Dr. Redwine believes endo is a static disease that you are born with it as a result of cells left behind during fetal development. In his study, Dr. Redwine found no statistical evidence that the number of areas in the pelvis involved with endo increased with age.
Again Dr. Redwine says there in no evidence to support the idea that endo tissue evaporates out of the body after menopause. In fact the oldest person diagnosed with endo was 78.
The diagnosis of endo can be tentatively made through a careful pelvic examination. There is usually exquisite tenderness of the ligaments supporting the uterus. Sometimes small lumps or nodules can be felt on the ligaments or just behind the uterus.
"I keep my eye on the patient's face, if she makes a grimace or arches her back a little bit, this is extremely significant," says Dr. Redwine.
Definitive diagnosis can be made only through surgery, usually through the laparoscope under a general anesthetic.
What Are The Symptoms Of Endo ?
Pelvic pain, not infertility, was the main symptom that caused two-thirds of the women Dr. Redwine studied to seek medical help. "They were fertile women whose main problem was pain," comments Dr. Redwine.
Nancy Petersen, R.N. and Director of the Endometriosis Treatment Program in Bend, Oregon, feels women do not make up symptoms of pelvic pain nor do they exaggerate about the severity of pain experienced.
In fact, Petersen says that 75 percent of the women who came to Dr. Redwine's clinic with proven endo had been dismissed in the past by their doctors as being neurotic.
Petersen feels it is logical to expect that anything that causes irritation or inflammation of the peritoneum (the clear saran-wrap-like covering of the abdominal organs) is likely to be extremely painful, as, for example, appendicitis.
She has heard some women describe the pain like "hot lead balls trying to fall out of the pelvis." Dr. Redwine describes the "twisting fist sign." This means that the woman twists her fist towards him or her own body as she describes the intensity of the pain.
The pelvic pain is usually described as sharp, stinging and burning in nature. The pain usually started at ovulation and at times other than during periods. The pain is not necessarily associated with periods.
Painful periods occurred in only 45 percent of women, painful sex in 37 percent and infertility in 27 percent. Other symptoms included pain with bowel movements, pain with aerobic exercise or jogging, and pain with posture changes. Twenty percent of women were asymptomatic.
Severe back and leg pain can also be caused by endo. Orthopedic surgeons are usually not aware of this potential cause of back pain. This pain cannot be cured unless the endo is removed from the uterine ligaments.
As Petersen says, "If a man had a disease which caused him to be unable to father a child and unbearable pain during sex and unbearable pain during bowel movements treated by feminizing hormones and surgery, endo would be a national emergency in this country."
Where Is Endo And What Colour Is It ?
Dr. Redwine felt he had to go back and study the basic assumptions about where endo was found and what it looked like.
To do this, he used the laparoscope to meticulously biopsy anything that didn't look like normal peritoneum. He advanced the tip of the laparoscope up to within one to two centimetres of the pelvic surfaces, which magnified the tissues three to five times. This he named "near contact laparoscopy" as opposed to the more common "panoramic laparoscopy" which views tissues from a greater distance.
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