May 8th, 2009
Sampson stated that menstrual blood containing viable fragments of endometrial tissue—the lining of the uterus was “regurgitated” through the fallopian tubes into the abdominal cavity. Later laboratory experiments and observations of patients during abdominal surgery disclosed that most women have retrograde menstruation, but only a percentage will become victims of endometriosis.
Recent probes into the theory of retrograde menstruation reveal that a great percentage of women show an increased amount of blood in the pelvic cavity around menstruation and after ovulation. Blood has even been present in the dialysate (liquid drawn from the abdominal cavity) of women undergoing kidney dialysis while they had their periods. What this proves, again and again, is that retrograde menstruation it common.
Earlier experiments, specifically those performed in the 1950s, were more aggressive. One team—doctors R. B. Scott, R. W. TeLinde, and L. R. Wharton, Jr., of Chicago’s Northwestern Medical Centers-created pelvic endometriosis in rhesus monkeys by inducing retrograde menstruation in an extreme manner. Basically, what they did was cot into the monkey’s uterus, opening it so that menstrual blood spilled directly into the pelvic cavity instead of being washed out through the vagina. Six of the ten experimental monkeys developed endometriosis—some within two and a half months, whereas others had no signs of it for nearly three years. In 1958 a number of women voluntarily submitted to an experiment wherein doctors injected endometrial cells into a laparotomy incision. This experiment also produced endometriosis in most women,
Sampson’s theory has found a few detractors, but most doctors agree that the backward spraying of menstrual blood places endometrial tissue on vulnerable organs. Even Sampson postulated that in all probability there is “more than one” avenue available for the development and spread of this disease. One conclusion was that, he wrote, “the invasion and dissemination of endometrial tissue employ the same channels as the invasion of cancer.” This meant that fragments of endometrial tissue reached other parts of the body through channels such as the blood and lymph systems. The actual process of tissue transference from one organ to another by blood or lymph glands is known as metastasis.
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May 8th, 2009
Prostaglandins are substances that are produced by many tissues throughout the body, including endometrial implants. One of their functions is to control the contraction and relaxation of the muscles in many of the internal organs of the body including the uterus and fallopian tubes.
It is thought that women with endometriosis have higher concentrations of prostaglandins in their peritoneal fluid and that these higher concentrations may contribute to infertility by hindering or preventing conception and implantation in a number of ways.
It is possible that prostaglandins interfere with the functioning of the ovaries and prevent the release of the ovum thereby preventing fertilisation.
Prostaglandins may affect the sperm as they move towards the ovum by slowing down their movement and thus reducing the number of healthy sperm that can reach the ovum in time for fertilisation.
Prostaglandins help the ovum move along the fallopian tube.
If the fertilised ovum is propelled too rapidly along the tube the ovum will reach the uterus too quickly. Therefore, when the fertilised ovum reaches the uterus it may not be mature enough to implant itself in the endometrium or the endometrium may not be ready to accept the fertilised ovum. If the fertilised ovum is propelled too slowly down the fallopian tube it may not reach the uterus in time to embed itself in the endometrium.
Prostaglandins may also affect the relaxation and contraction of the uterus. If they produce excessive contractions of the uterus they may prevent implantation of the fertilised ovum or they may cause it to be expelled soon after implantation.
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May 8th, 2009
There is no simple and accurate test which can be used to detect endometriosis. The only reliable way to diagnose the condition is by observing the implants during a minor operation known as a laparoscopy.
The diagnosis usually involves several stages which may include some or all of the following:
Reporting your symptoms to a doctor
Giving a history of your symptoms
Having a physical examination
Having an ultrasound
Having a laparoscopy
Taking a biopsy during a laparoscopy.
An early diagnosis is important as endometriosis is generally thought to be a progressive condition in which treatment is more effective in the early stages. If the progression of the condition can be stopped, or at least slowed down, then the likelihood of developing long-term complications such as infertility, adhesions and chronic pain is reduced.
For many women the road to a diagnosis is often long and it is not uncommon for women to see several doctors regarding their symptoms over a number of years before a diagnosis is made. In a survey conducted by the Endometriosis Association (Victoria), the average time between the onset of symptoms and diagnosis was over six years.
The long delay in diagnosis experienced by many women is partly due to the fact that endometriosis is often difficult to diagnose, especially in the early stages. The symptoms are easily confused with several other conditions and some doctors are not fully aware of the range of possible symptoms. In addition, a pelvic examination often appears normal.
Unfortunately, the diagnosis of endometriosis is also sometimes affected by doctors’ attitudes to the symptoms. Many doctors do not take women’s and teenager’s symptoms, such as period pain, seriously. Like many people in our community, they tend to assume that period pain is normal or psychological.
Doctors often do not consider a diagnosis in women and teenagers who do not conform to the traditional stereotype of women with endometriosis. Consequently teenagers and women under the age of 25, women who have had children and women from lower socio-economic backgrounds are often simply not considered for a diagnosis.
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April 23rd, 2009
Carbohydrates include sugars and starches. They are an important source of energy and are all eventually broken down in your body into the simple sugar, glucose. There are two types of carbohydrate – complex and simple. Complex carbohydrates include grains (such as wheat, rye, oats, rice, barley and maize), beans and pulses (such as lentils, chickpeas and kidney beans), and vegetables. Simple carbohydrates include white and brown sugar, honey, fruit and fruit juice.
To optimize your health, you should eat plenty of unrefined complex carbohydrates. This means choosing brown whole meal bread, brown rice and brown pasta, instead of the refined white versions which have been stripped of essential vitamins, minerals, trace elements and valuable fibre content. (In order to digest these refined foods your body has to use its own vitamins and minerals, thus depleting your stores.)
Simple carbohydrates, in the form of fruit and dried fruit, certainly have a place in a healthy, balanced diet. But it’s important, for your health and fertility, to maintain a steady blood sugar level. For this reason, you should avoid sugar, honey and undiluted fruit juice, which can all produce a sudden rise in blood sugar, followed by a sudden fall.
Soya
Soya is being studied extensively around the world for its effectiveness in lowering cholesterol and preventing cardiovascular disease. It also appears to have an important role to play in balancing male and female sex hormones. Scientists believe that hormonal imbalance and over-exposure to chemicals that have oestrogen-like qualities may be one reason for the rapid increase in breast and prostate cancers over the last couple of decades. Crucially, this hormonal dysfunction and overload are also implicated in the menstrual and reproductive problems that affect fertility.
Soya is classed as a phyto-oestrogen, which means that it contains substances that act like hormones. These phyto-oestrogens fit into oestrogen receptors in the breast and block them, effectively shielding the body from exposure to oestrogen which is believed to be one of the major causes of breast cancer. Studies of Japanese women, who traditionally eat a great deal of soya, suggest that it may protect them from this disease.
Oestrogen is not only implicated in breast cancer but is also believed to play a part in causing other problems like endometriosis, fibroids, and heavy and/or long periods – all of which can affect female fertility.
Some women have problems conceiving because the second half of their menstrual cycle, just after ovulation, is shorter than it should be. This ‘luteal phase defect’, as it is known, means that there is not enough progesterone at the right time to maintain a pregnancy. Scientists have found that if they add soya to a woman’s diet it can lengthen the cycle by 2.5 days.
For all these reasons, it’s well worth adding soya to your diet – perhaps in the form of soya milk and tofu (soya bean curd, often used in Oriental stir-fried dishes). However, you need to ensure that the soya used to manufacture these products is not genetically modified, so buy organic.
So, for optimum health, you should eat plenty of:
• Essential fats (nuts, seeds and oily fish)
• High-fibre foods (fruit, vegetables, whole grains, beans, nuts and seeds)
• Complex carbohydrates (whole grains, beans, pulses and vegetables)
• Non-GM organic soya
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March 12th, 2009
There are two ways that you can improve your chances of remaining well as you grow older: by looking after your health, and by health screening.
There are a few extra things to keep in mind if you’re over 60 years of age.
Diet
Good nutrition is always important. It’s hard to know just how important particular types of diet are in maintaining health. Around the world, people who have widely varying diets are now living to a ripe old age. Japan and Sweden have the highest life expectancy, with diets that could hardly be more different. Australia is close behind. The French, renowned for the richness of their cuisine and their wine consumption, also have excellent life expectancy.
If you’ve reached the age of 70 and you’re in good health, what you’ve been eating so far hasn’t done you any harm. Most people of this age will have grown up being taught that meat and dairy produce were good for you and bread and potatoes were the ‘baddies’. The new dietary guidelines are different, but they are based on a modern understanding of nutrition so it makes sense to follow them.
One big advantage of the new guidelines is that they advise you to increase the amount of fibre in your diet. This reduces the risk of constipation, which for some people increases as they grow older.
If you have problems with chewing, see your dentist promptly. Inability to chew properly used to be one of the main causes of malnutrition in older people.
The most important thing about food is to enjoy it. Eat enough of a mixture of foods that you like to maintain a healthy weight. Your doctor will advise you about healthy weight range for your height.
Try to choose foods from the Diet Pyramid to ensure that you obtain all the nutrients you need for good health. This will help increase your resistance to infection and keep you feeling healthy and vital.
Special dietary restrictions are only necessary if you develop gout, diabetes, or any other health condition that is diet influenced, or if you need any medicines (for example certain diuretics) that don’t combine well with some foods. Your doctor will tell you if you need a special diet.
Heavy drinking is very destructive, but there’s no evidence that a relaxing drink in the evenings and a glass of wine with dinner will do you any harm.
Exercise
The longer you keep fit, the longer you’ll be able to enjoy an active life. Exercise is good for the body and the soul, but as we get older it must be tempered with moderation to be kind to our ageing muscles (including our heart muscle) and joints, and to allow for any health disorders that develop. Hectic aerobic sessions at the gym and marathon training are definitely unwise for the over-fifties. Walking is considered the best exercise, and a brisk walk of 20 minutes or more at least every second day (better every day) will keep you fit and feeling good.
If this has happened to you, it’s very important for your physical and psychological health to overcome the incontinence and resume walking and any other exercise you enjoy.
Stopping smoking is wise at any age.
Health care
It’s likely that most of us will need to see our doctors more as we grow older, so it’s important to have a general practitioner that we trust and get on well with: someone who will answer questions clearly and explain any tests, diagnoses or treatments.
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March 12th, 2009
Some STDs caused by bacteria share or overlap in the way they are transmitted, the effects they produce and their treatments, so it’s convenient to consider them together. The most important of these are gonorrhoea and chlamydia. Pelvic inflammatory disease (PID) may be caused by either infection alone, other micro-organisms, or any combination of these.
Gonorrhoea
Gonorrhoea is caused by a bacterium called Neisseria gonorrhoeae. The disease and its association with sex has been known for hundreds of years, however until 1889 the germ that causes it wasn’t recognized. It’s named after its discoverer, Dr Albert Neisser. Another name for gonorrhoea was clap. The term ‘clap’ was used for centuries and is thought to be derived from the Les Clapier district of Paris where many prostitutes worked.
What is chlamydia?
This is a family of bacteria that is widespread in nature and causes a variety of illnesses in animals and birds. One species, Chlamydia trachomatis, is exclusive to humans. There are many different subtypes of this chlamydia. Some sub-types cause trachoma, a serious eye infection that can lead to blindness. Most sub-types of Chlamydia trachomatis can be sexually transmitted to cause a range of infections in the female and male genital and lower urinary tracts, and from mothers to cause serious infection in newborn babies.
Though there is plenty of evidence that chlamydia has been causing disease since ancient times, it wasn’t identified until 1940, and it wasn’t until around 1980 that simple and reliable tests for it were developed. Since then, it’s been discovered that sexually transmitted genital tract, urethral and rectal infections due to chlamydia are very common in women and men.
At present there is thought to be a worldwide epidemic of chlamydial infection. This is often called the ’silent epidemic’, because most infected people have minimal or no symptoms and can pass on the infection unwittingly.
Gonorrhoea and chlamydia attack only certain cells in the body: the columnar epithelial cells such as those that line the cervix, uterus, fallopian tubes, urethra, rectum and epididymis. These parts are all prone to infection during unprotected sexual intercourse with an infected person. A woman is more likely to be infected during one episode of sexual intercourse with an infected man than vice versa.
After invading a columnar cell, the germs begin to multiply and continue to do so until the cell bursts. The bacteria released invade nearby cells, and so the process goes on. The organisms can’t survive for long outside columnar cells because they need the energy produced by these cells to live and grow, but once infection is established in a lining membrane, inflammation develops and spreads in the tissues beneath the columnar cells, leading to pus formation and scarring.
Other bacteria that may cause similar effects to gonorrhoea and chlamydia include Ureaplasma unrealyticum and Mycoplasma hominis. Most people carry these germs in their genital tracts without them causing disease (in this situation treatment is not usually advised), but in some circumstances they can overgrow and cause inflammation. If someone has symptoms and signs of inflammation in the genital tract and only these germs can be demonstrated, they are assumed to be the cause and are treated.
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March 12th, 2009
Breast size and shape
As already discussed, many women are unhappy about certain features of their breasts. Because of their powerful sexual significance in our society, breasts seem to be a greater source of dissatisfaction than most other body features.
It’s easy to say that we should accept our bodies as they are and that people love us for our whole selves whatever the size of our breasts, the colour of our hair, the shape of our noses and so on. This type of statement doesn’t make much of an impression on the woman who’s been embarrassed since her early teens because of her big bosom, or the young woman with one breast twice the size of the other, or the woman whose breasts droop so much after her first pregnancy that she won’t undress in front of her husband.
I agree with the ideology that people should accept and love us for ourselves, warts and all. But unfortunately many people can’t love themselves if they feel that they have a physical feature that is freakish or ugly: they become depressed and withdrawn. I believe that there are many instances where the benefits of cosmetic surgery, in terms of improved self-esteem and confidence, outweigh any amount of ideological argument.
A skilled, caring surgeon and thorough counselling are the most important factors in ensuring satisfactory results.
Should we wear bras?
This question would never have arisen between about 1910 and the mid-1960s when all women wore bras, either to flatten and conceal breasts in the ‘flapper’ era, or to mould them into the fashionable shape of the 1940s-60s.
Today, the main advantage of a bra is that it supports the weight of the breasts, thus preventing premature stretching of the fibrous ligaments that anchor the breasts to the chest wall. Support is more important for heavy breasts, especially in the following circumstances:
• during adolescence if the breasts become large rapidly. A firm bra with non-stretch straps can help to reduce the number and size of stretch marks on the underside of the breast. Adolescent girls with small breasts don’t need a bra • during pregnancy and breast-feeding, when enlargement of the breasts puts additional strain on the supporting ligaments
• if you have tender breasts, a firm bra usually helps
• a bra is a good idea during active sports to cushion jolting movements of the breasts.
Louise’s story
Louise at the age of 22 was 164 cm tall and weighed 49 kg. Her bust measurement was 101 cm and she wore a D cup bra. She had lost 9 kg weight since the age of 18 – ‘I lost weight everywhere except from my bust’. All her clothes, including bras and bathers, had to be specially made. She had endured wolf whistles and jokes about her breasts since her early teens. She had come to think of herself as a freak and had become socially withdrawn and depressed. She had never accepted an invitation for a date.
Her parents and her family doctor suggested that she consider surgery for breast reduction. She consulted a surgeon who counselled her carefully about all aspects of the surgery and its likely physical and emotional effects, and decided to go ahead. Five years later she’s happily married with a baby son (whom she’s breast-feeding).
Louise’s story may sound extreme, but extremes are not so rare. It’s also a success story. You’ll all have heard cosmetic surgery stories that don t end happily, either physically or psychologically or both. If you’re considering surgery to change any part of your body, make sure that you’re aware of all possible outcomes. Two opinions are a good idea.
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March 12th, 2009
The Pill causes thrush
No, Candida albicans causes it. It used to be thought that the Pill caused changes in the vaginal environment (specifically, reduced acidity or increased glycogen) that could encourage overgrowth of Candida. It’s now known that the Pill by itself doesn’t significantly change the vaginal environment. Women on (or not on) the Pill who have quite severe thrush will have normal vaginal acidity as long as there is no bacterial infection present in addition to the Candida.
A possible explanation for the apparent increase in thrush among some Pill-takers (and most women get it no more frequently on than off the Pill) is that increased sexual activity may increase the risk of introducing infection from self or partner.
Thrash can be cured by locally applying or eating yoghurt
This belief arose from the notion that if lots of competition was provided in the form of the lactobacillus in yoghurt, it would clobber the Candida. However, the lactobacillus feeds on milk sugars only, and dies very quickly in the vagina and bowel, and on skin. That means it wouldn’t be around for long enough to provide competition for Candida.
Candidiasis is a modem disease
A side-effect of using antibiotics
Candida has been found in the tombs of ancient Egypt and was described as a cause of skin, vaginal and mouth infections in medical textbooks written well before the advent of antibiotics. It’s hard to know whether it causes infections in more people now than previously. People are certainly more prone to fungal infection while they’re taking broad-spectrum antibiotics, but not generally after the antibiotics are stopped unless they have continuing immune suppression through severe illness or if they’re receiving immune suppressant drugs to prevent rejection of organ transplants. Perhaps for some people, the stress of modern living increases susceptibility to all infections, including those that are fungal.
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March 12th, 2009
Oestrogen
Lack of oestrogen is the most important factor in the development of osteoporosis in women. Oestrogen decreases bone breakdown, prevents loss of calcium via the kidneys and improves absorption of calcium from the bowel. Even with enough exercise and calcium, women who lack oestrogen before or after the menopause will lose more bone more rapidly that those who don’t.
Health authorities now recognize the importance of oestrogen replacement in maintaining older women’s health, especially in the prevention of osteoporosis. However, some women don’t want to use HRT, and it would be overkill to recommend that all women take oestrogen to prevent fractures when two out of three postmenopausal women won’t suffer the symptoms of osteoporosis. It’s generally possible to predict whether a woman is at increased risk.
Techniques have been devised to measure bone density and the degree of bone loss from osteoporosis. These tests may be used to identify early those at higher risk of fractures in later life so that vigorous steps can be taken to prevent further bone loss. Your doctor might suggest such tests if you seem to be at high risk, though many doctors skip the tests and encourage all middle-aged women to begin and maintain a routine that will prevent them from ever suffering disability from osteoporosis. This means having enough exercise and calcium, and hormone replacement if needed.
For women who can’t take oestrogen, other medications may be helpful. Calcitonin (a hormone produced in the thyroid gland) and calcitriol (a type of vitamin D) have been used with some success in the prevention and treatment of osteoporosis, but they are not suitable for everyone and should be used only under supervision of a specialist in osteoporosis. Anabolic steroids seem to relieve the symptoms of established osteoporosis and slow down or halt the process, but also may have unwanted side-effects in some cases.
Other risk factors
Other factors can influence the risk of fractures from osteoporosis.
Body build
Thin women are at greater risk than plump women. Body fat can convert hormones from the adrenal gland into oestrogen: not as much as the ovaries produce before menopause, but enough to slow down bone loss. Also, the bones of heavier women are more stimulated by the greater weight they support. Short women are at greater risk than tall women, because they have less bone mass and so lose relatively more bone as they age.
Family history
Our genes determine our body shape and height, and family habits of diet and exercise may also be important factors in the development of osteoporosis.
Drugs and smoking
Certain drugs promote bone loss, mi through their effects on body calcium. These are alcohol, some diuretic anticonvulsants, thyroid hormone, cortisone and tetracycline antibiotics. Women who are prescribed these drugs for a long time will have been warned by their doctors that they may need more calcium.
Cigarette smoking encourages bone to by increasing the rate of oestrogen breakdown in the body and perhaps the rate of calcium loss in urine.
Amenorrhoea
Women who’ve had long episodes amenorrhoea between puberty and menopause are more likely to begin postmenopausal years with reduced bone strength.
Until recently one in three women coil expect to suffer a fracture from osteoporosis if they lived beyond 65 years. Now we can help prevent osteoporosis from casing disability by maintaining healthy bones before menopause, and by continuing adequate exercise, taking enough calcium and using HRT if needed, after menopause. If you’re around the age of 50, discuss these measures with your doctor.
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March 11th, 2009
Most women will recognize the gradual build-up of strength and frequency contractions and other signs (show of blood and breaking of the waters) that signal that labour has started. But not all labours go according to the books, of all you’ve learned, you can be taken by surprise. My favorite story, though unusual, is of a friend who, without any warning, at 37 weeks delivered health on the dining-room floor within minutes of serving the soup to dinner guests! Don’t be alarmed: this is a very rare experience.
It’s generally better to set off for the hospital early rather than too late. Check with the delivery suite if in doubt (there is someone on duty 24 hours a day). Your partner or the taxi driver could probably rise to the occasion if necessary, but I’m sure that both you and they would prefer
experienced hands for your delivery! Until about 70 years ago, most babies were born at home, usually with the help of the local midwife or GP. During the 1920s the trend to having a baby in hospital began, and by 1950 a home birth in Australia was a rarity. Childbirth in hospital became (and still is) favoured for its greater safety, leading to the rapid growth of obstetrics as a speciality, and medical technology was applied to childbirth. We’ve now gone the full circle. Since the late 1970s there’s been an increasing demand for the services of midwives for home births and for hospital services that would allow a natural delivery if appropriate, rather than every confinement being subjected to high-technology
interference.
Twenty years ago women rarely questioned what happened to them during hospital confinement. Today the reason and need for many common obstetric procedures has been challenged, and women expect to have a much greater say about how they would like their childbirth to be managed. The aim of all obstetric interventions should be the birth of as healthy a baby as is possible with minimum risk to the mother. Here are some of the controversies.
Recent changes in approach to childbirth
Many women these days have well-formed ideas about how they would like their labour and delivery to proceed. Judith was delighted when I confirmed her first pregnancy. She said: ‘I want to have this baby naturally. Jim and I have decided that we want our baby to be born without anaesthetics or any interference.’ Marie’s reaction was quite different. She said: ‘Refer me to a hospital where they believe in pain relief in labour. I don’t mind how the baby is born, as long as everything is done to ensure a safe delivery.’
Which approach is best? It’s impossible to say. It’s good to gather information about modern childbirth services so that you can decide what you would prefer, and then find a birth attendant – GP, midwife or obstetrician – who will respect your wishes, answer your questions clearly and carefully explain anything that necessitates a change in plans.
Judith may be sadly disappointed if, for safety’s sake, she needs assistance during delivery. On the other hand, Marie may be pleasantly surprised if she doesn’t need pain relief during labour. Because what’s going to happen is so unpredictable, I think it’s better to keep an open mind.
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