasal dari elemen ektodermal sehingga sel-selnya mirip kulit, yaitu sel epitel gepeng, tampak pula folikel rambut, kelenjar keringat, kadang-kadang elemen tulang. Potensi kista dermoid menjadi ganas relatif kecil, cuma sekitar 1-3%. Namun, lanjutnya, penyakit yang mengganggu kesuburan dan sering disalahartikan sebagai kista adalah endometriosis. Endometriosis memang ada yang berbentuk kista, karena itu sering disebut kista. Padahal, kista merupakan neoplasma, sementara endometriosis berupa kelenjar dinding rahim yang abnormal dan tumbuh di luar rahim. "Umumnya endometriosis memengaruhi kesuburan seorang wanita dan dapat berbentuk kista di indung telur," tutur Indra. Kista endometriosis mengganggu kesuburan karena secara mekanik dapat mengakibatkan perlengketan-perlengketan. Adanya perlengketan menyebabkan proses ovum pick-up (lepasnya sel telur yang telah matang), sehingga sulit ditangkap fimbriea (ujung tuba fallopi). Akibatnya, pembuahan sulit terjadi. Selain itu, kata Indra, adanya kista endometriosis. Secara imunologis kesuburan juga terhambat, karena timbulnya reaksi-reaksi kekebalan mengganggu fungsi sel telur, sperma, dan embrio secara alami. ''Jika dibiarkan, endometriosis akan semakin berat dan umumnya perempuan susah hamil. Dari survei, 40% perempuan yang sulit hamil diketahui memiliki endometriosis pada rahimnya.'' Untuk itu, lanjutnya, diperlukan operasi dengan cara laparoskopi. Setelah dilakukan operasi, 70% perempuan dengan endometriosis ringan (stadium 1 dan 2) dapat kembali hamil secara normal. Sebaliknya endometriosis berat (stadium 3 dan 4) akan sulit untuk hamil secara alami meskipun telah diobati, kecuali dengan cara inseminasi buatan atau bayi tabung. Meskipun kista tidak mengganggu kesuburan, Indra menganjurkan untuk selalu melakukan deteksi dini berupa pemeriksaan ultrasonografi (USG). Karena, ada kemungkinan kista tersebut neoplasma ganas dan bisa mengakibatkan kanker ovarium. Seperti diketahui, kanker ovarium merupakan kanker nomor tiga penyebab kematian perempuan Indonesia setelah kanker payudara dan kanker mulut rahim. "Jika terjadi kanker ovarium, ada kemungkinan organ reproduksi seperti indung telur atau rahim harus dibuang sehingga tidak dapat terjadi kehamilan," ujar Indra. Ketika ditanya apakah kista mengganggu hubungan seksual suami istri, Indra mengatakan kista di ovarium dan vagina tidak mengganggu. Sedangkan yang terletak di luar atau di vulva, bisa mengganggu. Apalagi jika sudah terjadi peradangan, dapat mengakibatkan nyeri. Tetapi kista endometriosis, kata Indra lagi, dapat mengganggu kehidupan seksual karena akan timbul rasa nyeri pada saat melakukan hubungan seksual. (CR-48/H-1) sumber: Media Indonesia Online, Rabu, 24 Agustus 2005

PUSAT RISET ENDOMETRIOSIS

THE ENDOMETRIOSIS RESEARCH CENTER WHO IS THE ENDOMETRIOSIS RESEARCH CENTER?Thank you for taking the time to learn more about our efforts concerning Endometriosis, a painful reproductive and immunological disease affecting more than 7 million women and teens in North America alone, with nearly 80 million more worldwide. Our organization, the Endometriosis Research Center (ERC), was founded in 1997 to address the growing international need for disease research, education, awareness and patient support.ERC Overview The Endometriosis Research Center was founded because of the limited research, support, education and awareness for Endometriosis. No one with this disease should ever feel alone, and one of our goals is to create enough awareness to ensure that women and adolescents - and their loved ones - never have to feel that way again. The ERC is a 501(c)3 tax-exempt, tax-deductible organization that operates from contributions generously donated by individuals, corporations and foundations that share our goals of making a positive difference in the lives of those with the disease, and ultimately, of finding a cure. The ERC does not accept funding from the makers of Lupron, Zoladex or Synarel, as we feel such funding presents a conflict of interest. Furthermore, unlike similar women’s health organizations, we are unique in that we do not have a membership fee, and there is never a cost to participate in or benefit from the ERC’s education and support programs. We are an international organization, with headquarters in beautiful South Florida, USA. We are pleased to have a virtual network of staff and volunteers from around the world who help implement our programs in both the online and local communities on a global basis. Founded by Executive Director Michelle E. Marvel in early 1997, the ERC strives to improve the quality of life for women and girls with Endometriosis through our extensive programs and outreach efforts. We are pleased to maintain and offer a vast database of unbiased and accurate materials, educational sheets, videos, newsletters and articles on every aspect of Endometriosis to practitioners, patients and all those interested in the disease. In addition, the ERC works with legislators and government officials to facilitate proper funding for Endometriosis research; assists medical industry leaders with developmental studies and data collection on the disease; lobbies the National Institutes of Health and similar foundations in support of various research grants; attends and presents at health fairs, medical symposiums and similar events; maintains one of the world’s most extensive Endometriosis patient registries; and so much more. We are actively involved in ongoing disease research, ranging from recruitment for clinical trials on proprietary new treatments to participation in genetic research studies for various biotech companies focused on the discovery of novel therapeutics and diagnostics to address significant unmet medical needs in Endometriosis. We were also involved in the A-Fem Medical pilot study conducted to validate the world’s first self-collection kit and testing method to attempt to provide a screening system for Endometriosis. The preliminary results were promising, particularly for undiagnosed women and adolescents, and this novel work has now become an area of focus for the global biotech community. Our organization also performed a recent product focus study involving a unique, all-natural topical product designed specifically for menstrual cramping. The ERC also conducted a study of medical professionals in collaboration with Agile Therapeutics, using data collection and analysis to determine the formation of a birth control patch compound. Other collaborations include Amgen Praecis Corporation; Neurocrine Bioscience; the International OxeGENE Study Group; the National Women’s Health Information Center; The Office on Women’s Health/U.S. Department of Health & Human Services; Helica TC Corporation; Zonagen Corporation; and many more. The ERC also investigates controversial issues in Endometriosis research to ensure that all facets of the disease are adequately addressed; in some instances, even publicly challenging popular study conclusions. For example, we refuted Yale University’s “Sexual Activity, Orgasm & Tampon Use are Associated with a Decreased Risk of Endometriosis” report in the Journal of Gynecologic & Obstetric Investigation, citing extensive evidence as to why this theory was flawed; more recently, we publicly confronted an “Expert Panel Consensus Report” in the Journal of Fertility & Sterility advocating the use of pre-diagnostic GnRH drugs. Our position on these matters can be viewed online at http://endocenter.org/endostudy.htm and http://endocenter.org/pdf/PreDiagnosisGnRH.pdf, respectively. Currently, we are conducting our own research concerning the potential risks associated with Menstrual Cups devices and Endometriosis in association with renowned Reproductive Toxicologist, Dr. Armand Lione. Dr. Lione is the President of Associated Pharmacologists & Toxicologists in Washington, DC, the author of the prestigious ReproTox database, and an Official with the Reproductive Toxicology Center in Bethesda, MD. In addition to our research facilitation and patient education programs, we also offer a vast support network for those with the disease and their loved ones. The ERC is pleased to host over 50 active, in-person support groups worldwide, and is the owner of the Internet’s largest electronic Endometriosis support group, currently with over 3,000 participants from around the globe. Access to location-specific listservs is also available, which are hosted by ERC support group leaders. For male partners of women with Endo, we recommend John Blondin’s group for men only, MENDO, located online at: http://groups.yahoo.com/group/mendomen/. The ERC also offers access to a special interest group, Endometriosis & the Military, for Military personnel and dependents, located at http://groups.msn.com/EndometriosisandtheMilitary run by ERC Volunteer Marina Gleason. In addition, until recently, we were the first and only Endometriosis organization to formally recognize and support the unique needs and perspectives of the lesbian woman with Endometriosis. In honor of young women with Endometriosis ages 25 and under, the ERC launched “Girl Talk TM.” Girl Talk TM is a specific support and education program tailored to meet the needs of young women and adolescents who have, or think they may have, the disease. In addition to providing patient advocacy and education, Girl Talk TM raises awareness about Endometriosis and improves patient care among practitioners offering healthcare services to young women. Education & Support Endometriosis affects twice the number of Alzheimer’s patients and seven times those with Parkinson’s Disease, and is a leading cause of female infertility, chronic pelvic pain and gynecologic surgery. It accounts for nearly half of the 500,000 hysterectomies performed in the United States annually. It is more prevalent than breast cancer, yet continues to be treated as an insignificant, obscure ailment. Recent studies have even shown an elevated risk of certain cancers in women with Endometriosis. Endometriosis can be so painful as to render a woman or teen unable to care for herself or her family or attend work, school or social functions. Endometriosis affects every aspect of a woman’s life, from her self-esteem to her relationships to her ability to be a contributing member of society. Even in this age of medical advances, Endometriosis remains a conundrum to patients and practitioners alike. The disease can only be diagnosed definitively through invasive surgery, and there is no absolute cure. The average delay in diagnosis is a staggering 9 years, and a patient may seek the counsel of 4 or more physicians before her pain is addressed. Though Endometriosis is one of the most prevalent illnesses affecting our society today, disease research continues to remain significantly under-funded. In fiscal year 2000, the National Institutes of Health planned to spend $16.5 billion on research. Of that funding, only $2.7 million was earmarked for Endometriosis; amounting to approximately 40 cents per patient, in stark contrast to other illnesses such as Alzheimer’s Disease and Lupus, which received approximately $105 and $30 per patient, respectively. The ERC strives to improve the public focus on Endometriosis, and provides extensive materials, fact sheets, videos, newsletters and articles on every aspect of Endometriosis to practitioners, patients and all those interested in the disease. Our organization raises awareness about Endometriosis throughout the medical and lay communities, works with Government officials to facilitate proper funding for Endometriosis research, and assists medical industry leaders with developmental studies and data collection. The ERC is also pleased to host over 50 support groups worldwide and is the owner of the Internet’s largest electronic Endometriosis support group, currently with nearly 3,000 participants. In 2000, the ERC organized and implemented a unique and groundbreaking opportunity for world-wide education and awareness regarding Endometriosis. World-opinion leaders on the disease brought forth the most current research and information on Endometriosis at this one-day Symposium entitled, Endometriosis 2000. The first of its kind, the Endometriosis 2000 Symposium was filmed and later broadcast on the internet so individuals unable to attend had the opportunity to watch the program right from their own home. Furthermore, VHS copies were also made available. Due to the overwhelming success of Endometriosis 2000, the ERC implemented Endometriosis 2001 a year later, which followed the same format as the original symposium. Without the ERC’s co-presenter, Amgen Praecis, neither Symposium would have been as successful. Amgen Praecis supported the ERC’s education program with unrestricted grants in 2000 and 2001. Developers of the new, investigational medication, Abarelix, Amgen Praecis completed the FASTER (First Abarelix-Depot Study for Treating Endometriosis Pain Rapidly) Study. The Study involved nearly 400 patients in multi-site, blinded trials to determine whether the medication is safe and capable of relieving pain associated with Endometriosis faster and with fewer side effects than current therapies. Research The ERC has the privilege of working with leaders in the ongoing study and treatment of the disease. ERC programs and operations are governed by an Executive Board of Directors and a Medical & Professional Advisory Panel consisting of pioneers in Endometriosis research and treatment; including Andrew Cook, MD, Director of Vitalcare Institute of Center in Los Gatos, CA, world-renowned for his dedication to Endometriosis research and treatment; Armand Lione, Ph.D., President of the Associated Pharmacologists & Toxicologists Association, David B. Redwine, MD, Director of the St. Charles Medical Center Endometriosis Treatment Program and founder of the innovative LAPEX procedure for Endometriosis, in Bend, Oregon; Serdar Bulun, MD, RE, Director of the Molecular Genetics & Reproductive Endocrinology at Northwestern University in Chicago, IL, known for his groundbreaking research on Aromatase Inhibitors; Nabil Husami, MD, Director and Founder of the Endometriosis Research & Treatment Center at Columbia University Medical Center in New York City, NY; Nancy Petersen, RN, Founder of the Endometriosis Treatment Program at St. Charles Medical Center in Bend, OR; Donna Laux, MA, former Program Director of the Center for Endometriosis Care in Atlanta, GA; Glenda Motta, RN, MPH, ET, of Washington, DC, co-Author of “Coping With Endometriosis” and “Successful Living With Endometriosis;” William Fleming, PhD, Vice Chairman of A-FEM Medical Corporation, also in Oregon, Linda Howard-Smith, Nurse Practitioner with the Vitalcare Institute of Health in Los Gatos, CA; and many other distinguished professionals. The organization is also implementing a unique program for Professionals only, which is designed to encourage global collaboration on, and advance the study and treatment of, all aspects of Endometriosis for researchers, physicians, scientists and healthcare professionals from all over the world. The ERC also enjoys collaborative relationships with similar like-minded foundations, including the National Endometriosis Society (United Kingdom), Associazione Italiana Endometriosi (Italy), the Endometriosis SHE Trust (United Kingdom), the Endometriosis Care Centre of Australia (ECCA), and RESOLVE, a national infertility organization. Additionally, the ERC is represented in the World Endometriosis Society, the National Pain Foundation and the American Chronic Pain Association. The ERC is also a Founding Partner in the Society for Women's Health Research, a collaboration sponsored by the Alliance for Women in Clinical Research, and a member of the Primate Freedom Project's "Moratorium on Primate Research." The Guidestar Foundation, a Federal charity watchdog organization, formally recognizes the organization as a member in good standing. Fundraising Since the ERC was founded, we have held numerous fundraisers including, "Cruising For A Cure" in October 1997; "Walk for the Women You Love" in February 1998; the "Classic Swing" Golf Tournament in June 1998; and the ERC National Raffle in October 1998 and March 1999. Generous individual donations, corporate sponsorships, raffle and silent auction proceeds along with event attendees have supported these fundraising events. Additionally, the ERC works with GBI Marketing bi-annually (spring and autumn) to host international Yankee Candle fundraisers. Through the ERC's volunteers, we have raised thousands of dollars annually through this fundraiser. In October 2001, we participated in an event known as The Shopping Benefit, sponsored by Bloomingdale's Department Store. This annual fundraising event is held throughout South Florida at each Bloomingdale's retail location (Miami, Aventura, Boca Raton & West Palm Beach). The ERC was successful in its efforts, and plans to continue participating each year. In addition to South Florida, Bloomingdale's holds this event in local communities throughout the United States where the company has retail locations. It is the ERC's goal to have volunteers living in these areas to also coordinate and participate in this fun fundraising event. Our organization also reaps fiscal benefits from member support of our online store, located at http://www.cafepress.com/ERC. The ERC’s online store allows interested parties to support the ERC and our efforts by purchasing various Endometriosis awareness items. We are also pleased by the support of many various fundraisers held by our members and supporters throughout the year, all of whom designate the ERC as their recipient charity of choice. As described, the ERC has enjoyed much fundraising success. With our dedication and continued public outreach, we will continue to gain the financial support to assist us in our future growth through innovative fundraising activities. Public Awareness Endometriosis affects more women than breast cancer. However, the general public is not aware of the disease. Among many of those who are aware of this affliction, it is mistakenly believed to be an insignificant issue because of the misconceptions that have developed through the years. "My sister had that and she was 'cured' with birth control pills;" “I had that and it ‘went away’ when I got pregnant;” “My friend had that, and a hysterectomy ‘fixed’ her” are all common fallacies about Endometriosis. The misconception develops because there are women in the world who have had surgery, become pregnant or taken hormones and – temporarily - no longer suffer symptoms of Endometriosis. However, speak with the millions of women and girls who live with chronic daily pain, and they will tell you that having Endometriosis is no life at all. To assist us with our awareness goals, the ERC has developed an Awareness Campaign that includes branded awareness products, including t-shirts, water bottles, license plate frames and more. Public knowledge about our organization and Endometriosis is very important, and is accomplished through the ERC’s ongoing efforts, including offering awareness items, press releases, feature stories, internet, speaking engagements, word of mouth, advertising and more. The ERC is also the premier awareness organization where legislative efforts are concerned. We raise awareness and provide education about Endometriosis not only throughout patient and medical communities through our free Symposiums, meetings and materials, but on State and Federal levels as well. For example, in late 2000, we testified before the California State Legislature at the invitation of Assemblyman Dennis Cardoza on behalf of Assembly Bill 2820, a crucial health bill calling for independent research into the presence of dioxins in feminine hygiene products and the subsequent risks these toxins pose to women and their children. AB 2820 was approved by majority vote and passed on to the Senate Committee on Health & Human Services. Our organization has also been very successful over the years in working with concerned legislators and policymakers to establish Resolutions formally recognizing the need for disease awareness throughout society. To that end, the states of New York, Colorado, Florida, Michigan, California and Pennsylvania have all passed Resolutions officially recognizing the Month of March as "Endometriosis Awareness Month." Our most gratifying success, however, came in late October 2002 when Congress unanimously passed our Country's first-ever National legislation, House Concurrent Resolution 291. Introduced on behalf of the ERC by Congressman Howard "Buck" McKeon and supported by numerous Co-sponsors, H.Con.Res.291 formally proclaimed March as National Endometriosis Awareness Month. H.Con.Res.291 also expresses the sense of the United States Congress that it "strongly supports the ERC's efforts to raise public awareness of Endometriosis throughout the medical and lay communities and recognizes the need for better support of patients with Endometriosis, the need for physicians to better understand the disease, the need for more effective treatments, and ultimately, the need for a cure." The Endometriosis Research Center is open to all those concerned with Endometriosis: medical professionals, researchers, women of all ages with Endometriosis, and anyone interested in the disease. Help us make a difference by making a donation to the ERC today. Together, we can find the cure so that our daughters will not suffer as we have. Help us make a difference and join the ERC today for free. Together, we can find the cure so that our daughters will not suffer as we have.

ENDOMETRIOSIS ASSOCIATION

The Endometriosis Association The Endometriosis Association was the first organization in the world created for those with endometriosis. As an independent self-help organization of women with endometriosis, doctors, and others interested in the disease, it is a recognized authority in its field whose goal is to work toward finding a cure for the disease as well as providing education, support, and research. Founded in Milwaukee, Wisconsin in 1980 by Mary Lou Ballweg and Carolyn Keith, it is now a worldwide, independent organization. It has grown to such an extent that it now has a network of chapters, groups, sponsors, and women with endometriosis in 66 countries throughout the world. Information is available in 28 different languages. Since its creation, the Endometriosis Association has achieved many goals, one being the undertaking of massive educational projects involving mailings to every gynecologist, hospital, and college health service in the US and Canada. It has also published two books: Overcoming Endometriosis and The Endometriosis Sourcebook. A wide range of literature, fact sheets, videotapes and audiotapes can also be obtained through the Association. Operating as a non-profit organization, the Association aims to establish funds to enable more research into the causes of endometriosis. As part of its research program, the Association has established a special program at Dartmouth Medical School and has funded and assisted a number of researchers in various parts of the world. It also maintains a large data research registry and continues work on the relationship between dioxin and endometriosis, a relationship the Association discovered. The Association has recently teamed up with the prestigious Vanderbilt University School of Medicine to create a dedicated research facility to address the mechanisms responsible for causing endometriosis. Among other research projects supported by the Association are a study of the dioxin-exposed young women in Seveso, Italy; publicity and help obtaining patients and families for a genetic study at Oxford University, England; support for research on a non-invasive diagnostic technique by a U.S. researcher; and small grants and tissue samples for a number of researchers studying dioxin and related toxins and endometriosis. For further information, contact:Mary Lou Ballweg,President/Executive Director,International Headquarters,8585 N. 76th Place,Milwaukee, Wisconsin 53223, USA(For a free packet of information call 1-800-992-3636.)Tel: (414) 355-2200/ Fax: (414) 355-6065

ENDOMETRIOSIS jhr

Daging Dapat Timbulkan Endometriosis Wanita yang mengkonsumsi daging merah lebih dari tujuh kali dalam seminggu dapat meningkatkan risiko untuk menderita endometriosis. Dan wanita yang mengkonsumsi daging setiap hari akan dua kali lipat lebih besar kemungkinannya menderita endometriosis dibanding dengan wanita yang mengkonsumsi hanya sedikit daging dan lebih banyak makan sayuran dan buah-buahan. Penelitian ini dilakukan di Italia, dengan melakukan interview terhadap 500 wanita yang menderita endometriosis dan 500 wanita sehat, dengan usia dan latar belakang yang sama. Para wanita ini diberi pertanyaan-pertanyaan mengenai makanan yang mereka konsumsi tahun lalu, termasuk juga berapa sering dan berapa banyak mereka mengkonsumsi daging, susu, hati, wortel, sayuran hijau, buah-buahan segar, telur, daging ham, ikan dan keju, juga termasuk berapa banyak konsumsi alkohol dan kafein. Semua jenis makanan ini dilihat porsi yang mereka makan dari tiap jenis makanan tersebut setiap minggunya dan masuk dalam kategori jumlah rendah, sedang atau tinggi. Ternyata wanita yang mengkonsumsi daging dengan kategori jumlah terbanyak (daging sapi, daging merah lainnya dan daging ham), meningkat risikonya 80 hingga 100% untuk menderita endometriosis. Dibanding dengan wanita yang mengkonsumsi banyak sayuran dan buah-buahan segar, risiko untuk menderita endometriosis hanya sekitar 40%. Endometriosis adalah suatu keadaan dimana jaringan yang hanya ada dalam rahim, dapat ditemukan di bagian lain dalam tubuh. Keadaan ini menimbulkan rasa nyeri, terutama pada saat haid dan dapat menyebabkan infertilitas (mandul). Endometriosis adalah penyakit yang berkaitan dengan hormon estrogen dalam darah. Makanan yang mengandung fitoestrogen, seperti kacang kedelai, sayuran hijau dan kacang-kacangan, dapat menurungkan tingkat sirkulasi dari estrogen dalam darah dan tampaknya akan melindungi kita dari penyakit-penyakit seperti endometriosis dan kanker indung telur. Sedang makanan yang tinggi akan lemak jenuh akan meningkatkan konsentrasi estrogen dalam darah. Sumber:Jurnal Human Reproduction

ENDOMETRIOSIS antara

Banyak Perempuan Menderita Endometriosis Hamburg (ANTARA News) - Banyak perempuan yang harus berjuang menahan sakit perut hebat ketika masa-masa menstruasi mendatangi mereka. Bahkan banyak dari perempuan itu yang tidak bisa beraktivitas sama sekali dan membutuhkan obat penghilang rasa sakit agar bisa melewati satu hari itu. Rasa sakit yang diderita setiap bulan itu sebenarnya tidak normal dan mengandung endometriosis atau salah satu penyakit gineakolog paling umum bagi para perempuan. Penyakit tersebut membuat jaringan endometrial mengendap pada organ di luar rahim seperti ovarium, "tube fallopi", atau di mana saja sekitar perut.Jaringan endometrial yang tidak berada pada tempatnya itu mulai menyebar dan bereaksi seperti jaringan endometrial lainnya, yaitu berdarah ketika siklus bulanan perempuan. Banyak kasus endometriosis ini terjadi pada perempuan berusia 26 tahun dan juga pada perempuan berusia 35 tahun. Penyakit itu sebenarnya tidak terlalu berbahaya, tetapi ia memiliki karakteristik seperti tumor yang akan terus tumbuh, kata Andreas Ebert, seorang profesor pada Universitas Humboldt di Berlin Jerman, seperti dikutip dpa. Endometriosis dapat menyebabkan kemandulan. Hal itu terjadi karena jaringan serta darah yang mengalir pada organ itu menghalangi terjadinya kehamilan kata Christan Albring, Presiden dari Asosiasi Federal Gineakologis Jerman yang berpusat di Hannover. Gejala umum lainnya yang diderita oleh para perempuan yang menderita endometriosis adalah rasa sakit tidak normal ketika sedang berhubungan badan. Katrein Hoffman dari Asosiasi Endometriosis Jerman yang berpusat di Leipzig mengatakan sangat penting bagi perempuan yang merasa sakit ketika sedang berhubungan badan harus segera pergi ke dokter untuk memberikan deskripsi yang jelas kepada dokter tentang letak rasa sakit dan seberapa sering ia mengalami itu. "Banyak perempuan yang tidak tahu bagaimana cara mengekspresikan perasaan mereka," kata Hoffmann. Sangat penting bagi kita, lanjutnya, untuk mengembangkan kesadaran di masyarakat mengenai penyakit itu. Para perempuan dapat melakukan diskusi secara menyeluruh dengan dokter atau praktisi kesehatan mengenai penyakit endometriosis itu. Penyelidikan lebih lanjut termasuk ultrasound serta penelitian pada area pelvic untuk merasakan adanya adhesi juga amat dibutuhkan. Walaupun begitu hanya "laparoscopy" yang dapat membuktikan adanya kehadiran dari endometriosis. Adhesi dapat dihilangkan saat proses penyelidikan itu dan si pasien harus dalam fase pembiusan. Rata-rata endometriosis dapat tidak terdeteksi selama enam atau delapan tahun. Di jerman ada 30 ribu kasus baru tiap tahunnya. Para pasien di awal pengobatannya harus memutuskan apakah akan diobati untuk kemandulan atau rasa sakitnya, kata Ebert. Pada kedua kasus itu fase yang harus dilakukan adalah menghilangkan adhesi itu. Hormon akan diberikan kepada perempuan yang memilih untuk menghilangkan rasa sakitnya dan biasanya mereka mendapatkan hasil yang positf, kata Albring. Berbagai pil serta obat-obatan lainnya yang diberikan sebelum siklus bulanan dapat membantu penyembuhan. Perempuan yang ingin memiliki anak akan akan dirawat dengan cara berbeda. Mereka akan diberikan hormon yang dapat mengubah secara artifisial tubuh mereka ketika proses pembakaran adhesi tadi terjadi, kata Albring. Setelah enam bulan perawatan hormon itu berakhir maka tubuh akan berfungsi secara normal kembali. Pekerjaan Hoffman termasuk pada meningkatkan kesadaran para perempuan yang menderita endometriosis. Ia pernah menderita endometriosis selama bertahun-tahun. "Tidak ada yang menanggapimu dengan serius, semua orang akan menganggap kita berpura-pura sakit," kata Hoffman menggambarkan berbagai pengalaman yang umumnya dihadapi para perempuan penderita endometriosis secara sosial. Organisasi yang dipimpin oleh Hoffman itu menawarkan pembicaraan secara berkelompok melalui telepon dimana mereka dapat berbagi pengalaman dan saling menguatkan diri mereka masing-masing untuk melawan penyakit itu. "Kita tidak ingin mendramatisir penyakit ini, kita hanya ingin membuat masyarakat lebih menyadarinya," kata Hoffman.(*)

ENDOMETRIOSIS gatra

Sulit Hamil Akibat Nyeri Haid Endometriosis Dapat Diobati GATRA.com - Dokter spesialis kandungan, dr Aswin W. Sastrowardoyo,SpOG mengatakan, nyeri haid yang menyertai menstruasi akibat kelainan endometriosis yang dapat menyebabkan kesulitan hamil dapat disembuhkan dengan `laparoskopi` atau operasi menggunakan teropong dan pembakaran `kauter` atau listrik.Aswin di Samarinda, Selasa mengatakan, nyeri seperti tusukan pada perut yang dirasakan wanita sebelum dan setelah masa menstruasi berlangsung, terjadi akibat letak lapisan endometriosis atau lapisan haid yang seharusnya berada di dinding terdalam rahim berada di luar rahim."Endometriosis yang seharusnya berada di dinding rahim justru berada di tempat yang salah, yaitu pada otot rahim, indung telur, dinding panggul, bahkan lebih jauh lagi bisa mencapai paru-paru dan otak," katanya.Ia menjelaskan, pada saat menstruasi, lapisan endometriosis di rahim akan ke luar menjadi darah, kelenjar dan pembuluh darah atau disebut darah kotor, demikian juga endometriosis yang berada di tempat yang salah.Endometriosis yang berada di rahim, lanjutnya, dapat dikeluarkan langsung dari rahim, sedangkan darah, kelenjar dan pembuluh darah yang dikeluarkan oleh endometriosis di luar rahim, misalnya di indung telur, akan menyebabkan darah mengumpul di tempat yang salah, bahkan membentuk benjolan berisi cairan darah haid atau `kista coklat`.Ia mencontohkan, darah haid yang dikeluarkan endometriosis yang terdapat di paru-paru menyebabkan batuk disertai darah, di otak menyebabkan sakit kepala, di usus menyebabkan darah ke luar bersama kotoran sisa makanan dan endometriosis di otak menyebabkan pasien akan sering mengalami sakit kepala.Aswin mengatakan, tubuh akan merespon darah haid tersebut sebagai zat asing dan membentuk antibodi yang terdiri atas sel darah putih untuk memerangi dan melindungi tubuh dari zat asing yang direspon sebagai kuman tersebut.Akibatnya, tambahnya, akan terjadi pelengketan kuat, terjadi bercak coklat akibat darah haid, bahkan akan terbentuk kista coklat pada indung telur yang dapat menyebabkan saluran telur buntu sehingga sperma tidak bisa masuk.Laparotomi"Selain `laparoskopi` dengan membakar mengunakan listrik atau mengangkat kista coklat, cara lain yang dapat dilakukan untuk membuang selaput akibat pelengketan sel darah putih ke indung telur atau menghilangkan kista coklat adalah `laparotomi` atau operasi dengan pembedahan di perut," kata dr Aswin.Guna mengantisipasi tumbuhnya endometriosis di tempat yang salah, katanya, setelah operasi, dokter akan merekomdasikan sejumlah obat berupa pil atau tablet untuk dikonsumsi dan obat berupa cairan yang harus disuntikkan yang diberikan selama tiga sampai enam bulan.Ia menambahkan, selama masa pengobatan tersebut pasien jangan panik karena masa haid pasien akan berkurang bahkan berhenti.Sering ditemukanMenurut dr Aswin, kasus nyeri haid endometriosis sudah ada sejak dulu, namun saat ini kasus tersebut lebih sering ditemukan. Angka kejadian sulit dipastikan karena awalnya penyakit ini terjadi tanpa gejala atau umumnya pasien mengira nyeri haid yang dialaminya adalah sesuatu yang wajar."Mungkin kencederungan menunda kelahiran atau gaya hidup yang semakin modern justru menyebabkan kasus nyeri haid endometriosis sering ditemukan," katanya.Dengan adanya kehamilan, katanya, wanita tidak mengalami masa menstruasi karena pada rahim tidak terbentuk endometriosis sehingga kasus tersebut dapat berkurang bahkan hilang.Dikemukakan, keluarga yang memiliki bakat endometriosis kemungkinan besar akan terjadi pada anak perempuan generasi berikutnya."Sedangkan endometriosis yang menyerang salah seorang anak `kembar indung telur` atau memiliki wajah sama persis, maka saudara kembarnya yang lain akan mengalami kemungkinan terserang gejala yang sama sekitar 75 persen," demikian dr Aswin.

ENDOMETRIOSIS wikipedia

ENDOMETRIOSIS Endometriosis is a common medical condition characterized by growth beyond or outside the uterus of tissue resembling endometrium, the tissue that normally lines the uterus. Affecting an estimated 89 million women of reproductive age (those who have yet to become pregnant) around the world, endometriosis occurs in one in every five females.[1][citation needed] However, endometriosis can occur very rarely in postmenopausal women.[1] An estimated 2%-4% of endometriosis cases are diagnosed in the postmenopausal period. In endometriosis, the endometrium (from endo, "inside", and metra, "womb") is found to be growing outside the uterus, most commonly in the pelvis. Locations Endometriosis most commonly exists in the most inferior aspects of the female pelvis.The most common site of disease is the ovary (approximately half of the cases). The broad ligaments (beneath the ovaries), uterosacral ligaments (supporting structures of the cervix containing sensory nerves from the uterus) and pouch of douglas (peritoneum between the rectum and the cervix) are the most frequently involved areas and can produce intense to no pain[2] felt in the pelvis, low back, and during premenstrual period . Less commonly lesions can be found on the bladder, intestines, ureters, and diaphragm. Bowel endometriosis affects approximately 10% of women with endometriosis, and can cause severe pain with bowel movements. Diaphragmatic endometriosis is rare, most always on the right hemidiaphragm, and causes severe cyclic pain of the right shoulder just before and during menses. Very rarely endometriosis is found distant from pelvis,in sites such as the lung, brain, and kidney. Plural implantations are associated with recurrent right pneumothoraces at times of menses, termed catamenial pneumothorax. Similarly, lesions in the central nervous system can cause catamenial seizures. Symptoms A major symptom of endometriosis is severe recurring pain. The amount of pain a woman feels is not necessarily related to the extent or stage (1 through 4) of endometriosis. Some women will have little or no pain despite having extensive endometriosis affecting large areas or having endometriosis with scarring. On the other hand, women may have severe pain even though they have only a few small areas of endometriosis. Symptoms of endometriosis can include (but are not limited to): (dysmenorrhea) - Painful, sometimes disabling menstrual cramps; pain may get worse over time (progressive pain) Chronic pelvic pain - typically accompanied by lower back pain and/or abdominal pain. dyspareunia - Painful sex dyschezia - Painful bowel movements Nausea, vomiting, and/or diarrhea. Urinary urgency, frequency, and sometimes painful voiding (dysuria) Infertility and subfertility. Endometriosis may lead to fallopian tube obstruction. Even without this, there may be difficulty conceiving. In some women, subfertility is the sole symptom, and the endometriosis is only discovered after fertility investigations. Some women may also suffer from Depression and fatigue. In addition, women who are diagnosed with endometriosis may have gastrointestinal symptoms that may mimic irritable bowel syndrome. Patients who rupture an endometriotic cyst may present with an acute abdomen as a medical emergency. Endometriotic cysts in the thoracic cavity may cause some form of thoracic endometriosis syndrome, most often catamenial pneumothorax. Frequency “ In the US: Endometriosis occurs in 7-10% of women in the general population (Wheeler, 1989). It is an estrogen-dependent disease and, thus, usually affects reproductive-aged women. Endometriosis has a prevalence rate of 20-50% in infertile women (Rawson, 1991; Strathy, 1982; Verkauf, 1987) and as high as 80% in women with chronic pelvic pain (Carter, 1994). Evidence of endometriosis was found during laparoscopy in 20-50% of asymptomatic women (Williams, 1977). Approximately 4 per 1000 women are hospitalized with endometriosis each year. A familial association exists, with a 10-fold increased incidence in women with an affected first-degree relative (Cramer, 1987). Monozygotic twins are markedly concordant for endometriosis (Hadfield, 1997).[3] ” Epidemiology Endometriosis can affect any woman, from premenarche to postmenopause, regardless of her race, ethnicity or whether or not she has had children. Endometriosis often persists after menopause. Endometriosis in postmenopausal women is an extremely aggressive form of this disease characterized by complete progesterone resistance and extraordinarily high levels of aromatase expression.[4] A majority of 50 postmenopausal women diagnosed with endometriosis had no previous history of the disease. In less common cases, girls may have endometriosis before they even reach menarche.[5][6] Current estimates place the number of women with endometriosis at between 5% and 20% of women of reproductive age. About 30% to 40% of women with endometriosis are infertile, making it one of the leading causes of infertility. However, endometriosis-related infertility is often treated successfully with surgical destruction of the disease. Some women do not find out that they have endometriosis until they have trouble getting pregnant. While the presence of extensive endometriosis distorts pelvic anatomy and thus explains infertility, the relationship between early or mild endometriosis and infertility is less clear. The relationship between endometriosis and infertility is an active area of research. Early endometriosis typically occurs on the surfaces of organs in the pelvic and intra-abdominal areas. Health care providers may call areas of endometriosis by different names, such as implants, lesions, or nodules. Larger lesions may be seen within the ovaries as endometriomas or chocolate cysts (they are termed chocolate because they contain a thick brownish fluid, mostly old blood). Endometriosis may trigger inflammatory responses leading to scar formation and adhesions. Most endometriosis is found on structures in the pelvic cavity: Ovaries Fallopian tubes The back of the uterus and the posterior culdesac The front of the uterus and the anterior culdesac Uterine ligaments such as the broad or round ligament of the uterus Pelvic and back wall Intestines, particularly the appendix Urinary bladder Endometriosis may spread to the cervix and vagina or to sites of a surgical abdominal incision. In extremely rare cases, endometriosis areas can grow in the lungs or other parts of the body. Surgically, endometriosis can be staged I-IV (Revised Classification of the American Society of Reproductive Medicine).[7] Theories of Origin There are two major theories of origin that are commonly accepted within the scientific community. Sampson's theory is that of reflux menstruation. According to this theory, every month during a woman's menstrual flow, endometrial cells slough normally, then exit the uterus through the fallopian tubes, attach to the peritoneal surface (the lining of the abdominal cavity) and then invade to cause the disease of endometriosis. There are many problems with this theory, these are just a few: 1. Most women have some degree of reflux menstruation, yet only 10-15% of them have endometriosis; 2. Endometriosis follows reproducible patterns of distribution within the pelvis, and older women do not have more widespread disease than younger women as one would expect if reflux menstruation was truly the origin; 3. More than 700 gene differences exist between endometriosis and native endometrium, which should not be the case if endometriosis is an autotransplant disease formed by reflux menstruation; 4. Conservative surgical excision of endometriosis (removing the disease without removing the uterus or ovaries) produces a cure rate of approximately 60% which would be impossible if Sampson's theory were true, because every month new endometriosis would form as long as a woman kept menstruating; 5. Sampson's theory cannot explain endometriosis of distant sites including the brain, lungs, and skin. Because of these inconsistencies, another theory has been proposed, that of Embryologically patterned metaplasia. This theory states that cells destined to become endometriosis are laid down in tracts during embryologic development. These tracts are typically in the posterior pelvis, possibly forming as the female reproductive (Mullerian) tract migrates caudally at 8-10 weeks of embryonic life. These cells act like seeds, lying dormant until puberty when ovarian estrogen production starts and stimulates their growth. Active endometriosis produces inflammatory mediators that cause pain and inflammation, as well as scarring or fibrosis of surrounding tissue. Causes While the exact cause of endometriosis remains unknown, many theories have been presented to better understand and explain its development. These concepts do not necessarily exclude each other. Endometriosis is a condition caused by excess estrogen created each month in the female body, and is seen primarily during the reproductive years. In experimental models, excess estrogen is necessary to induce or maintain endometriosis. Medical therapy is often aimed at lowering estrogen levels to control the disease. It is hypothesized that excess estrogen levels may be measured by a female taking her morning temperature (with a thermometer showing a tenth decimal) at the same time each day for a month or two. To learn more about taking your waking temperature, please see the book: "Taking Charge of Your Fertility" by Toni Weschler, MPH. A normal woman's body temperature varies from 98.5 to 97.5 degrees Fahrenheit (36.9 to 36.3 degrees Celsius), however it is hypothesized that someone with endometriosis may see temperatures of 98.5 to 97.0 °F (36.9 to 36.1 °C). The lower temperatures signify the estrogen phase of a normal female's cycle, therefore it is logical that women with excessively lower body temperatures, may have an excess of estrogen, thus endometriosis. Research is needed to determine the reliability of using waking temperatures to diagnose endometriosis and its severity. Additionally, the current research into Aromatase, an estrogen-synthesizing enzyme produced by the implants themselves, has provided evidence as to why and how the disease persists after menopause and hysterectomy. "Retrograde menstruation", in which some of the menstrual debris of menstruation flows into the pelvis, may play an important role (John A. Sampson). While most women may have some retrograde menstrual flow, typically their immune system is able to clear the debris and prevent implantation and growth of cells from this occurrence. However, in some patients, endometrial tissue transplanted by retrograde menstruation is able to implant and establish itself as endometriosis. Factors that might cause the tissue to grow in some women, but not in others, need to be studied, and some of the possible causes below may provide some explanation, e.g. hereditary factors, toxins, or a compromised immune system. It can be argued that the uninterrupted occurrence of regular menstruation month after month for decades, is a modern phenomenon, as in the past women had more frequent menstrual rest due to pregnancy and lactation. A competing theory suggests that endometriosis does not represent transplanted endometrium but starts de novo from local stem cells. This process has been referred to as coelomic metaplasia. Triggers of various kind (including menses, toxins, or immune factors) may be necessary to start this process. Hereditary factors play a role. It is well recognized that daughters or sisters of patients with endometriosis are at higher risk of developing endometriosis themselves, for example low progesterone levels may be genetic causing part of the hormone imbalance. A recent study (2005) published in the American Journal of Human Genetics found a link between endometriosis and chromosome 10q26.[8] One study found that, in female siblings of patients with endometriosis the relative risk of endometriosis is 5.7:1 versus a control population.[9] It is accepted that in specific patients endometriosis can spread directly. Thus endometriosis has been found in abdominal incisional scars after surgery for endometriosis. On rare occasions endometriosis may be transplanted by blood or by the lymphatic system into peripheral organs (e.g. lungs, brain). Recent research is focusing on the possibility that the immune system may not be able to cope with the cyclic onslaught of retrograde menstrual fluid. In this context there is interest in studying the relationship of endometriosis to autoimmune disease, allergic reactions, and the impact of toxins.[10] However it is possible that toxins are causing autoimmune disease, not the endometriosis. There's a growing sentiment that there are environmental factors which may cause endometriosis; specifically some plastics, and cooking with certain types of plastic containers with microwave ovens.[2] Other sources suggest that pesticides and hormones in our food cause a hormone imbalance. Another area of research is the search for endometriosis markers. These markers are substances made by or in response to endometriosis that health care providers can measure in the blood or urine. If markers are found, health care providers could diagnose endometriosis by testing a woman's blood or urine which might show high levels of estrogen or low levels of progesterone, and reduce the need for surgery. CA-125 is known to be elevated in many patients with endometriosis,[11] but not specifically indicative of endometriosis. A small-scale 1995 study by University of Louisville School of Medicine suggests "an association between the occurrence of natural red hair and those factors that lead to the development of endometriosis".[12] Diagnosis A health history and a physical examination can in many patients lead the physician to suspect the diagnosis. Use of imaging tests may identify larger endometriotic areas, such as nodules or endometriotic cysts. The two most common imaging tests are ultrasound and magnetic resonance imaging (MRI). Normal results on these tests do not eliminate the possibility of endometriosis--areas of endometriosis are often too small to be seen by these tests. The only way to confirm and diagnos endometriosis is by laparoscopy or other types of surgery. The diagnosis is based on the characteristic appearance of the disease, if necessary corroborated by a biopsy. Laparoscopy also allows for surgical treatment of endometriosis. Generally, endometriosis-directed drug therapy (other than the oral contraceptive pill) is utilized after a confirmed surgical diagnosis of endometriosis. Cause of pain The way endometriosis causes pain is the subject of much research. Because many women with endometriosis feel pain during or related to their periods and may spill further menstrual flow into the pelvis with each menstruation, some researchers are trying to reduce menstrual events in patients with endometriosis. Endometrial tissue reacts to hormonal stimulation and may "bleed" at the time of menstruation. It accumulates locally, causes swelling, and triggers inflammatory responses with activation of cytokines. It is thought that this process may lead to pain perception. Endometriosis is thought to be an auto-immune condition and if the immune system is compromised with a food intolerance, then removing that food from the diet can, in some people, have an effect. Common intolerances in people with endometriosis are wheat and dairy.[13] Women with endometriosis frequently suffer from painful ovarian cysts, making ovulation quite painful. Sometimes, the cysts burst and can cause life-threatening infections in the pelvic cavity. Women with endometriosis commonly have problems with extraordinarily painful periods and severe cramps. The bleeding can be profound and continue for weeks, leading some women to require iron supplements and even blood transfusions. These women are usually treated with birth control pills, hormone therapies, IUDs with hormones, drugs that induce menopause, or even hysterectomy to stop the dysmenorrheal symptoms. While the menstrual pain itself can be quite excruciating, it is not the only time a person with endometriosis suffers. The lesions cause scar tissue to grow in the abdomen (and sometimes elsewhere), which bind internal organs to each other. Fallopian tubes, ovaries, the uterus, the bowels, and the bladder can be permanently damaged. This kind of pain is more debilitating on a daily basis and goes on for years, yet most sources of information seem to focus on menstrual symptoms.[citation needed] When a woman suffers from endometriosis long enough, the pain may go from the original site to include back pain as well. This symptom is rarely discussed by doctors, despite the fact it is quite common.[citation needed] Through all this, there is the pain encountered from multiple surgeries. Laparoscopy, laparotomy, hysterectomy, oophorectomy, bowel and bladder surgeries are all common and a woman usually goes through many before menopause finally gives her the best relief from pain. Treatments Currently, there is no known 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. The reason being because the adhesions can be found on other organs besides the reproductive organs and even on the abdominal walls. Conservative treatments usually try to address pain or infertility issues. Medical herbal treatments can sometimes be effective in controlling the disease. It is suggested but unproven that pregnancy and childbirth can cease the growth of endometriosis.[citation needed]. Nevertheless, after the pregnancy, there is no guarantee that the endometriosis will not reoccur. Other treatments for endometriosis pain include: Medication 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. 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 hormonal contraception consists of the use of combined oral contraceptive pills without the use of placebo pills, or the use of NuvaRing or the contraceptive patch without the break week. 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.[14] Lupron depo shot is also a gonadotropin and is used to lower the hormone levels in the womans body to prevent any growth of endometriosis. The lupron shot is given in 2 different doses a once a month for 3 month shot with the dosage of (11.25mg) or a once a month for 6 month shot with the dosage of (3.75mg). The side effects of this shot are mild to severe hot flashes by putting the body into a medicated menopause also there is also a drop in bone density but once you stosp the shot your body regenerates the lost mass.[15] The therapy is the less invasive way than the surgical approach but has been known to help women. Although there is no cure for endometriosis this is a way to control it for a short period of time. You can go on the lupon website to find out more on what you can expect from the shot during and after treatment [16] Surgery 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. Studies have shown that with true excision, recurrence rates are less than 20%. 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). Bowel resection can be useful if there is bowel involvement. For patients with extreme pain, a presacral neurectomy may be indicated where the nerves to the uterus are cut. Serotonin modulation This section may contain original research or unverified claims.Please help Wikipedia by adding references. See the talk page for details.(December 2007) Serotonin modulation involves raising one's serotonin levels. Low serotonin levels reduce the pain threshold, and make people more susceptible to pain. Many people like sweets: eating sugar or chocolate temporarily increases serotonin levels, but creates a rebound effect, characterized by heightened PMS symptoms. Melatonin and serotonin levels are increased, and levels of the stress hormone cortisol are decreased, by meditation. Melatonin causes the onset of the delta sleep phase, during which period Human Growth Hormone is released. As melatonin levels drop from childhood (100%) to age 20 (30%) and age 30 (20%)[citation needed], recovering takes more time, so good sleep is essential. Serotonin is manufactured by the body from 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[citation needed] by stimulating serotonin and inducing a feeling of calm and happiness. Light therapy increases serotonin levels.[citation needed] Women particularly need adequate amounts of full-spectrum light during the second half of their menstrual cycles, when their serotonin levels may already be low. CAD This section may contain original research or unverified claims.Please help Wikipedia by adding references. See the talk page for details.(December 2007) 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[citation needed] showing that prostaglandins series 1 and 3 have an anti inflammatory effect which can help with endometriosis. Nutrition can also help to boost the immune system, which is important if endometriosis is an auto-immune disorder. Avoid coffee and alcohol. Both can increase the levels of estrone.[citation needed] Avoid wheat and wheat products. While it can't cure endometriosis, acupuncture can be quite effective at treating the pain associated with menstrual cramps, back symptoms, and endometriosis adhesions.[citation needed] Prognosis Proper counseling of patients with endometriosis requires attention to several aspects of the disorder. Of primary importance is the initial operative staging of the disease to obtain adequate information on which to base future decisions about therapy. The patient's symptoms and desire for childbearing dictate appropriate therapy. Not all therapy works for all patients. Some patients have reoccurances after surgery or pseudo-menopause. Most patients can be told that they will be able to obtain significant relief from pelvic pain and that treatment will assist them in achieving pregnancy.[1] It is important for patients to be continually in contact with their physician and keep an open dialog throughout treatment. Unfortunately, this is a disease without a cure and with the proper communication, one with endometriosis can attempt to live a normal, functioning life. Complications The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women who have difficulty becoming pregnant have endometriosis. For pregnancy to occur, an egg must be released from an ovary and travel through the fallopian tube to the uterus (womb), where it can be fertilized by a male's sperm and then attach to the uterine wall to begin development. Endometriosis can produce adhesions that can trap the egg near the ovary. It may inhibit the mobility of the fallopian tube and impair its ability to pick up the egg. In most cases, however, endometriosis probably interferes with conception in more complex ways. Internal scarring Adhesions Pelvic cysts Chocolate cysts Ruptured cyst Infertility - occurs in about 30-40% of cases. Complications of endometriosis consist of bowel and ureteral obstruction resulting from pelvic adhesions. Rarely, endometriosis can be extraperitoneal and is found in the lungs and CNS.[17] Infertility Endometriosis is associated with a lowered fertility and is the second leading cause of infertility in females that ovulate normally (the leading cause is pelvic inflammatory disease). Treatment of infertility Laparoscopy to remove or vaporize the growths in women who have mild or minimal endometriosis is effective in improving fertility. One study has shown that surgical treatment of endometriosis approximately doubles the fecundity (pregnancy rate).[18] In patients with small amounts of endometriosis treatment with fertility medication clomiphene may lead to success. This drug stimulates ovulation. Lipiodol flushing may increase fecundity. In-vitro fertilization (IVF) procedures are effective in improving fertility in many women with endometriosis. IVF makes it possible to combine sperm and eggs in a laboratory and then place the resulting embryos into the woman's uterus. IVF is one type of assisted reproductive technology that may be an option for women and families affected by infertility related to endometriosis. Relation to cancer Endometriosis is not the same as endometrial cancer. However it is hypothesized that the excess estrogen creation by endometriosis may eventually cause ovarian or other cancers over a woman's lifetime. The staging of endometriosis is similar to the staging of cancers, as well, in the sense that they both gauge the spread of disease in a similar fashion to different zones of the body. Current research has demonstrated an association between endometriosis and certain types of cancers.[19][20] Endometriosis often also coexists with leiomyoma or adenomyosis, as well as autoimmune disorders. References ^ a b Sanaz Memarzadeh, MD, Kenneth N. Muse, Jr., MD, & Michael D. Fox, MD (September 21 2006). Endometriosis. Differential Diagnosis and Treatment of endometriosis.. Armenian Health Network, Health.am. Retrieved on 2006-12-19. ^ Robbins and Cotran Pathologic Basis of Disease 7th Edition ^ Dharmesh Kapoor and Willy Davila, 'Endometriosis', eMedicine (2005). ^ Aromatase Expression in Postmenopausal Endometriosis. Aromatase in Aging Women. Medscape (1999). Retrieved on 2007-09-23. ^ Batt RE; Mitwally MF (2003-12-01). "Endometriosis from thelarche to midteens: pathogenesis and prognosis, prevention and pedagogy". Journal of pediatric and adolescent gynecology 16 (6): 337–47. doi:10.1016/j.jpag.2003.09.008. PMID 14642954. Retrieved on 2006-04-15. ^ Marsh EE; Laufer MR (2005-03-01). "Endometriosis in premenarcheal girls who do not have an associated obstructive anomaly". Fertility and sterility 83 (3): 758–60. doi:10.1016/j.fertnstert.2004.08.025. PMID 15749511. Retrieved on 2006-04-15. ^ "Revised American Society for Reproductive Medicine classification of endometriosis: 1996" (1997). Fertil. Steril. 67 (5): 817–21. PMID 9130884. ^ Treloar SA, Wicks J, Nyholt DR, Montgomery GW, Bahlo M, Smith V, Dawson G, Mackay IJ, Weeks DE, Bennett ST, Carey A, Ewen-White KR, Duffy DL, O'connor DT, Barlow DH, Martin NG, Kennedy SH. Genomewide linkage study in 1,176 affected sister pair families identifies a significant susceptibility locus for endometriosis on chromosome 10q26. Am J Hum Genet. 2005 Sep;77(3):365-76. Epub 2005 July 21. PMID 16080113. Full Text. ^ Kashima K, Ishimaru T, Okamura H, Suginami H, Ikuma K, Murakami T, Iwashita M, Tanaka K. Familial risk among Japanese patients with endometriosis. Int J Gynaecol Obstet. 2004 Jan;84(1):61-4. PMID 14698831 ^ Capellino S, Montagna P, Villaggio B, Sulli A, Soldano S, Ferrero S, Remorgida V, Cutolo M. Role of estrogens in inflammatory response: expression of estrogen receptors in peritoneal fluid macrophages from endometriosis. Ann N Y Acad Sci. 2006 Jun;1069:263-7. PMID 16855153 ^ do Amaral V, Ferriani R, de Sá M, Nogueira A, e Silva J, e Silva A, de Moura M (2006). "Positive correlation between serum and peritoneal fluid CA-125 levels in women with pelvic endometriosis". Sao Paulo Med J 124 (4): 223-7. PMID 17086305. ^ Woodworth SH, Singh M, Yussman MA, Sanfilippo JS, Cook CL, Lincoln SR. (1995). "A prospective study on the association between red hair color and endometriosis in infertile patients.". Fertility and Sterility J 64 (3): 651-2. PMID 7641926. ^ Dian Mills & Michael Vernon. "Endometriosis A Key to Healing and Fertility through Nutrition" ^ Attar E, Buttun SE. Aromatase inhibitors: the next generation of therapeutics for endometriosis? Fertil Steril 2006;85:1307-18 PMID 16647373 ^ How Lupron Depot therapy is used in treating Endometriosis ^ Lupron.com: about Lupron Depot®, injections, treatment and side effects ^ Shawn Daly, MD, Consulting Staff, Catalina Radiology, Tucson, Arizona (October 18 2004). Endometrioma/Endometriosis. WebMD. Retrieved on 2006-12-19. ^ Marcoux S, Maheux R, Berube S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med. 1997 July 24;337(4):217-22. PMID 9227926. ^ Endometriosis cancer risk. medicalnewstoday.com (5 July 2003). Retrieved on 2007-07-03. ^ Roberts, Michelle (3 July 2007). Endometriosis 'ups cancer risk'. BBC News. BBC / news.bbc.co.uk. Retrieved on 2007-07-03.