Allissa Barnett

Human Sexuality

Endometriosis

April 14, 1998

Annotated Bibliography

Albee, R. B. (1997) Endometriosis: Basic questions and answers.

<http://www.dunwoodymed.com/endo/question.html> (March 21, 1998).

Four levels of surgery used to treat endometriosis range from diagnostic to radical. Diagnostic surgery consists of simply finding out what is going on with the patient, and no attempt is made to correct or treat anything. Very conservative surgery occurs when a surgeon treats a very large, obvious section of endometriosis. Aggressive surgery removes all the endometriosis while saving the organs, thereby maintaining fertility. Radical surgery consists of removal of the reproductive organs. Many women can find long lasting relief from pain without resorting to such drastic measures as removal of the uterus and/or ovaries.

Anthony, J. (1996). Endometriosis: the hidden epidemic. American Health, 15, 60.

As many as 10% of women of reproductive age may suffer from endometriosis. Debilitating pain and infertility are two possible consequences of the disease. Endometriosis is one of the most common but the least understood diseases. Endometriosis 2000, a federally sponsored exploration of the causes and treatments of the disease, acknowledge endometriosis as being a progressive disease. Some of the most effective treatments for relieving the pain include drugs such as Lupron, Synarel, and Zoladex. The lack of research, interest, and federal funding until recently could have been resulting from sexism. Endometriosis was not taken seriously by many male physicians who claimed that the pain women were feeling was only in their heads.

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Begany, T. (1997). Gynecologic disorders: Current approaches to endometriosis. Patient

Care, 31, 34-44.

Research suggests that rates of endometriosis may be increasing. This could be because of the greater awareness of the disease among the general population and among physicians. Because of the tendency for women to wait to have children, menstrual patterns have been changing and occurring longer than in the past. The more menstrual patterns produce greater chance for women to have endometrial tissue implant outside the uterus. Exposure to the environmental toxin dioxin can possibly cause higher rates of endometriosis. Further studies are being conducted regarding the effects of dioxin on endometriosis rates. Researchers still do not know the cause of endometriosis, but there is four major theories. The retrograde theory maintains that endometriosis is a result of the backward flow of menstrual fluid through the fallopian tubes. The coelomic metaplasia theory stems from the belief that epithelial cells in the abdominal cavity are capable of differentiating into different types of cells. The lymphatic theory states that endometrial cells travel to various sites in the body through the lymphatic system and then implant. The embryonic theory states that endometrial cells are misplaced during the embryonic stage of development and then grow. Part of the problem is believed to be deficiencies in the immune system that prevent the removal of any endometrial cells.

Dioxin tied to endometriosis. (1993). Science, 262, 1373-4.

Tests run on Rhesus monkeys show that dioxin increases the rates of endometriosis. Dioxin is found in pesticides, in food, or is airborne. 79% of the female monkeys exposed daily to dioxin contracted endometriosis. The monkeys with the most severe endometriosis were shown to have had the most exposure to dioxin. This finding has prompted

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studies of dioxin and it’s effect and relationship to endometriosis by the Environmental Protection Agency Health Effects Research laboratory. The National Institute for Environmental Health Sciences in North Carolina has also begun researching the effects on endometriosis of all the chemicals in the family containing dioxin.

Dixie, F. (1993). Endometriosis: Painful, but Treatable. FDA Consumer, 27, 24-27.

In the treatment of endometriosis, the sooner the treatment begins, the better. The disease can be arrested more easily if it is found at an early stage. Severe endometriosis can lead to infertility in several different ways including producing cysts that prevent the egg’s release, implants can block the passage of the egg in the fallopian tubes, and adhesions can fix ovaries and tubes in place so that projections on the tubes cannot grasp the egg and pull it into the fallopian tubes. Some new drugs used to treat endometriosis include Danocrine, Synarel, and Lupron Depot. With diagnosis and treatment, women can get on with their lives.

Endometriosis association international headquarters. (n.d)

<http://www.endometriosisassn.org/causes.html> and

<http://www.endometriosisassn.org/treatment.html> (March 21, 1998).

The causes of endometriosis, including retrograde menstruation, lymphatic theory, genetic theory, surgical transplantation, and embryonic development theories are summarized. Treatment options include pain medication, including ibuprofen and tylenol; hormonal medication, such as oral contraceptives, progesterone drugs, testosterone derivatives, and GnRH agonists; surgery, including laparoscopy, laparotomy, and hysterectomy; and alternative treatment, including Chinese medicine, nutritional approaches, and immune therapy.

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Endometriosis awareness and information. <http://geocities.com/HotSprings/9783> (March 23, 1998).

A woman tells her story of endometriosis and the struggles she endured through the course of the disease and how she coped. She touches on the four basic stages of endometriosis and stresses that pain is not normal. Her story consists of delayed diagnosis because she accepted her pain and did not try to find out if something was wrong. She talks about the theories that cause endometriosis including the retrograde theory and some of the myths frequently thought about. Myths including the belief that only women in their reproductive years are affected, and menstrual pain is mostly in your head. She has become an avid researcher about the disease and is convinced that more knowledge and research is needed to help the women with endometriosis.

Endometriosis treatment options. (n.d) <http://www.endometriosis.org/endotrea.html> (March 21, 1998).

Endometriosis is an incurable disease, however there are certain treatments that can help relieve the symptoms of the disease and keep the endometriosis from growing. Some of these treatments include hormonal treatments, oral contraceptives, GnRH agonists, testosterone derivatives such as danzanol, surgery, or alternative treatments. Alternative treatments include dietary changes, vitamins and herbs such as the B complex, and vitamin E & selenium, acupuncture and stress reduction techniques such as yoga, biofeedback, meditation, and regular exercise.

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Flood, J. T. (1996) Endometriosis. <http://www.beachcenter.com/surgical/endometriosis.shtml> (March 21, 1998).

A thorough summary of endometriosis descriptions, causes, appearance, symptoms, diagnosis, treatment options, and psychological implications shown. Endometrial tissue, whether found inside or outside the uterus responds to the rise and fall of estrogen and progesterone produced by the ovaries. The bleeding caused by the endometrial tissue outside of the uterus results in the abdominal tissue absorbing the internal bleeding which leads to scars and lesions. Women with endometriosis need to find a qualified physician to help them deal with the implications of their disease.

From your doctor: About endometriosis. (1997). Patient Care, 31, 47-48.

Endometriosis, occurring when tissue found normally inside the uterus grows other places in the body, is a serious disease. The pain is real and not made up. Diagnosis is correct only when done surgically. Pregnancy is quite possible even though endometriosis badly damages the reproductive tract of the woman. Surgery is one option for helping to keep endometriosis under control and possibly stop the symptoms. Recurrence is always possible however.

Garner, Catherine. (1997). Endometriosis: What you need to know. RN, 60, 27-31.

Women with endometriosis need the support of spouses, family, and friends. The disease that affects over five million women in this country may have very elusive or misleading symptoms. Symptoms range from severe pelvic pain to painful menstruation to infertility. Nearly half of all women with endometriosis have trouble conceiving. Because the severity of symptoms is not good indicator of the extent of the disease, a surgical procedure called a

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laparoscopy is done to diagnose the disease. Endometriosis affects the marital relationship in sexual, communicative, and emotional ways. Support groups are there to help women cope with endometriosis.

GnRH Agonists- Lupron, Naferelin, Synarel, Goserelin, Zoladex. (n.d.)

<http://www.fertilitext.org/lupron.html> (March 28, 1998).

GnRH agonists are synthetic derivatives that are up to sixty times as potent as the gonadotropin releasing hormones themselves. GnRH agonists stop estrogen production and consequently the growth of endometriosis. The most commonly prescribed GnRH is Lupron. Side effects include menopausal like state of the body such as calcium loss, hot flashes, decreased sex drive, and vaginal dryness.

Hunt, R.B. (n.d.) Endometriosis- FAQ’s <http://wardweb.com/endomet.html> (March 21, 1998).

Hunt answers many questions regarding endometriosis. Endometriosis, normal tissue which is in the wrong place, is not associated with cancer. He describes the holistic treatments that have been used and have been found useful, such as massage therapy and acupuncture. Endometriosis has been identified as a major cause of infertility among women although many women do conceive after surgery.

International endometriosis awareness campaign. (1997). Endometriosis awareness web site. <http://www.scu.edu.au/schools/nhep/endo/info.html> (March 23, 1998).

Endometriosis affects one in four women, and it is an incurable disease. Being an invisible disease, many women go for years without being diagnosed because the only successful diagnosis is through surgery. A problem with the insufficient diagnosis is the belief that pain

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women feel is purely made up, and women are labeled hypochondriacs. Diagnosis usually takes place after the woman has demanded several opinions. The only current way to treat endometriosis is through hormone treatments or surgery or a combination of both. Endometriosis affects every aspect of a woman’s life and has a toll on family members and friends as well.

Kashef, Z. (1996). Coping with endometriosis. Essence, 26, 32-35.

Of the estimated 5-12 million women suffering from endometriosis in the United States, many can be treated with hormone therapy, surgery, or a combination of both. Diagnosis by laparoscopy is the only accurate way to be sure of endometriosis. Hormones are prescribed for four to six months only because of the undesirable side effects they produce. Surgical procedures including laparoscopy and laparotomy may be used to remove scar tissue and the disease itself. When hormone treatment and surgery has both been attempted but have failed to remove the symptoms or stop the disease, a hysterectomy has been suggested. Hysterectomy, the complete removal of the uterus and sometimes the ovaries and fallopian tubes, does not guarantee complete relief from endometriosis. In some cases, the disease has spread to the nonreproductive organs as well. Some women turn to alternative therapies such as changing their diet to a low-fat, high-fiber menu. Support groups are available for women with endometriosis.

Mastro, T. T. (1996). The Missed Disease. < http://www.ivf.com/endowp.html> (April 14, 1998).

By depicting case studies of women who have endometriosis, Mastro examines the diagnosis and implications of endometriosis. Mastro describes the struggle to diagnose endo

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and the elusiveness of the disease. Endometriosis is not diagnosed until a surgical operation is done to visualize the disease. Endometriosis is often mistaken for other disorders such as pelvic inflammatory disease. Mastro stresses the importance for women to be educated about their bodies and take an active role in taking care of themselves.

Myths about Endometriosis. (n.d.) <http://www.endometriosis.org/endomyth.html> (March 21, 1998).

There are several myths regarding endometriosis that need to be recognized and stopped. Some of these include that endometriosis is the career woman’s disease, that pregnancy cures endometriosis, and that hysterectomy cures endometriosis. Endometriosis is a nondiscriminatory disease, it affects women of all ages. Women who get pregnant or have a hysterectomy still have the risk of the disease recurring which is common in many cases. Much more research is needed in the area of endometriosis.

Olive, D. L., & Schwartz, L. B. (1993). Endometriosis. The New England Journal of

Medicine, 328, 1759-1767.

Endometriosis is a disease that has recently come under much investigation, but the causes and diagnostic information regarding this debilitating disease is severely lacking. The knowledge that is known is examined and reviewed. Because of inadequate diagnostic techniques, besides surgery, the mean age of women at time of diagnosis is 25029, however, this disease is quite common among adolescents. The accurate surgical diagnosis of the laparoscopy really depends on the ability of the surgeon to recognize the disease. A need for further research is apparent in how the endometrium actually gets outside of the uterus and attaches to various organs in the abdominal cavity.

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Perloe, M. (1995). Endometriosis association: education support research.

<http://www.ivf.com/endoassn.html> (March 21, 1998).

The endometriosis association is a self-help organization of women with endometriosis and others wanting to know more about the disease. The association offers mutual support and help to women affected by the disease. Sharing with other women who understand, endometriosis sufferers find encouragement, hope, and learn more through the stories and knowledge of other women. Endometriosis is one of the most puzzling diseases and there is an obvious lack of research in the area of diagnosing the disease.

Perloe, M. (1996). Endometriosis: Conquering the silent invader.

<http://www.ivf.com/ch17mb.html> (March 21, 1998).

Mark Perloe does an excellent job of describing what endometriosis is and how it affects the female body. He answers all the most common questions about the disease and goes into detail regarding how endometriosis affects fertility. A complete listing of all the symptoms and the percentage ratings for the amount of women experiencing these symptoms is included. Surgery and the success rates for pregnancy afterwards shows that conception depends on the severity of the disease.

Perloe, M. (July 1995). Endometriosis 2000 meeting focuses on research agenda. Research Reports. <http://www.ivf.com/endo2000.html> (March 21, 1998).

At a meeting to explore the causes and treatments of endometriosis, which was described as mystifying and hard to explain. Endometriosis is one of the top two leading causes for hysterectomies. Endometriosis is often diagnoses long after symptoms appear which is speculated to be the reason so many women get hysterectomies. The disease is difficult to

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diagnosis because it takes on so many different forms, ranging from tiny reddish growths to large brown lesions. The final summary of the conference stated that there is an essential need for more research about the classification of endometriosis lesions and more education regarding endometriosis.

Perloe, M. (1995). Sperm-egg transport:solving tubal problems.

<http://www.ivf.com/ch16mb.html#lap> (March 21, 1998).

Detailing the process of laparoscopic surgery, this article gives a good understanding of the processes of surgery and the purpose and when it is performed. The possible procedures used during laparoscopy include removal of the fallopian tubes and removing an ovary. Also discussed is a laparotomy which is more detailed abdominal surgery. This is used for more delicate removal of the disease. Laparotomy requires a longer recovery period. Perloe stresses the key to successful surgery is minimizing the damage from infection, from the organs drying out, and from bleeding. Adhesions can possibly grow back.

Protein missing in endometriosis cases. (1994).Science News, 146, 118-119.

Researchers have found a protein that may be associated with infertility caused by endometriosis. About 40% of infertile women suffer from endometriosis. Beta-3 is a protein that may have possible validity for nonsurgical diagnosis of mild cases of endometriosis. Currently the only accurate diagnosis of endometriosis is through a laparoscopy. Beta-3 appears on the endometrial epithelium on the 19th and 20th days of the menstrual cycle of healthy women. Researchers testing beta-3 from biopsies have shown that beta-3 was missing from the epithelium lining on the 19th and 20th days of the menstrual cycle in 86% of women in their study. However, not all patients who had endometriosis were lacking the beta-3 protein.

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Researchers hope that from discoveries about the beta-3 protein, a cheap and easy test for diagnosing endometriosis will be developed.

Redwine, D. B. A better approach to endometriosis. <http://www.scmc.org/reprints1.html> (March 23, 1998).

Seeing a need for further research and knowledge about endometriosis, Dr. Redwine started investigating. Many of his patients had subtle lesions that ended up being endometriosis. Deciding to make laparoscopic surgery his standard treatment, he cut down on the number of laparotomies he needed to perform. He stresses the importance of a skilled surgeon who specializes in endometriosis so as to avoid unnecessary and ineffective surgery. It is apparent to Dr. Redwine that not enough information is known about endometriosis.

Surgical therapy: Laparoscopy of laparotomy. (1997). RN, 60, 30.

When drug therapy fails to control the pain and other symptoms of endometriosis, there are several surgical choices. Laparoscopy is the removal of endometrial cells by use of a laser. The two small abdominal incisions required for the surgery take only a few days to heal. A laparotomy is a more in depth operation requiring a large abdominal incision and a lengthy recovery period of 4-6 weeks. With both of these types of surgery, a woman will need to undergo several months of drug therapy afterwards. The drug therapy will ensure that if any parts of the endometrial cells were forgotten and left behind, they will be kept under control by the effects of the drugs. If the woman does not respond to either the drug therapy or the surgery, a partial or complete hysterectomy is the only treatment option left to control the pain and the endometriosis.

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Syranel Nasal Spray. (1995) <http://home.intekom.com/pharm/searle/syranel.html> (March 28, 1998).

Synarel is a nasal spray used for the hormonal management of endometriosis, including pain relief and reduction of endometriotic lesions for a period of six months in patients. Synarel should not be used in women with undiagnosed vaginal bleeding, who are breast feeding, or who are pregnant. Side effects include hot flushes, vaginal dryness, headaches, acne, and decreased breast size. Synarel inhibits ovulation and puts the body into a menopausal like state.

Whitney, M. (n.d.) The social support experiences of women with endometriosis.

<http://www.ivf.com/socendo.html.> (March 21, 1998).

Women with endometriosis want to network, commiserate, be informed, not focus on misery, and be recognized as an individual by other women and people in general. Support groups for women with endometriosis provide a view of their past and a glimpse toward the future as they listen to the stories told by other women regarding their struggles with endometriosis. Women need from their husbands commitment, caring, and an understanding that they cannot fix their wife’s problem. Husbands need to be informed about their wife’s disease so they can be supportive. Communication is imperative if the sexual relationship which is affected by endometriosis is to survive. Women with endometriosis want to be listened to by their family. Above all else, women need to have their feelings and pain validated, not minimized by health care providers, family, friends, or spouses.

Wiater, K. My aunt with endometriosis.

My aunt, Kathleen Wiater, enthusiastically offered to send me a little biography of her struggles with endometriosis.