It doesn’t seem possible to have a progressive, chronic condition and not be aware of it, but with endometriosis this can happen. A sufferer may consult an unsympathetic doctor or a practitioner inexperienced in diagnosing or treating the disease. For her pain, she may be dismissed—told that her symptoms are all in her head or that they are blown out of proportion. The chief complaint—pelvic pain—is however, not psychosomatic at all, but a very reef characteristic sign of the disease.
Victims of endometriosis experience an unnatural biological phenomenon: the misplacement of endometrial cells that normally line the uterine cavity. These cells are pushed backward from the uterus during menstruation and run wild, implanting themselves on pelvic organs, where they not only grow but proliferate. Eventually, clumps of endometrial1 masses spread more and more with each menstrual cycle, contorting organs and making normal functioning difficult or impossible. This invasive process results in severe cramps, pain, and, if the ovaries and fallopian tubes are gravely involved, sterility.
Along the way, women who suffer from endometriosis often are subjected repeatedly to unnecessary surgery, endure years of drug therapy that may not be of much benefit or can even worsen the disorder, develop other stress-related problems from unrelenting abdominal discomfort, and relinquish chances for fulfilling personal and professional goals because of ill health.
Dr. Donald Chatman, an obstetrician and gynecologist at the Michael Reese Hospital and Medical Center in Chicago, specializes m treating women with pelvic pain. He, too, is concerned that a problem exists in medical circles when it comes to understanding this disease. «There is no question that endometriosis is often misdiagnosed or underdiagnosed,» he told. «Primarily, I think physicians are not aware of the potential presence of the disease. For example, a mother calls her doctor and says, ‘My teenage daughter has recurrent menstrual pain.’ He might well say, ‘That’s a woman’s curse,’ and prescribe a drug like ibuprofen or Motrin and assume the girl’s pain is of no consequence. Similarly, a woman in her thirties with severe menstrual pain can race the same kind of put-off response when she sees her gynecologist.
Misdiagnosis is predictable when physicians don’t have the heightened awareness needed to make the correct diagnosis. In fact, a study was done on pelvic inflammatory disease (PID), a sexually transmitted disorder, in which it was found chat the error rate of diagnosis was 35 to 50 percent! Many of those women actually had endometriosis, not PID.
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Behind bio-feedback lies something of a revolution in medical theory. Man’s muscles are obviously at the command of his will. He can force his arms to move up and down, his eyelids to blink fast or slow. Until recently it had been thought that man cannot consciously control his autonomic nervous system, the unseen regulator of such processes as pulse rate, glandular secretions, and oxygen consumption—the complex mechanisms which, when they go wrong, so frequently trigger the stress diseases.
Taking advantage of the many delicate electronic devices now available, doctors and psychologists have set up systems in which patients are kept continuously informed of what is going on within certain organs. For example, a blood pressure monitor may be set up in front of the subject. By concentrating on the monitor, the subject may learn to moderate the blood pressure. Nobody knows how this is done, and the theories are many. The feedback signal is the vital element, the tool by which a patient learns control, and having learned it, the subject can sometimes then go back into the stressful world and control his visceral response without needing the visible feedback signal.
The brain itself emits different electrical signals during different activities. The highest frequency signal, called beta, is emitted under pressure to complete tasks. Next down the scale is alpha, reflecting a more relaxed and contemplative mood. Then comes theta, associated with creative thinking; and delta, the lowest frequency, which comes with sleep. This brainwave activity can be monitored with special instruments. It has been demonstrated that people can be trained, through feedback, to shift their brains from beta to alpha, and sometimes even to theta waves. Here again, then is a method which some people may use in certain circumstances to modify their anxiety levels.
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1. There is a need to recognise individual differences and, in particular, the influences of the environment, biology, behaviour and physiological adjustment in deterrnining equilibrium body fat levels.
2. Distinguishing between different types of environments (micro, macro, physical, socio-cultural) is helpful for understanding the variety of external influences on an individual.
3. Obesity in modern society should be seen as a normal physiological response to a pathological environment rather than vice versa. For this reason, there is limited value in searching for abnormalities (genetic /metabolic/ psychological) as major causes of obesity.
4. There should be increased emphasis on influencing fat intake and fat oxidation as the modalities of first choice in managing and preventing obesity.
5. This approach heralds a move away from restrictive dieting and calorie counting, in favour of ad libitum lifestyle eating plans with an emphasis on a reduction in dietary fats.
6. It is necessary to emphasise the distinction between physical activity for fat loss (or prevention of fat gain) in contrast to ‘exercise’ for fitness.
7. Because of physiological adaptation, greater emphasis should be placed on long term maintenance of body fat losses in contrast to easier, short term, immediate changes in body weight.
8. It is ethically inappropriate to advertise or promote quick and large weight losses.
9. Because of the broad ranging requirements of the field of weight control management, its treatment belongs to no one particular profession. Hence, professionals must learn to work with and refer to experts in other disciplines in order to provide clients with the best opportunity to deal with their problems.
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Many endometriosis sufferers feel that they cannot exercise because of chronic pain or constant tiredness and lethargy. However, exercise is important in that it increases your muscle tone, improves your fitness and gives you a feeling of well-being. Exercise also increases the production of endorphins.
Before starting on an exercise programme it might be sensible to visit your doctor for a physical examination.
One of the most important aspects of exercise is that you must find it enjoyable. Try to find a form of exercise that causes you little or no pain. Start exercising slowly for a short time each day. As your muscles strengthen you will gradually be able to increase the rate and length of the time that you exercise.
If necessary avoid jarring exercises, such as jogging, which may cause more pain by pulling on adhesions and scar tissue.
An excellent non-jarring exercise is swimming. Your exercise regime should also include some weight-bearing exercises such as walking, to help protect against the development of osteoporosis.
During the last few years many women in Australia have found that they have benefited by attending water aerobics classes.
Water aerobics has the benefit of being a weight-bearing, low impact exercise and is suitable even for those who can not swim. Because the water is supportive it does not have the same jarring effect on the body as floor aerobics.
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There is a huge range of possible symptoms of endometriosis and it is important to remember that the symptoms women experience can vary widely. Some women will have few symptoms. Others, unfortunately, suffer many. A few women experience no symptoms and their endometriosis is only discovered during surgery for an unrelated condition. Other women experience no symptoms other than infertility.
The symptoms experienced depend on a number of factors including the severity and extent of the endometriosis and the location of the implants.
The severity of the symptoms varies from mild to severe and does not necessarily have any relationship to the extent of the disease but it usually bears a closer relationship to the location of the implants.
Thus, a few tiny spots of endometriosis may cause excruciating pain especially if they are located in an area where there are many nerve endings, such as in the Pouch of Douglas or on the utero-sacral ligaments. In contrast, severe endometriosis may cause little pain because the implants are located in an area where there are few nerve endings, such as on the ovary.
The range and severity of symptoms often increases as the disease progresses. In addition, the number of days in the month during which the symptoms are felt often increases as the condition worsens.
Thus, in the early stages of the disease the symptoms may be mild and only apparent for the first one or two days of a period but, as the condition worsens, the symptoms may be felt with increasing severity for most of the month. However, for some women the range and severity of their symptoms remains constant for many years.
The most common symptoms include dysmenorrhoea, dyspareunia, pelvic pain, bleeding problems, ovulation pain, bowel problems and infertility.
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