This was from the Readers digest..thought you might like to read it..

Hidden Health Risk Women Face

BY ANNE PAILLARD

SINCE her early teens, 33-year-old Lisa Hull of Vananda, B.C., had been plagued by mysterious symptoms -- severe pain in her back and legs, chronic pelvic pain and a constant, dragging fatigue. Over the years doctors had told her the problem was psychological.

       In desperation Hull went to see a gynecologist at Powell River General Hospital, who admitted her for tests. At first doctors couldn't agree what was wrong with her. Then an ultrasound revealed an enormous cyst on her ovary.

       Today a gold-mine operator, Hull still recalls that moment vividly: "When they showed me the extent of the damage to my insides -- the large growth, the organs sticking together -- I actually felt relieved. The pain was real. But I was also angry that no one had taken me seriously."

       Hull was told that her womb, fallopian tubes, ovaries and part of her bowel and bladder were riddled with endometriosis. She would never be able to have children. "That night in hospital was the worst of my life. In an instant all my plans for the future vanished. I cried for days."

AN ESTIMATED 500,000 women in Canada suffer from endometriosis, a devastating progressive disease that affects women in their childbearing years.

       Normally the endometrium, the inner lining of the uterus, thickens each month to allow an egg to implant. If the woman does not become pregnant, the egg and the womb lining are shed during menstruation. But in some women, for reasons still not fully understood, fragments of the lining apparently travel up the fallopian tubes into the pelvic cavity, where they adhere to organs such as the ovaries and the outer surface of the uterus. These fragments still respond to hormones and bleed each month, causing inflammation and the formation of scar tissue and even cysts.

       Endometriosis is closely linked with (though has not been proved directly to cause) infertility: Women who have problems getting pregnant are two to three times more likely than fertile women to suffer from it. And it undermines fertility if delicate organs such as the fallopian tubes become damaged and welded together with scar tissue.

       "If endometriosis is not detected, as is often the case, it can seriously affect a woman's life," says Dr. Kay Lie, an expert in endometriosis surgery at the Women's College Hospital in Toronto. "She looks healthy, yet she may have constant, even extreme pain. Unfortunately, many people, including her family and friends, often don't believe her."

MEDICAL experts are still not certain what causes endometriosis. Some researchers are looking for a guilty gene, or set of genes, while others are investigating the possibility that endometrial cells that went astray before birth bleed each month later in life when stimulated by hormones.

       Another theory is that patients have some form of immune dysfunction that prevents the scattered womb lining from being eliminated in the normal way.

       Mary Lou Ballweg, president of the Endometriosis Association, suggests that endometriosis is more likely triggered by chemicals in the environment. "Research by a number of different institutes shows that some hormonally activated chemicals, such as PCBs and dioxins, can cause spontaneous development of endometriosis in a variety of animals."

WOMEN who suffer from endometriosis are more likely to have heavy and frequent periods. These symptoms should sound warning bells to doctors, but the disease is often left undetected for years, as in Hull's case.

       According to a recent survey conducted by the Endometriosis Association on 4,000 women with endometriosis in Canada and the United States, the average time from the onset of symptoms to diagnosis is about ten years.

       "Endometriosis can present many different symptoms and simulate a number of diseases," Dr. Lie explains. "That's why if the doctor doesn't know what to look for, the patient is in real trouble."

       The experience of Sara Tellier, 25, an office-administration student in Welland, Ont., is a classic example. "For nearly ten years, I regularly consulted my family doctor for severe pain during my period, backaches, acute exhaustion and head-aches," she says. "I was in pain most of the time and missing four to seven days of school a month. He told me I was complaining for nothing. I saw another doctor, but he couldn't find anything wrong either."

       The day before her 21st birthday, Tellier was rushed to the hospital in excruciating pain. A huge endometriotic cyst on her ovary had burst.

       "During an operation the surgeons found and excised extensive endometriosis," says Tellier. "I also lost an ovary. When I read up on the condition afterwards, I discovered I had all the classic symptoms. Yet endometriosis had never been considered by any of the doctors who examined me."

       Doctors agree the medical community needs to learn more about the disease. Dr. John Jarrell, a fertility specialist and professor of obstetrics and gynecology at the University of Calgary, says,"The whole area of pelvic pain is starting to gain more attention in the medical curriculum, but there's still room for improvement."

       To add to the problem, the only certain way to diagnose endometriosis is via a laparoscopy. After a general anesthetic is administered, the surgeon inserts a small telescopelike tube into the navel to look for telltale signs -- blood-filled blisters or cysts on the surface of the womb, ligaments or ovaries.

       "We have to get GPs -- and women -- to rethink this myth that pain with menstruation is normal," says Ballweg. "If your doctor tells you your symptoms are imaginary, or if the pain persists, insist on being referred to a gynecologist, who will be more tuned into endometriosis."

Warning Signs

       According to Dr. Lie, the common indicator of endometriosis is pain in the pelvic area. Yet, as he points out, "Some women with endometriosis have no symptoms, and many women have painful periods but don't have the disease."

       However, the type of pain you experience can be a marker. Pain characteristic of endometriosis begins before the period, intensifies during it and may linger after bleeding is finished. And it doesn't respond to ordinary painkillers. Very heavy periods with clots can also be a symptom.

       The disease's other cardinal signs are pain during penetrative sex, painful ovulation and difficulty conceiving. Symptoms can include headaches, constant tiredness, pre-menstrual tension, back pain, depression and bloating. Nausea, bowel problems and pain during urination and defecation can also occur; as a result of these, endometriosis is often confused with that other catch-all diagnosis, irritable bowel.

Treatment

       Endometriosis can be treated and, if it is caught early enough, fertility can be achieved. In 1997 Dr. Rodolphe Maheux, then director of the obstetrics and gynecology department at Laval University in Quebec City, conducted a study on 341 infertile women with mild endometriosis in 25 Canadian hospitals to see whether laparoscopic surgery would improve fertility.

       The study, published in The New England Journal of Medicine, showed that the women who had lesions on the ovaries or abdomen removed by laparoscopic treatment greatly increased their chances of becoming pregnant.

       For lucky women not rendered infertile by the disease, becoming pregnant may suppress the hormonal cycle and give the body a chance to right itself. The absence of periods during pregnancy and breast-feeding sometimes offers enough of a respite for the endometriosis to shrink and for healing to take place.

       Hormone suppression treatment can also alleviate the symptoms of endometriosis. These therapies include a group of drugs called GnRH (gonadotropin-releasing hormone) analogues, such as zoladex, that induce a pseudomenopause by suppressing the function of the ovaries and shrinking the endometriosis. (While pregnancy is uncommon during treatment with this drug, use of a condom during sex is essential in order to prevent possible birth defects related to the drug.) To minimize side effects such as night sweats and hot flashes, doctors may simultaneously prescribe low-dose hormone-replacement therapy.

       GnRH drugs have proved very effective in reducing painful symptoms, but can be used only short term. Oral contraceptives may safely be prescribed for longer periods to further suppress the disease.

HOPEFULLY there will be more cases like that of Micheline Laramée, a 42-year-old pension consultant from Montreal, whose condition was caught in time. For three years in her early 30s she and her husband tried in vain for a baby. Then in 1987 she underwent a series of fertility tests at Montreal's Maisonneuve-Rosemont Hospital. Months later, doctors finally discovered endometriosis via a laparoscopy. In Laramée's case, infertility had been the only clue.

       "I was very discouraged when I found out I might never be able to have children," she says. "It became an obsession -- I was jealous of every pregnant woman I saw."

       However, over six months Laramée was prescribed a synthetic hormonal drug, danazol -- a male hormone derivative -- that brought on a temporary menopause, allowing time for the pieces of stray womb lining to die. A year and a half later, she was pregnant and gave birth in 1990 to her first daughter, and two years later to another girl.

       Today Laramée is still free of symptoms. "But if they come back, or if my daughters have the disease," she says, "I'll know what to do -- and I'll know that there's hope."