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Endometriosis and the toxic link.

Endometriosis is a puzzling endocrine and immune disease that affects an estimated 89 million girls and women around the world, regardless of ethnic or social origin. The incidence of allergies, asthma and chemical sensitivities in women with endometriosis is higher than in the general population. Women with endometriosis are also at higher risk for autoimmune diseases and certain types of cancers.

The name "endometriosis" comes from the word endometrium, which is the tissue that lines the inside of the uterus and builds up and sheds each month in the menstrual cycle. In endometriosis, endometrial tissue is found outside the uterus in other areas of the body. This misplaced tissue develops what are called nodules, tumors, lesions, implants or growths.

The most common locations of endometrial growths are in the abdomen involving the ovaries, fallopian tubes, the ligaments supporting the uterus, the area between the vagina and the rectum, the outer surface of the uterus, and the lining of the pelvic cavity. Sometimes the growths are also found in abdominal surgery scars, on the intestines or in the rectum, on the bladder, vagina, cervix and vulva (external genitals). Endometrial growths have also been found outside the abdomen, in the lung, arm, thigh and other locations, but these are uncommon.

Like the lining of the uterus, endometrial growths usually respond to the hormones of the menstrual cycle. They build up tissue each month, break down and cause bleeding. However, unlike the lining of the uterus, endometrial tissue outside the uterus has no way of leaving the body. The result is internal bleeding, degeneration of the blood and tissue shed from the growths, inflammation of the surrounding areas, and formation of scar tissue. Other complications, depending on the location of the growths, can be rupture of growths (which can spread endometriosis to new areas), the formation of adhesions, intestinal bleeding or obstruction (if the growths are in or near the intestines), interference with bladder function (if the growths are on or in the bladder), and other problems. Symptoms seem to worsen with time though cycles of remission and reoccurrence are the pattern in some cases.

Symptoms

The most common symptoms of endometriosis are pain before and during periods (usually worse than normal menstrual cramps), pain during or after sexual activity, infertility and heavy bleeding. Other symptoms may include fatigue, painful bowel movements with periods, lower back pain with periods, and diarrhea, constipation or other intestinal upset with periods. Many with endometriosis also experience a range of immune disorders, including allergies, asthma, eczema and certain autoimmune diseases. Infertility affects about 30-40% of women with endometriosis and is common in later stages of the disease.

The amount of pain is not necessarily related to the extent or size of growths. Tiny growths (called petechial) have been found to be more active in producing prostaglandins which may explain the significant symptoms that often seem to occur with small implants. Prostaglandins are substances produced throughout the body involved in numerous functions and thought to cause many of the symptoms of endometriosis.

Because pregnancy often causes a temporary remission of symptoms and because it is believed that infertility is more likely the longer the disease is present, women with endometriosis are often advised not to postpone pregnancy. However, there are numerous problems with encouraging pregnancy to treat endometriosis. The woman might not yet have made a decision about childbearing, certainly one of the most important decisions in life. She might not have critical elements in place to allow for childbearing and child-rearing (partner, financial means, etc.). She may already be infertile.

Other factors may also make the pregnancy decision and experience harder. Women with endometriosis may have higher rates of ectopic pregnancy and miscarriage, and one study has found they have more difficult pregnancies and labors. Research also shows family links to endometriosis, increasing the risk of endometriosis and related health problems in the children of women with the disease.

Although relatively rare, it is possible for endometriosis to become cancerous. Recent research has indicated women and girls with endometriosis are at greater risk for cancer, particularly ovarian and breast cancer and melanoma. Because of this and the life-disrupting nature of endometriosis in many cases, women and girls are encouraged not to ignore symptoms.

Diagnosis

Diagnosis of endometriosis is generally considered uncertain until proven by laparoscopy. Laparoscopy is a minor surgical procedure done under anesthesia. The patient's abdomen is distended with carbon dioxide gas to make the organs easier to see, and a laparoscope (a tube with a light in it) is inserted into a tiny incision in the abdomen. By carefully moving the laparoscope around the abdomen, the surgeon can check the condition of the abdominal organs and see the endometrial implants. A doctor can sometimes feel endometrial implants during a pelvic examination, and symptoms will often indicate endometriosis. But treatment of this disease should not be initiated without confirmation of the diagnosis. (Ovarian cancer, for instance, sometimes has the same symptoms.) A laparoscopy also indicates the locations, extent and size of the growths and may help the doctor and patient make better informed, long-range decisions about treatment and pregnancy.

Causes

The cause of endometriosis is unknown, but a number of theories have been advanced. The retrograde menstruation or transtubal migration theory suggests that during menstruation some of the menstrual tissue backs up through the fallopian tubes, implants in the abdomen and grows. Some experts believe that all women experience some menstrual tissue backup and that an immune system problem or a hormonal problem allows this tissue to grow in the women who develop endometriosis.

Another theory suggests that endometrial tissue is distributed from the uterus to other parts of the body through the lymph system or through the blood. A genetic theory suggests that certain families may have predisposing factors for the disease.

Other theories suggest that remnants of tissue from when the woman was an embryo may later develop into endometriosis or that some adult tissues retain their ability from the embryo stage to transform reproductive tissue in certain circumstances.

Surgical transplantation has also been cited in many cases where endometriosis is found in abdominal scars although it also has been found in such scars when accidental implantation seems unlikely.

Toxic Link to Endometriosis

Research spearheaded by the Endometriosis Association since 1992 has revealed a startling link between exposure to environmental toxins such as dioxin and PCBs and the development of endometriosis. These chemicals, which act like hormones in the body and damage the immune system, have been shown conclusively to cause endometriosis in animals.

Dioxin is a toxic chemical byproduct of industrial and consumer processes that involve chlorine or incineration of chlorine-containing substances, such as PVC (polyvinyl chloride, commonly known as "vinyl") plastics. The main sources of dioxins are medical waste incineration, municipal waste incineration, chemical and plastic manufacturing, some pesticides, and pulp and paper bleaching. PVC disposable medical devices such as IV bags and tubing are a major concern because they become medical waste which is often incinerated. Dioxins formed during incineration are released into the air and travel via air currents, contaminating fields and crops. Cattle and other livestock eat the crops and the dioxin enters their tissue. Humans then eat the contaminated animal products.

In the early 1990s, the Endometriosis Association found that 79% of a group of monkeys developed endometriosis after exposure to dioxin in their food during a research study over ten years earlier. The severity of endometriosis found in the monkeys was directly related to the amount of TCDD (2,3,7,8-tetra-chlorodibenzo-p-dioxin--the most toxic dioxin) to which they had been exposed. Monkeys that were fed dioxin in amounts as small as five parts per trillion developed endometriosis. In addition, the dioxin-exposed monkeys showed immune abnormalities similar to those observed in women with endometriosis.

As explained in books including Our Stolen Future (E.P. Dutton, 1996), Dying from Dioxin (South End Press, 1995), and The Endometriosis Sourcebook (McGraw-Hill, 1995), scientists have come to the realization that chemical compounds such as dioxin have profound immunological and reproductive impacts at exposures far below the level known to cause cancer. These chemicals are known as endocrine disruptors and can mimic hormones and interfere with many physiological processes. Scientists are still researching how this occurs, but they already know that these man-made chemicals persist in the body for years.

PCBs (polychlorinated biphenyls) are a group of dioxin-like chemicals that were used in industry until they were banned in the 1970s. Some PCBs persist in the environment for more than one hundred years. According to Endometriosis Association research, certain PCBs appear to be linked with TCDD in endometriosis in the monkeys. The severity of endometriosis correlated with the blood levels of a particular PCB.

Based on animal studies and observation of wildlife, impaired fertility is a result of exposure to endocrine disruptors. Infertility affects approximately 40% of women with endometriosis. The Endometriosis Association's research registry provides data showing that endometriosis is starting at a younger age and is more severe than in the past. Could this be the result of a rising "body burden" level of dioxins and other endocrine disruptors?

Treatment Options

Although there is no cure for endometriosis, a variety of treatment options exist. Goals may include: relieving/reducing pain symptoms, shrinking or slowing endometrial growths, preserving or restoring fertility, and preventing/ delaying recurrence of the disease. Hysterectomy and removal of the ovaries has been considered a definitive "cure," but research by the Endometriosis Association and others has found such a high rate of continuation/recurrence that women need to be aware of other steps they can take to protect themselves.

Pain Medication: Over-the-counter pain relievers may include acetaminophen and aspirin, as well prostaglandin inhibitors such as ibuprofen, naproxen sodium, indomethecin and tolfenamic acid. In some cases, prescription drugs may be prescribed for the pain of endometriosis.

Hormonal Therapy: Treatment with hormones aims to stop ovulation for as long as possible and can sometimes force the disease into remission during the time of treatment and sometimes for months or years afterwards. Hormonal treatment may include oral contraceptives, progesterone drugs, a testosterone derivative (danazol) and GnRH (gonadotropin-releasing hormone) drugs. New drugs are being tested. With all hormonal treatments, side effects may be a problem.

Surgery: Conservative surgery seeks to remove or destroy the growths, relieve pain and may allow pregnancy to occur in some cases. As with other treatments, however, recurrences are common. Conservative surgery can involve laparoscopy, described above, which has rapidly replaced laparotomy (a more extensive procedure with a full incision and a longer recovery period). Hormonal therapy may be prescribed along with conservative surgery. Radical surgery, involving hysterectomy and removal of all growths and the ovaries (to prevent further hormonal stimulation), may be recommended in cases of longstanding, troublesome disease.

Menopause also is believed to end the activity of mild or moderate endometriosis although little research has been done in post-menopausal women. Even after radical surgery or menopause, however, a severe case can be reactivated by estrogen replacement therapy or continued hormone production. Some authorities suggest no estrogen be given for a short time after hysterectomy and removal of the ovaries for endometriosis.

Alternative Treatment: Complementary treatment options may include traditional Chinese medicine, nutritional approaches, homeopathy, allergy management techniques and immunotherapy. A survey of 4,000 women with endometriosis found that alternative treatments often worked best.

The Symptoms of Endometriosis

* Pain before and during periods

* Pain with sex

* Infertility

* Fatigue

* Painful urination during periods

* Painful bowel movements during periods

* Other gastrointestinal upsets such as diarrhea, constipation, nausea

In addition, many women with endometriosis suffer from:

* Allergies

* Chemical sensitivities

* Frequent yeast infections

The following article reprinted with permission from the website of the Endometriosis Association (http://www.EndometriosisAssn.org) and the Association's brochure "What is Endometriosis?"

For more information and links to support groups, visit the Endometriosis Association website or contact Penelope Ann Vodle, Support Program Coordinator, e-mail: Endo@EndometriosisAssn.

RELATED ARTICLE: How the Endometriosis Association can help.

The Endometriosis Association is a self-help organization of women with endometriosis and others interested in exchanging information about it, offering mutual support and help to those affected by the disease, educating the public and medical community about the endometriosis, and promoting related research. Overcoming isolation, sharing with others who understand what one is going through, counteracting the lack of information and misinformation about endometriosis, and learning from each other are ways those affected by the disease help each other.

The Association is an international organization with headquarters in Milwaukee, Wisconsin (USA), members in numerous countries, and chapters and activities worldwide. Elected officers guide the Association with help and suggestions from an advisory board which includes medical professionals. The Association was founded in Milwaukee in 1980 by Mary Lou Ballweg and Carolyn Keith and was the first group in the world dedicated to helping women with endometriosis.

The Support Program provides a wide range of services to help women and their families. These services include support groups, a counseling/crisis call line, assistance finding knowledgeable doctors, a prescription drug savings plan. networking and other help. At the local group level, meetings and activities are planned according to each group's wishes. Usually some meetings are planned to allow informal sharing of information and support. Other meetings offer speakers and presentations on various aspects of the disease. Group activities also may include fundraising and community outreach to teach about endometriosis.

The Education Program provides a wide range of literature, books, videotapes, audiotapes, CDs and other educational items to help individuals, the public and the medical community learn about the disease. Members of the Association receive a popular newsletter covering the latest treatment and research news as well as activities of the Association. The Association also provides ongoing help to the media and medical community to aid in the dissemination of accurate information about endometriosis.

The Association's Research Program includes maintaining the world's largest database on the disease, a major research partnership with Vanderbilt University School of Medicine, and funding of promising research worldwide. Researchers interested in working with the Association or seeking funding should contact its headquarters.

Endometriosis Association

8585 N. 76th Place

Milwaukee, Wisconsin 53223 USA

Tel.: (1-414) 355-2200

Fax: (1-414) 355-6065

E-mail:

endo@endometriosisassn.org

Website:

www.EndometriosisAssn.org
COPYRIGHT 2003 Latin American and Caribbean Women's Health Network
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Title Annotation:Such sweet poison: chemicals in our environment and women's health
Publication:Women's Health Journal
Geographic Code:1USA
Date:Jul 1, 2003
Words:2366
Previous Article:Communicating about environmental risks and infant feeding.
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