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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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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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The key is to buy food in its most natural state. As a general rule, avoid foods that have had chemicals added (either to replace something natural, as with artificial sweeteners) or to prolong shelf-life.

Remember that you are aiming to avoid chemicals that could compromise your fertility. You also want to optimize your health by eating as naturally as possible, in order to increase your chances of getting pregnant.

The first step is to get into the habit of reading labels carefully.

Reading Labels

Although most of us lead busy lives, and tend to do our shopping as quickly as possible, it’s worth investing some time in looking at labels on foods and drinks before you buy them. Once you are familiar with the best brands to buy, shopping for the healthiest foods becomes relatively easy.

Firstly, it is best to avoid ingredients which sound like something from a chemistry lesson, especially products containing E numbers. Some are fine to eat, as they are naturally derived, but the vast majority are not and have known side-effects. Without carrying a reference book with us all the time we cannot know which ones are which. Usually food manufacturers make it clear if the additive in question is a natural one because it is a good selling point. However, if in doubt, avoid it altogether.

Also check the label for artificial sweeteners (such as saccharin and aspartame) and, where possible, avoid them. They are chemicals too and the safety of many of them is in doubt.

Generally, the longer the ingredients list, the more suspicious you should be about the product.

Manufacturers argue that additives, preservatives and flavourings are used in such small quantities that they have no adverse effect. However, if you take into account the cumulative effect of these additives in all the different products you eat each day, the quantities soon mount up. Nobody knows what the combined effect of this chemical cocktail might be or how it could affect fertility and a developing baby.

These days it’s more or less impossible for most people to make sure that every single thing they eat is chemical-free, especially if their lifestyle means they need to eat snacks or meals away from home. But, without getting unduly anxious about it, you need to eat as naturally and healthily as possible. For example, as you will undoubtedly need to buy convenience or packaged food from time to time, try to find the best brand you can by going for the shortest, most chemical-free ingredients list.

Healthy cooking tips

• With organic carrots and potatoes, you only need to scrub the skins. Do not peel them, as many of the nutrients are concentrated just under the skin.

• To avoid nutrient loss, lightly cook vegetables in a little water or steam them.

• Avoid frying where possible. Try grilling or baking instead.

• Choose cookware with care. Avoid all aluminum cookware, as this is a heavy toxic metal that can enter food through the cooking process. The same applies to aluminum foil and cases. Avoid any coated cookware, such as non-stick, which is thought to be carcinogenic. The best cookware materials are cast iron, enamel, glass and stainless steel.

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