WOMEN’S BODIES: ENDOMETRIOSIS
A letter I received from a woman who lives on a remote sheep station in South Australia highlights the problems of isolated women in getting health information and treatment. City women take these services for granted. Here is Julie’s story.
I
had been trying for three years to get pregnant. No
luck. It was getting me down, so I
finally went to Adelaide to see a specialist. The doctor didn’t find a cause when he examined me. He suggested that because I live so jar away, I should have as many tests as possible while I was in town, including a laparoscopy, which meant staying in hospital overnight. Soon after I woke from the anaesthetic the doctor came to see me and told me he had found endometriosis. He said he was surprised that I hadn’t had pain with periods or sex. I
had, sometimes, but nothing to complain about.
I was prescribed tablets to take for six months, and asked to go back when I’d finished the course. I’ve been on them for five weeks. My face has broken out and I haven’t had a period, but a sheet of instructions with the tablets said to expect side-effects.
I’ve never heard of endometriosis before. My doctor tried to tell me something about it, but I was too groggy from the anaesthetic to remember much or ask any questions. I
had to leave for home the next morning, so I
didn’t have a chance to find out any more. I
rang the nearest library but the book sent to me was no help. I want more information so that I can have my questions ready for my next visit to the doctor.
In endometriosis (‘osis’ means ‘а condition of) spots of tissue identical the endometrium grow outside the uterus. They are called endometrial deposits or implants, and may occur on the ovaries (the most common place), tubes, in the muscle or on the outer covering of the uterus and on the membrane lining the pelvic cavity. They are occasionally found on the outside wall of the bowel. The endometrial deposits range in size fro spots that can only be seen under microscope up to a centimeter or more in diameter.
Endometrial deposits are influenced the same hormones that control the growth of the endometrium in each menstrual cycle. Endometriosis tissue dies and bleeds at the time of each period but fluid can’t drain away. It irritates other tissues and organs that it touches, causing the formation of fibrous tissue that sticks the parts together (adhesions). With time this tissue contracts, distorting the shape and disturbing the function of the parts. In severe, longstanding endometriosis the pelvic organs and part of the bowel may become bound together into a solid mass.
The surface of most endometrial deposits also becomes covered by a capsule of fibrous tissue. The fluid and blood then collects underneath to form cysts, which become slightly bigger with each menstrual cycle. These cysts are also known as endometriomas or ‘chocolate cysts’. Some of the watery constituent of the fluid in the cysts is absorbed and the blood darkens, leaving a thick, viscous fluid like melted chocolate – hence the name. Cysts usually remain less than a centimeter in diameter (mostly pinhead-size) but may grow up to 3 cm, rarely 10 cm or more.
Endometriosis is not cancerous or life-threatening (though rarely, the pressure inside a cyst may increase to the point where the wall ruptures, creating an abdominal emergency). But it can cause so many problems that it has been described as ‘the thorn within’.
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