Ma Vie d'Autrefois, Ou est-ce Encore la Même ?

Sunday, November 18, 2007

Endometriosis and PCOS - Some of the Story

For several years, I was sick. Nothing life threatening or dramatic. But definitely life-altering and a most difficult time of my life. One of many. From about the age of 17 or 18, until April 15, 2001, I suffered from endometriosis and polycystic ovarian syndrome.

According to Yahoo! Health,

Endometriosis is:

Topic Overview

What is endometriosis?

The endometrium is the tissue that lines the uterus. During each menstrual cycle, a new endometrium grows, preparing for a possible pregnancy. If you do not become pregnant during that cycle, the endometrium is shed, which you know as your menstrual period.

Endometriosis is endometrium tissue that grows outside of the uterus. This usually occurs on the ovaries, the fallopian tubes, the outer surface of the uterus, the bowels, or other abdominal organs. Rarely, it can affect other organs and structures in the body.

Endometriosis growths are called “implants.” They grow, bleed, and break down with each menstrual cycle, just like the endometrium does. This can cause pain and can make it difficult to get pregnant. In some cases, scar tissue forms around implants. Scar tissue can also cause pain and problems getting pregnant, and it can interfere with an organ's normal function.

What causes endometriosis?

Experts do not know the exact cause of endometriosis. However, we do know that estrogen "feeds" it. That is why endometriosis only affects women during the years before menopause. During the childbearing years, when the menstrual cycle is regular, women normally have high levels of estrogen. At menopause, menstrual periods stop, and the body's estrogen levels drop.

There are several theories that explain how endometrial cells grow outside of the uterus. The cells may be carried up the fallopian tubes and into the abdomen during menstruation. They may grow from cells that are similar to the endometrium. Or, they may be moved from the uterus by blood or lymph circulation or during a surgery or childbirth.

Experts believe that the body's own defense system (called the immune system) normally kills off any endometrial cells outside of the uterus. However, it appears that in women who have endometriosis, a problem with the immune system helps these cells implant and grow where they don't belong. 1

Endometriosis also is known to run in families.

What are the symptoms?

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

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

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

How is endometriosis diagnosed?

Since pelvic pain and infertility have many causes, your health professional will check you for signs of several possible conditions. Diagnosis of endometriosis starts with talking about your history of symptoms and your menstrual periods. You will also have a pelvic exam, which often includes checking both the vagina and rectum.

If your exam, symptoms, and risk factors strongly suggest that you have endometriosis, your health professional may suggest that you try medicine before having more tests. Usually, medicine treatment starts with hormone therapy and/or nonsteroidal anti-inflammatory drug (NSAID) therapy. If your symptoms improve after a few months of treatment, it is even more likely that you have endometriosis.

If you have signs of an endometriosis cyst on an ovary (endometrioma), a test called a transvaginal ultrasound can show the cyst on a computer screen. An MRI or CT scan can also show what is inside your pelvis.

Your doctor may eventually do a laparoscopy. During this surgery, your doctor places a viewing instrument through a small incision in your belly (abdomen) to see how severe your condition is.

How is it treated?

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

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

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

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

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

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

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

And, PCOS is:

Topic Overview

What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a health problem that can affect a woman's hormone levels, periods, and ovulation. This can affect fertility and pregnancy. It can also cause male-type body changes.

If you have PCOS, your hormone (endocrine) system is out of balance. This can lead to serious health problems, such as diabetes and heart disease.

What are the symptoms?

If you have PCOS, you may have problems with:

  • Acne.
  • Weight gain and have trouble losing weight.
  • Male pattern baldness or thinning hair on the scalp.
  • Hair growth on the face, back, or chest.
  • High blood sugar (hyperglycemia).

PCOS also can cause menstrual and pregnancy problems, including:

Living with PCOS symptoms can affect your emotional well-being, sexual satisfaction, and overall quality of life. This can lead to depression. 1

What causes PCOS?

The cause of PCOS is not known.

PCOS problems are caused by hormone changes. One hormone change triggers another, which changes another. This makes a "vicious circle" of out-of-balance hormones in your endocrine system, including:

  • Ovary hormones. When the hormones that trigger ovulation are not at the right levels, the ovary does not release an egg every month. In some women, cysts form on the ovaries. These cysts make androgen.
  • High androgen levels. High androgen in a woman causes male-type hair and acne problems and can stop ovulation.
  • High insulin and blood sugar levels. About half of women with PCOS have a problem with how the body uses insulin, called insulin resistance. When the body doesn't use insulin well, blood sugar builds to high levels. If not treated, this can lead to diabetes.
  • High cholesterol levels. This is common with PCOS.

Experts do not yet fully understand what triggers PCOS hormone changes. But they have found that lowering insulin levels seems to improve PCOS problems. 2

You may have a high risk of PCOS if members of your family have had PCOS or type 2 diabetes.

Does PCOS increase your risk for other health problems?

PCOS raises your risks of infertility, high cholesterol, high blood pressure, obstructive sleep apnea, heart disease, uterine (endometrial) cancer, and diabetes. (Of women who have PCOS, about 1 in 10 have type 2 diabetes by age 40. 2 ) If you do not have menstrual bleeding for a year or more, your risk of uterine cancer increases.

Treating PCOS can lower these health risks.

With PCOS, you also have higher risks of miscarriage and gestational diabetes. This may be linked to high insulin levels. 3

How is PCOS diagnosed?

No single test can show that you have PCOS. Your doctor will talk to you about your medical history, symptoms, and menstrual cycles. During your physical exam, he or she will check you for physical signs of PCOS. You may also have tests to measure your blood sugar (glucose), androgen, and cholesterol levels.

Many women find out that they have PCOS after they have had a repeat miscarriage or problems getting pregnant.

How is it treated?

If you have PCOS, your hormone system is out of balance. To correct this, your first step is to look at what you eat, how much you eat, and how much physical activity you get.

  • Having PCOS raises your risks of serious health problems. Eating heart-healthy foods, along with getting regular exercise, is the key to lowering these risks.
  • If you are overweight and have PCOS, a small amount of healthy weight loss is likely to start up your menstrual cycle and ovulation. (PCOS can make it hard to lose weight—making a plan with your doctor, a nutritionist, and/or an athletic trainer can help.)

Talk to your doctor about your goals for treatment.

  • If you are trying to get pregnant, healthy weight control may be all that you need to start ovulating. Sometimes, also using diabetes and/or fertility medicine can help.
  • If you are not trying to get pregnant, birth control pills can help get your menstrual cycle back on track. (A healthy diet and exercise are still important—taking this medicine alone does not help with heart, blood pressure, cholesterol, and diabetes risks.) Sometimes, also using diabetes medicine can help.

1 Comments:

  • At 14/2/08 17:51 , Anonymous Anonymous said...

    The fundamental problem with PCOS is anovulation and not making progesterone for two weeks every cycle.

    This lack of progesterone leads to hormonal imbalance in the ovary, causes the ovary to produce testosterone and leads to the irregular menstrual cycles and infertility. This is aggravated by obesity and insulin resistance.

    Progesterone is missing, therefore replacing it makes sense.

    To read more, click here:

    Understanding PCOS the Hidden Epidemic

     

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