" Endometriosis
FOR
DUMmIES
by Joseph W. Krotec, MD
‰
Former Director of Endoscopic Surgery at Cooper Institute for Reproductive Hormonal Disorders
and Sharon Perkins, RN
Coauthor of Osteoporosis For Dummies
Endometriosis For Dummies®
Published by Wiley Publishing, Inc. 111 River St. Hoboken, NJ 07030-5774
www.wiley.com
Copyright © 2007 by Wiley Publishing, Inc., Indianapolis, Indiana Published by Wiley Publishing, Inc., Indianapolis, Indiana Published simultaneously in Canada No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Sections 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600. Requests to the Publisher for permission should be addressed to the Legal Department, Wiley Publishing, Inc., 10475 Crosspoint Blvd., Indianapolis, IN 46256, 317-572-3447, fax 317-572-4355, or online at http://
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About the Authors
Dr. Joseph W. Krotec from Philadelphia, Pennsylvania, has practiced general gynecology, reproductive endocrinology, and gynecologic surgery specializing in endoscopic surgery. He has instructed peers, residents, and students for more than 25 years and has been Chair of Obstetrics and Gynecology, Chief of Gynecology, and Director of Endoscopic Surgery at various institutions. Dr. Krotec recently won the Milton Goldrath, M.D. Award for excellence in teaching. Sharon Perkins is an RN with 20 years of experience in maternal child health. She currently works for retinal specialists. Sharon has five children, two daughters-in-law, one son-in-law, and two perfect grandchildren. Oh, and a retired husband. This is her fourth For Dummies book.
Dedication
To all the women with endometriosis we’ve known and treated and to all the women who’ve suffered without knowing why.
Authors’ Acknowledgments
I thank my wife, Susan and my children, Joshua, Alexis, and Nicholas, for their love, support, and patience — and Sharon Perkins for her ideas, writing, persistence, and nagging to get it done. —Joseph Krotec Many people helped me write this book, and most of them don’t even know it. On days when I was discouraged, tired, and grouchy, a phone call from a family member, a smile from a patient, kind words from a co-worker, or an encouraging word from someone at church gave me the energy to get back to writing. For all the people who have crossed my path and lifted me up when I needed it badly, I thank you — even if you don’t know who you are, I do. My family just assumes I can do this without a lot of effort, and even though it isn’t true, I appreciated their confidence. I was fortunate to grow up with parents who supported everything I did, and I’m blessed to have a mom who still does. Thanks, Mom! (And Dad, I’m sure you’re watching and applauding still.) To all the rest of my family, thanks for being there when I need you. And to Matthew and Emma, my wonderful grandchildren — you’ll never know what a joy to my life you are. Thanks, Josh, for being willing to take on this task at a tough time; we’ve been through some interesting times together. You’re a good doc. —Sharon Perkins Both of us want to say thanks to our acquisitions editor, Stacy Kennedy; our indomitable project editor, Chad Sievers; copy editor Pam Ruble; technical editor Dr. William Hurd; and our medical illustrator Kathryn Born. Another great Wiley team!
Publisher’s Acknowledgments
We’re proud of this book; please send us your comments through our Dummies online registration form located at www.dummies.com/register/. Some of the people who helped bring this book to market include the following: Acquisitions, Editorial, and Media Development Project Editor: Chad R. Sievers Acquisitions Editor: Stacy Kennedy Copy Editor: Pam Ruble Editorial Program Coordinator: Erin Calligan Technical Editor: William Hurd, MD, Professor of Obstetrics and Gynecology, Wright State University School of Medicine Editorial Manager: Michelle Hacker Cartoons: Rich Tennant (www.the5thwave.com) Illustrations: Kathryn Born, M.A. Composition Project Coordinator: Heather Kolter Layout and Graphics: Stephanie D. Jumper, Barbara Moore, Barry Offringa, Lynsey Osborn, Laura Pence, Alicia South Proofreader: Techbooks Indexer: Techbooks
Publishing and Editorial for Consumer Dummies Diane Graves Steele, Vice President and Publisher, Consumer Dummies Joyce Pepple, Acquisitions Director, Consumer Dummies Kristin A. Cocks, Product Development Director, Consumer Dummies Michael Spring, Vice President and Publisher, Travel Kelly Regan, Editorial Director, Travel Publishing for Technology Dummies Andy Cummings, Vice President and Publisher, Dummies Technology/General User Composition Services Gerry Fahey, Vice President of Production Services Debbie Stailey, Director of Composition Services
Contents at a Glance
Introduction .................................................................1 Part I: Endometriosis: What It Is and Isn’t ......................7
Chapter 1: The Lowdown on Endometriosis: A Quick Run-Through...........................9 Chapter 2: Suspecting Endometriosis: Defining the Symptoms .................................23 Chapter 3: Endometriosis: A Quick Review of Biology................................................39 Chapter 4: Determining What Causes Endometriosis..................................................55
Part II: Digging Deeper into Endometriosis ...................81
Chapter 5: Understanding Your Menstrual Cycle (And Its Relationship to Endometriosis) ....................................................................83 Chapter 6: Looking Closer at How Endometriosis Also Affects Other Body Parts .....97 Chapter 7: Endometriosis and Infertility: Having a Baby (Or Trying To)................113 Chapter 8: Finding the Right Doctor ............................................................................143 Chapter 9: Do You Have Endometriosis? Your Initial Exam and Diagnosis.............155
Part III: Treating Endometriosis .................................171
Chapter 10: Relying on (Prescription) Drugs to Treat Endometriosis ....................173 Chapter 11: Contemplating Surgery to Improve Your Endometriosis .....................197 Chapter 12: Considering Alternative Therapies and Remedies to Relieve the Pain .......................................................................................................227 Chapter 13: Managing the Chronic Physical Pain ......................................................245 Chapter 14: All Things Teens: Diagnosing, Treating, and Coping with Endometriosis......................................................................................................259
Part IV: Living with Endometriosis .............................271
Chapter 15: Coping with Endometriosis and Your Emotions ...................................273 Chapter 16: Changing Your Lifestyle When You Have Endometriosis .....................287 Chapter 17: Just for Friends and Family: Help and Support .....................................305
Part V: The Part of Tens ............................................315
Chapter 18: Ten Myths about Endometriosis .............................................................317 Chapter 19: Ten (Or So) Trends in the Future of Endometriosis .............................321 Chapter 20: Ten Strategies to Help with the Pain.......................................................327
Part VI: Appendixes ..................................................331
Appendix A: Glossary ....................................................................................................333 Appendix B: Resources and Support ...........................................................................341
Index .......................................................................345
Table of Contents
Introduction ..................................................................1
About This Book...............................................................................................2 Conventions Used in This Book .....................................................................2 What You’re Not to Read.................................................................................2 Foolish Assumptions .......................................................................................3 How This Book Is Organized...........................................................................3 Part I: Endometriosis: What It Is and Isn’t...........................................4 Part II: Digging Deeper into Endometriosis.........................................4 Part III: Treating Endometriosis............................................................4 Part IV: Living with Endometriosis.......................................................4 Part V: The Part of Tens.........................................................................4 Part VI: Appendixes................................................................................5 Icons Used in This Book..................................................................................5 Where to Go from Here....................................................................................6
Part I: Endometriosis: What It Is and Isn’t.......................7
Chapter 1: The Lowdown on Endometriosis: A Quick Run-Through . . . .9
Defining Endometriosis ...................................................................................9 Figuring out why endometriosis moves ............................................10 Understanding why endometriosis hurts .........................................10 Going Public: Why Don’t People Know About Endometriosis?................12 Endometriosis is a women’s disease .................................................12 Endometriosis symptoms are “all in your head” .............................12 Endometriosis is invisible until you have surgery...........................13 Endometriosis isn’t glamorous...........................................................13 Who Gets Endometriosis? .............................................................................14 Counting the women with endometriosis .........................................14 Looking at age and endometriosis .....................................................15 Linking pregnancy and endometriosis ..............................................17 Calculating the Cost of Endometriosis ........................................................18 Eying the economic costs ...................................................................19 Considering the diagnostic and treatment costs .............................19 Looking at the cost on relationships .................................................20 Do You Have Endometriosis: A Self-Test .....................................................21
Chapter 2: Suspecting Endometriosis: Defining the Symptoms . . . . .23
Considering the Most Common Symptoms of Endometriosis .................23 Dealing with painful periods ...............................................................24 Hurtin’ for certain during sex .............................................................25 Feeling mid-cycle pain .........................................................................27
x
Endometriosis For Dummies
Experiencing abnormal bleeding........................................................27 Conceiving problems ...........................................................................28 Experiencing chronic pain ..................................................................29 Facing autoimmune issues ..................................................................30 Being tired all the time.........................................................................31 Noting the Not-Quite-As-Common Symptoms of Endometriosis .............32 Living with your bowels in an uproar................................................32 Recognizing urinary symptoms..........................................................33 Coping with respiratory symptoms ...................................................33 Minding endometriosis and the brain ...............................................34 Writing It Down: How a Diary Can Help.......................................................35 Recording symptoms (and everything else important) from month to month.......................................................................35 Keeping track of your menstrual cycle..............................................36 Rating your pain ...................................................................................36 Locating your pain ...............................................................................37 Homing in on your feelings .................................................................37 Plotting your energy levels .................................................................38 Listing your pain treatments — both the good and the bad ..........38
Chapter 3: Endometriosis: A Quick Review of Biology . . . . . . . . . . . . .39
Getting Back to Basics: Bio 101 of Female Anatomy..................................39 The uterus: Your womb .......................................................................40 The uterine ligaments: The stabilizers ..............................................41 The ovaries: Your egg producers .......................................................42 The fallopian tubes: Your conveyor belts .........................................42 The vagina and cervix: The openings................................................42 Other important parts .........................................................................43 Measuring How Endometriosis Affects Your Reproductive and Other Organs...............................................................44 Endometriosis and your fallopian tubes ...........................................45 Endometriosis and your ovaries ........................................................46 Endometriosis and your pelvic cavity ...............................................49 Endometriosis and your cervix and vagina ......................................54
Chapter 4: Determining What Causes Endometriosis . . . . . . . . . . . . . .55
Speculating on How Endometriosis Develops: The Most Common Theories ....................................................................55 Migrating out the tubes: Retrograde menstruation .........................56 Blaming Mom: Is endometriosis hereditary? ....................................58 Exploring Other (Not-So-Common) Theories .............................................61 Using tampons ......................................................................................61 Having a tubal ligation .........................................................................63 Answering some of the unanswered questions: The metaplasia theory .....................................................................64 Understanding your immune system’s role in endometriosis........65
Table of Contents
Meeting the immune cells ...................................................................65 Exploring the autoimmune connection .............................................68 The Mystery of Traveling Endometriosis ...................................................72 Hitching a ride in the lymphatic and vascular systems ..................72 Spreading endometriosis through surgery .......................................73 Avoiding Endometriosis: Is It Possible? ......................................................75 Does pregnancy help prevent endometriosis? .................................75 Watching what you eat ........................................................................76 Considering environmental factors ...................................................77
xi
Part II: Digging Deeper into Endometriosis ....................81
Chapter 5: Understanding Your Menstrual Cycle (And Its Relationship to Endometriosis) . . . . . . . . . . . . . . . . . . . . . . . . .83
Your Period and Endometriosis: Why Are They Connected?...................84 Looking at a healthy cycle...................................................................84 Understanding how endometriosis affects your period .................88 A Pain by Any Other Name Is Still a Pain, But Is It Endometriosis?.........91 Identifying the pain ..............................................................................91 What causes the pain? .........................................................................91 Regulating Your Menstrual Cycle to Reduce the Pain ...............................93 Using medication....................................................................."
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