**I just found out that my website has been connected to Google.com.  I understand that most of you surfers are looking for information about “middleschmertz.”  Middleschmertz is the term used for normal ovulation pain.  When the egg bursts through the wall of the ovary, sometimes it causes a twinge of pain that may radiate around the abdomen.  If you have light, kind of funny feeling pain that goes away in a day or two, don’t worry.  If you have troubling pain that won’t go away and your ob/gyn has brushed you off with the diagnosis of  “middleschmertz,” please read this article about endometriosis.  My former doctor chuckled and told me all about ovulation pain when in reality I had this disease.  It is grossly under diagnosed and can be a serious threat to fertility. If you want more info please email me at [email protected]


Endometriosis:  It’s Not Just Part of Being a Woman

                                                        By Linde Margret Aseltine


            We’ve grown up with women who weren’t allowed to complain.  Mothers, aunts and grandmothers were told that pain during their periods was just part of nature.  They were given water bottles and tea and told to just be quiet.

            Years of Advil and Midol later, we’re still lead to believe that horrible menstrual pain is normal.  In some cases, it is.  But in other cases it is definitely not.  The disease is called endometriosis and it affects nearly 10% of the female population.  That means it’s a bigger epidemic than cancer or AIDS among women. It strikes women of all ages during childbearing years—mostly between the ages of 20-40.  It is the cause of infertility 30-40% of the time.   It has gone misdiagnosed for decades.  In the early 1990’s a study revealed that it was more common among educated women.  Perhaps studying long hours was responsible for the retrograde menstruation that causes endometriosis.  More likely, the educated women would not take “It’s part of being a woman” for an answer and demanded that someone find out what was going on.

            As we all know from sixth grade health class, the lining of the uterus (the endometrium) thickens during ovulation.  If there is no fertilized egg to be implanted, the uterus sheds this lining through the vagina. Endometriosis is defined as the abnormal growth of endometrial cells outside the uterus. This is the result of retrograde menstruation.   In the case of those women with endometriosis, some of the menstrual flow goes backward through the fallopian tubes and into the body cavity.  These cells adhere to other organs and continue to grow.  The growths are called endometriomas and though they are usually found on the ovaries, intestines, fallopian tubes, bladder and cul de sac (the area behind the uterus) they can grow anywhere in the female body.  Endometriomas don’t know they are outside the uterus and during the next cycle, they thicken and bleed but cannot be shed.  Why retrograde menstruation occurs is unclear.  Some researchers relate it to a possible autoimmune condition (whereby the body attacks its own cells.)  If endometriomas continue to grow unchecked, they can interrupt ovulation and strangle the fallopian tubes making the travel of fertilized eggs impossible. As a result, infertility and ectopic pregnancies (when the egg implants in the tubes instead of the uterus) are more common among those with endometriosis

            This process can continue for years undetected.  Some women with endometriosis have no symptoms.  But most experience agonizing pain during their period—enough to halt daily activity.  This pain is accompanied by heavy bleeding, diarrhea, nausea and fatigue.  Nothing new, right?  However, for many endometriosis sufferers, the nightmare doesn’t stop with the bleeding.

            Debilitating pelvic pain can happen at anytime during the cycle—during intercourse, urination, bowel movements or for no reason at all. The pains can be described as twisting, stabbing, shooting, and radiating.  Intense episodes can strike at any time—especially during ovulation. 

            These pains outside menstruation are what send many women to their gynecologists.  But the diagnosis of endometriosis is still in the dark ages.  Most endometriomas cannot be felt during a pelvic exam.  Even more frustrating, endometriosis is virtually undetectable through imaging.  Upon review of a normal ultrasound—and eventually a normal CT scan, doctors shrug their shoulders and give women such diagnoses as “middleschmertz” (normal ovulation pain) or plain old stress.

For some women, the inquiry stops there.  But for many, women’s intuition tells them that something is amiss.  Some women then get on a “doctor’s office merry-go-round” where they are referred to one specialist after another—gastroenterologists (for the diarrhea and pain during bowel movements,) nephrologists (for the pain during urination,) even endocrinologists.  After tests and blood work come back negative, the next diagnosis is “psychosomatic symptoms.”  They’re written prescriptions for Motrin and told to exercise and drink more fluids.

            But endometriosis does not go away with pain medication and a healthy lifestyle.  The pain will get worse; reproductive organs can become permanently damaged.  Likewise, severe enough endometrioma growth can cause adhesions that fuse other organs together thereby causing intense health risks. 

            The only accurate method of diagnosis is through laproscopic surgery.  The patient is put under general anesthesia and a small scope is inserted through tiny incisions in the naval and abdomen.  The doctor can then visually identify endometriomas.  Often times, these growths will then be removed.  The procedure is usually done on an outpatient basis with a recovery time of 3-7 days. 

            After a positive diagnosis is made, the next step is hormone therapy.  Such drugs as Lupron and Synarel put the woman’s body into a menopausal state.  Other drugs such as Depro-Provera stop the thickening of the lining of the uterus.  Lastly there are drugs such as Zolodex that introduce male hormones to interrupt the menstrual cycle.  The good news is that these drugs normally cause the endometriomas to shrivel up and disappear.  The bad news is that the hormone therapies come with their own set of side effects.  Nausea, acne, bloating, loss of sex drive, weight gain, and mood swings are among the more common side effects but the list goes on depending on the drug and the length of time it is used.  The only natural pause in endometriosis is pregnancy.  The only final cure for it is a hysterectomy (the surgical removal of the uterus.)

            In all, endometriosis is a long, painful struggle both physically and emotionally.  Since it is a relatively newly discovered disease, many doctors don’t know the proper questions to ask.  If you suspect you have endometriosis, consider doing the following:

1.      Keep a journal of your symptoms.  Be thorough and specific.  Describe any time you have pain.  Also note changes in mood, bowel movements or urination as they correlate with your cycle.  When you make an appointment with your gynecologist, bring your journal with you.

2.      Ask around your family.  Endometriosis is largely hereditary.  Do you have aunts that could never conceive?  Were you warned of this pain as a teenager by your mother or grandmother?  Chances are, there are more women—on the maternal or paternal sides of your family—that have the same symptoms as you have.  This fact may help your doctor in diagnosing you.

3.      Review your own health history.  When did you begin puberty?  Many women with endometriosis report having started adolescence at a younger than normal age.  Have you ever had an ectopic pregnancy?  A history of miscarriages?  Infertility?  These are clues to endometriosis.

4.      Follow your instinct.  You know your body.  Don’t let a doctor dismiss your symptoms—even if it is the doctor you’ve had for years whom you trust.  Trust is not a guarantee for accuracy.  Find another gynecologist—perhaps one who specializes in either endometriosis or infertility.  More often than not, you are not crazy.


And that is really the bottom line:  This is a serious, pathological disease, not a neurosis.  It requires adequate medical attention.  You require respect.


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