Despite cutting-edge medical advances, gyno ailments often go unresolved (or worse, misdiagnosed). Here’s what you need to know about these vexing conditions.
By Stacey Colino, Women’s Health
Some mysteries, such as the Bermuda Triangle or the contents of a Twinkie, are fun to ponder. But trying to figure out why you’re doubled over with cramps or swapping out supersize tampons every hour? Not so much. Sadly, millions of women (and a whole lot of docs) are perplexed by pelvic problems. Learn how to help your physician spot and deal with the down-there maladies that affect women the most.
6.3 Million Suffer from Endometriosis
When Senie Byrne, 25, of Manassas, Virginia, was 15 her periods were accompanied by vomiting and cramps so bad she would often pass out from the pain. She went from doctor to doctor until finally, at age 21, she found out she had endometriosis, a uterine disease that can take a decade to diagnose.
When a woman has endometriosis, the uterine lining (the one you’re supposed to shed each month during your period) gets stuck elsewhere. It can travel down through your cervix and vagina, but also up through your fallopian tubes, where it can attach to your bowel, bladder, or ovaries. The latter path can disrupt hormonal cycles and lead to thick scarring, inflammation, and heavy bleeding during menstruation, says Tommaso Falcone, M.D., chairman of obstetrics and gynecology at the Cleveland Clinic. It can also result in killer cramps, painful sex, diarrhea, or constipation—or no aches at all.
“The peculiar thing is that the amount of pain you’re in may have no correlation to the amount of endometriosis you have,” says ob-gyn Mary Jane Minkin, M.D., of the Yale University School of Medicine.
But even pain-free patients are at risk of a troubling side effect: infertility. About 38 percent of infertile women can blame endometriosis, according to the American College of Obstetricians and Gynecologists, often because of scarring or inflammation. Endometrial tissue also releases fluid that can mess with egg-sperm interaction. The best way to preserve fertility is to catch and treat the problem early.
Scientists aren’t sure exactly what causes endometriosis, but they do know that genetics plays a leading role in risk (if your mom or sister has it, your chances increase sixfold); exposure to pollutants such as dioxin, a chemical used in pesticides and bleached paper, might also be a prime risk factor. For now, the only way to score a definitive diagnosis is through surgery.
“To be sure, we have to physically see this tissue living where it doesn’t belong,” explains ob-gyn Shari Brasner, M.D., of the Mount Sinai School of Medicine in New York City. This procedure involves general anesthesia and a camera exploring the inner abdomen and pelvis. If a physician finds any wayward tissue, it can often be removed right then, though it can grow back. The good news: Less-invasive diagnostic procedures (including in-office biopsies and blood tests to measure inflammation levels) should be available within three to five years, says Falcone.
Of course, after getting the diagnosis, you still have to live with the condition, which can come and go or persist for as long as you menstruate. Birth control can decrease the pain and bleeding, and hormone-manipulating drugs such as danazol and Lupron can shrink the growths by “turning off” the ovaries. (Similarly, “pregnancy will keep endometrial tissue quiet because your hormones aren’t cycling,” says Brasner.) Scientists are now studying how anti-progesterone and breast-cancer drugs may help.
If Rx medicines don’t yield relief, alternative treatments like acupuncture may ease pain. And if nothing else works, more surgery may be in order. But the crucial thing is for each endometriosis patient to receive a tailored health plan that lets her move past the pain and get on with her life.