naturopathydigest.com -- Endo Aware

buy microsoft office enterprise 2007

buy Microsoft Office 2003 Professional sp3buy autodesk autocad 2009

Endo Aware

March is Endometriosis Awareness Month - it's time to put endo on your clinical radar screen

By Amy Day, ND

In the U.S., endometriosis (endo) affects more than 7 million women and is the leading cause of female infertility, chronic pelvic pain and gynecologic surgery. It accounts for nearly half of the hysterectomies performed here each year; in fact, many of these women have multiple surgeries prior to deciding on a hysterectomy.

This is a serious and common disease, yet a woman might go through multiple visits with many different physicians before being diagnosed. In the spirit of Endometriosis Awareness Month, the intent of this article is to put endo on your diagnostic radar screen.
The average delay from symptoms to diagnosis is eight years, and during this time, many women either are misdiagnosed or told their pain is "all in their head." As health care providers who often work with people frustrated by the conventional medical system, naturopathic doctors have an opportunity to truly help these women. By listening carefully, validating their real pain and informing them it might be due to a disease called endometriosis, we can help these women gain control and evaluate their options. We also can be on the lookout for early signs, related diseases and uncommon presentations.
Old Paradigm
Endometriosis has been defined for decades as a pelvic disease with growths of endometrial tissue outside of the uterus. This tissue responds to hormones and grows and bleeds with the menstrual cycle. With no route to leave the body, the bleeding causes inflammation, pain and scarring. The endometrial tissue can implant in various locations, including the ovaries, fallopian tubes, uterine ligaments, between the vagina and the rectum, on the outer surface of the uterus, the abdominal wall, intestines, bladder, and, rarely, at distant sites such as the lung, arm or nose. The most common clinical presentation is a woman in her reproductive years with severe dysmenorrhea, dyspareunia and infertility. Other frequent symptoms include heavy menstrual bleeding, pain with ovulation and low back pain.
New Paradigm
Based on the latest information from the Endometriosis Association, the Endometriosis Research Center and the World Endometriosis Society, the emerging definition of endo encompasses a broad whole-body view. Endo now is seen as a hormonal and immune disease with contributing factors such as heredity and exposure to environmental toxins.
Endocrine imbalances including ovarian, thyroid and adrenal hormones are found in many women with endo. Local immune factors in the pelvis are altered and there is growing evidence that the endo implants function quite differently than normal endometrium. Evidence of a familial tendency encouraged researchers to look at patients' genes, and a likely chromosome has been identified but needs further investigation. Since 1992, research findings have demonstrated that dioxins and polychlorinated biphenyls (PCBs) can cause the development of endo. This should come as no surprise considering these and other environmental toxins have been shown to cause many endocrine and immune problems.
Recognizing Endo
This new paradigm gives us many signs and symptoms that can remind us to consider the possibility of endo in a patient. In addition to pelvic pain, infertility and family history that have long been recognized as hallmarks, there are many related diseases and whole body signs that also should raise your suspicion of endo.
One factor is a high exposure to estrogen. This can be due to early menarche, short cycles, nulliparity, or exposure to xenoestrogenic toxins and might manifest as heavy flow, fibroids or migraines. Another common factor is digestive disturbance such as infant colic, IBS, food sensitivities, dysbiosis, nausea, vomiting, diarrhea, constipation, painful bowel movements or blood in the stool. Women with endo also tend to have more frequent infections (bacterial, viral and fungal, including Lyme, Epstein-Barr, and Candida). This lowered immunity might have been evident early in childhood as frequent ear infections, bladder infections, tonsillitis, strep throat or mono.
Women with endo often have an imbalance of ovarian, thyroid or adrenal hormones. There also might be impaired insulin production and poor blood sugar control. The immune dysregulation might be seen as allergies, asthma, eczema or multiple sensitivities to chemicals, foods, hormones or inhalants. There also is an association of higher rates of certain auto-immune diseases in women with endo including hypothyroidism, fibromyalgia, CFIDS, lupus, Sjogren's, rheumatoid arthritis and multiple sclerosis.
When a patient has several of the above factors in their history, whether or not they have pelvic pain or infertility, you should include endo in the differential. It's also helpful to remember endo occurs in populations that fall outside the classic presentation. This includes teens, parous women, women after hysterectomy (often the implants are not completely removed) and post-menopausal women (especially with the use of hormone replacement therapy).
What Next?
To confirm the diagnosis of endo, the current guidelines recommend surgery with a biopsy of the tissue. For best results, this should be a laparoscopy performed by a specialized endo surgeon. These specialists are highly trained to be able to locate all of the lesions and often can properly remove them at the time of diagnosis. The Web sites listed at the end of this article are good resources for locating qualified surgeons.
For those who wish to avoid surgery, a new diagnostic test that requires a blood draw and an endometrial biopsy is being evaluated, though it's not widely available at this time. New MRI imaging techniques which would allow for noninvasive diagnosis and monitoring also are being developed. In the meantime, it might be appropriate, depending on the risks for other conditions such as ovarian cancer, to treat presumptively.
It's ultimately the patient's choice whether to pursue a laparoscopic surgery and a definitive diagnosis. Either way, we can be of great help by using naturopathic therapies to reduce inflammation, support the liver and detoxification, improve digestion, balance hormones, support proper immune function and teach the patient about healthy diet and lifestyle. Most importantly, we can be the patient's partner in their health care and help them to be informed. For more information, go to www.endometriosisassn.org, www.endometriosis.org, www.endocenter.org, or feel free to contact me at .

About the Author: Amy Day, ND, received her Doctorate of Naturopathic Medicine from National College of Naturopathic Medicine (NCNM) in Portland, Ore., and was among the first NDs licensed in California. Dr. Day is in private practice in San Francisco at SOMA Acupuncture and Natural Health Clinic and is a Western medicine faculty member at the American College of Traditional Chinese Medicine. She currently serves on the Board of Directors for the California Naturopathic Doctors Association and is a physician member of the Endometriosis Association where she strives to improve integrative care for this condition. She can be reached at www.SOMAacupuncture.com or .