Health related information and news from around the world.

Jacqui is a patient who for years suffered from infertility problems related to endometriosis. After surgery and medication, she was able to conceive two children. Now it appears that her disease is under control. When Jacqui came for a routine examination last spring, she mentioned that her sister was taking high-dosage birth control pills.

“Franny has been telling me how bad she’s been feeling”, Jacqui said. “I think of myself when I hear her—I could swear that the symptoms sound just like she’s got endometriosis. Franny never had any problems like cramps and pain before starting the Hill. She’s got a bit of a weight problem, and that worries me, too. What are the chances that the Pill is giving her endometriosis?”

Birth control pills do not cause endometriosis. In fact, they were once considered the treatment of choice to control the disease. Oral contraceptives are a balance of estrogen and progesterone, and the pills vary in formula and dosage. Although we know that estrogen influences the growth of endometrial cells, it has not yet been implicated in creating mutant cells that may become endometriosis. Let’s take the next step. If we examined under a microscope the endometrial tissue of women on oral contraceptives, we would find that the cells have become somewhat abnormal. This abnormality renders them inactive; that is, as a result of retrograde menstruation, they will not implant themselves on host organs and grow there.

About half of all such women, in fact, have suffered from some form of uterine cancer. High-fat or cholesterol-laden foods are most responsible for weight gain, and researchers are finding that these treacherous tats have the ability to convert into estrogen or stimulate hormone production. Greater production of estrogen influences buildup of the endometrium, causing a heavier menstrual flow.

A family predisposition to the disease could be conclusive here. There is a good chance that Franny already had endometriosis before taking oral contraceptives. The likelihood it that the estrogen in the pill stimulated the growth of endometrial cells to a certain degree. And since being overweight has been connected to higher levels of estrogen, we would strongly recommend that Franny keep her weight down.

Women with Jacqui and Franny’s history of endometriosis may find themselves facing a problematic option upon reaching menopause: should they have hormone replacement therapy? Such hormone therapy, in the form of estrogen supplements, is prescribed to control hot flashes, loss of vaginal elasticity, and other signs of aging related to lowering of female hormone levels. Mild endometriosis can occur as a result of estrogen replacement therapy, and this is not just the case with lifelong sufferers, women without any disabling symptoms of the disease may find that the estrogen has activated dormant cells. Jacqui and Franny, and women who share their problem, may have to battle a recurrence of the disease when they reach menopause. Perhaps by that time, however, doctors will have found a cure that trees a woman from the disease throughout her lifetime.

Scientists seeking the organic causes of endometriosis have scrutinized genetics, chemistry of the body, the influence of stress, distress, and the tempo of a woman’s life, hormonal responsibility, and even emotional attitudes. Sometimes there is great excitement in a laboratory or a doctor makes an astute observation and our knowledge of endometriosis is increased. Each quest for information brings us closer to the answer of why. Progress is being made. Until we can cite the precise components that cause endometriosis, we can work with effective methods for controlling and preventing the disease. That begins with you: your body will tell you what’s wrong, but you must be able to communicate your symptoms to a doctor. For now, let’s take the emphasis off why and learn what you can do to help yourself by understanding the disease more fully.

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A variety of animals—both domestic and otherwise—are known to transmit diseases to man. Several bacterial infections which affect humans may be contracted from animals. Domestic dogs and cats, being the most popular of household pets, are especially likely to be implicated in this regard. Both staphylococcal and streptococcal germs are carried in the mouths and throats of dogs and cats, and are easily transmitted to their owners. As well as transmitting their own infections to man, pets may also convey infections they themselves have acquired from man back to man himself.

Brucellosis is a bacterial infection of cattle, sheep, goats and pigs. This may he contracted by humans, either through contact with infectious milk or directly from the infected animals. In addition to skin infections, brucellosis may cause a high fever and muscle pain. Another bacterial disease, anthrax, is contracted from the handling of infected bones, hides, wool or hair of animals. The disease may cause severe pustular infections, associated with very high fever, and may be fatal. Cat-scratch disease, which usually results in painful, enlarged lymph glands and rashes, may be contracted as a result of being scratched by an infected cat or kitten. Tropical fish enthusiasts are not immune from infection either. The water in tropical fish tanks is often contaminated by the bacteria Mycobacterium marinum, which closely resembles the tuberculosis germ. It may also be present in lakes or heated swimming pools. Infection usually occurs at the site of an abrasion. It appears as a lump or infection, which breaks down to form a non-healing sore. Most commonly, ft occurs on the hands. Treatment with the appropriate antibiotic is most satisfactory.

Similarly, there are a number of viral infections of animals which may affect humans. These include ornithosis, a most unpleasant disease which may affect the lungs, heart or liver, and cause a fever and a fairly characteristic rash. Another viral infection, foot-and-mouth disease, is common in European and Asian farm animals. Rarely, however, does it infect man. When it does, it results in blisters of the mouth, tongue, lips and the palms and soles. It tends to be more severe in infants and children than adults. The disease milkers’ nodule is derived from the teats of infected cows, and results in tender, red lumps on the fingers of those who milk these cows. Orf is a similar condition, mainly derived from lambs. It infects humans, either through their direct contact with the affected animal, dead or alive, or even through contact with contaminated pastures. It results in painful nodules on the hands which may ulcerate.

Animals are also known to transmit a number of fungal infections to man. Four of these infections are frequently causes of ringworm; they are: microsporum canis, commonly found on cats and dogs; trichophyton verrucosum, commonly found on cattle; trichophyton men tagrophytes and microsporum gypseum, soil inhabitants. (Ringworm is discussed in detail on page 73.1 There are other fungal infections which not only infect the skin but the internal organs as well. Fortunately—for they are difficult to treat—such infections are rare. In Australia there are three forms which are known to affect man: sporotrichosis, blastomycosis and cryptococcosis.

Certain parasites harboured by our pets may be transmitted to us accidentally; these parasites may be a source of irritation in themselves, or they may be carriers of some disease. One of the more serious of these parasite-transmitted diseases is hydatids. Normally, the tapeworm responsible for the disease lives in the intestine of the dog and if its eggs are accidentally swallowed by man, large hydatid cysts develop internally. The common intermediate host is the sheep, which may eat infected grass. Other parasitic worms which may affect humans are cat or dog hookworms. These may be picked up from infested soil, the worms depositing larvae which are able to penetrate the skin. This results in a characteristic creeping eruption. Similarly, swimmers itch is caused by penetration of the skin by the larvae of bird worms. This is usually picked up in shallow lakes from snails, which are the intermediate hosts. Another infection, leptospirosis, is an infection caused by a parasite frequently found in domestic animals (including dogs, pigs and cattle) and rats. Humans are usually infected by contact with infected urine via a cut or an abrasion. The resultant illness may be experienced as a mixture of fever, muscle pain, rashes, headaches and jaundice.

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Fibre probably has an important effect on satiety. In one study researchers showed that a high-fibre breakfast, including 20g of soluble and insoluble fibre, significantly suppressed ad libitum lunch energy intake 4 hours later when compared with a low fibre breakfast. There was, however, no significant effect on total energy intake for the day.

Other studies have found increased feelings of fullness for 3-4 hours after eating high-fibre breakfast cereals. The highest scores always corresponded to the highest fibre content. Because fibre does not seem to limit consumption at the test meal it seems that the appetite benefits of eating fibre emerge at the next meal rather than the current meal. That is, fibre has a bigger effect on satiety than satiation. However, simply adding fibre supplements to a high-fat diet is not likely to have the same effect as eating a selection of high-fibre foods. This is because the fibre in supplements is not ‘bound’ to the nutrients in the food consumed.

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Most women with endometriosis have felt anger at some stage. It may happen after you overcome the initial confusion and feelings of isolation because then you start asking yourself: ‘Why me?’, ‘Why am I infertile?’, ‘Why didn’t doctors pick this up sooner?’, ‘Why isn’t there a cure?’, ‘What research is being undertaken?’, ‘Why isn’t more information available about this disease?’.

With all these questions racing through your mind it is difficult to realise that you have not been singled out to suffer. You will feel angry that at some stage this disease may interrupt your life or that it may prevent you from having children, or attaining other goals in your life or pursuing some sporting interest or hobby.

You may also feel angry because endometriosis is a chronic disease for which there is no ‘cure’. You may be angry because a diagnosis has taken so long, because doctors do not have all the answers and it seems that no-one understands your turmoil.

Your partner too may be confused and frustrated by the disruption the disease has caused to your lives. He may feel angry that there is no cure, or may find it difficult because you may need his constant support.

How do you cope with this anger and frustration that you both may feel?

Try to include your partner in talks about the disease. Encourage him to accompany you on visits to the doctor or to meetings of support groups.

Let your partner talk about his fears and concerns and include him in any decision making.

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For the majority of women with endometriosis the initial decision regarding treatment is whether to have hormonal or surgical treatment. Ideally, you should make this decision yourself in consultation with your gynaecologist.

The reasons for selecting a particular treatment vary widely and will depend on a number of factors including:

Extent and severity of the endometriosis

Size and location of the endometrial implants

Extent and location of any adhesions

Nature and severity of symptoms

Duration of any infertility

Desire for future childbearing

Age

Whether or not related problems exist

Success of previous treatments

Your preferences

The preferences and practices of your gynaecologist.

If you have minimal to moderate endometriosis, hormonal treatment is usually recommended. In contrast, if you have severe endometriosis you are more likely to have surgical treatment although hormonal treatment may still be appropriate if you do not have any large cysts.

If you have any adhesions or endometriomas greater than two centimetres in diameter, these can only be removed surgically as hormonal treatment has no effect on adhesions or large endometriomas.

Some women choose hormonal treatment rather than surgery because they do not want to have their lives totally disrupted for several weeks while they recover from an operation. Others choose hormonal treatment because they feel that it is a less drastic form of treatment or because they do not like the idea of having surgery. Some women do not want surgery because they do not want to take the risk of developing adhesions which surgery can cause.

Some women choose surgery because they do not want to delay trying to conceive for another six to nine months while they are having hormonal treatment. Others may have already experienced intolerable side effects from previous hormonal treatment and would rather try surgery. Others simply do not wish to use drugs or are concerned about the possible long-term effects of hormonal treatment.

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