In simpler cultures where age-old, traditional women’s roles are still abided by, women bear their first child at an earlier age. They then breast-feed their child, conceive a second child, and the cycle begins again. Over their life-spans, women who have borne children at a younger age, or who eventually have larger families, are found to be less frequent victims of endometriosis. Statistics from medical experts in underdeveloped areas tend to bear this out. Over the last twenty years, however, as personal achievement for women in developed countries has become more defined by professional gains than by creating and rearing a family, the incidence of endometriosis has increased.

A different vision of her place in the world is one way the contemporary woman is set apart from her more traditional counterpart. A second yet equally significant difference is the number of menstrual periods today’s woman will experience. By bearing more children at an earlier age and by breast-feeding them between pregnancies, the traditional woman has about ten to fifteen times fewer menstrual periods than today’s career woman. Such a woman, in other words, has about 55 periods during her lifetime as compared with a woman who does not bear a child and may thus menstruate 550 times until menopause.

Although endometriosis is directly linked to menstruation, its cessation by pregnancy is not a cure for the disease, as less-informed medical specialists once believed it was. Endometriosis is very insidious and may, ironically, spare women who would appear to be very likely candidates—childless career women— while it cripples others with less characteristic profiles.

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Pain is a vicious cycle. It causes fear, tension, stress and anxiety which leads to muscles tightening, which in turn aggravates the pain. An increase in blood pressure and heart rate may also occur. More energy is used up when a woman is anxious and tense and this may lead to feeling drained and exhausted.

If the cycle of pain, tension, more pain and exhaustion can be broken, then it should eventually result in a reduction of pain.

Most people develop tension throughout their lives as a reaction to some type of stress. You need to learn how to release your tension and develop the ability to relax. There are several ways of developing relaxation skills. Here are two examples of relaxation techniques that you may like to practice.

Controlled breathing

This is one of the oldest and simplest relaxation techniques. With this method you can relax tense muscles, slow your heart rate and lower your blood pressure.

Choose an area where you will be alone and undisturbed for about half an hour. Find a spot where you can sit or lie in a well supported, comfortable position.

Close your eyes and try to relax your body. Now take a breath slowly and deeply through your nose and out through your partly-closed lips. Concentrate on the rhythm of breathing in and out and feel your tension begin to melt away. Try to maintain this slow, deep, rhythmic breathing for fifteen minutes. It is recommended that this breathing technique be performed daily to gain maximum relief.

Progressive muscle relaxation

If your muscles are tense and tight as a direct consequence of your pain then muscle relaxation can be helpful.

When practising muscle relaxation you should again choose an area where you will be undisturbed for about twenty minutes.

Start by taking slow deep breaths and then concentrate on curling up your toes and tightening them as hard as you can. Maintain this tension and tightness in your toes and feet for about ten seconds. Then relax the feet completely and you will notice how the toes uncurl and your feet become heavy. Feel the contrast between when your muscles are tense and when they are relaxed.

Gradually move up your body, systematically tensing and relaxing the muscles of your legs, thighs, buttocks, abdomen, shoulders, arms, hands, neck, jaw and face.

As you continue to work through this regime you will again notice the contrast between muscle tension and relaxation; with practice you will be able to relax your muscles when they tighten in response to pain.

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Dyspareunia often causes much heartache for women with endometriosis and it can have devastating effects on their self-esteem and their sexual relationships.

Dyspareunia due to endometriosis may be felt during or after intercourse and may be so severe as to make intercourse impossible. The pain maybe described as sharp, stabbing, jabbing, or a deep aching. Intercourse may always cause pain or only when intercourse occurs at certain times of the month — for example, during menstruation or at ovulation. The pain may be felt only during deep penetration but it may also be felt during any form of intercourse, particularly if the uterus is rigidly fixed by adhesions in a retroverted position.

Dyspareunia is usually associated with endometriosis in the Pouch of Douglas, the

utero-sacral ligaments and the rectovaginal septum. It may also be associated with cysts or implants on the ovaries, vagina or cervix.

If the endometriosis is located in the Pouch of Douglas, the utero-sacral ligaments or the recto-vaginal septum the pain may be due to stretching or jarring of the endometriosis on those tissues.

If cysts are located on the ovary the pain may be due to compression of those cysts, particularly if the ovary is rigidly held in position by adhesions. In addition, penetration may cause some implants to bleed slightly and this may cause pain for some time after intercourse.

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These remarkable results were achieved by a combination of conventional and complementary medicine. While the couples were being medically investigated by Reproductive Healthcare’s director consultant gynecologist and specialist in reproductive medicine and treated in collaboration with one of London’s leading fertility centers, they also came to see me and had full nutritional analysis, lifestyle recommendations and a supplement programme for the months leading up to treatment.

By having ‘the best of both worlds’ they achieved a 50 per cent pregnancy rate. This shows that conventional and complementary medicine need not mutually exclusive. They can be used very successfully together – all it res is open-mindedness on the part of both the conventional and the complementary practitioner, who can learn from each other, and open-mindedness on your part too. You have nothing to lose and everything to gain, as Jill and her partner discovered.

Case History

Before coming to see me, Jill and her partner, both in their early thirties, had been trying to conceive for two years. Jill’s blood tests showed abnormal reproductive hormone levels and her scan showed that one ovary was not functioning and that the other one had multiple cysts, a symptom of polycystic ovary syndrome (PCOS).

Her partner had had a number of sperm tests with conflicting results, and a post-coital test had shown no sperm in the sample. They both had stressful jobs and worked long hours.

Before the diagnosis of PCOS she had been treated for eight months with clomiphene citrate, and they had had one unsuccessful IUI attempt. They had already decided to go for IVF treatment by the time they came to see me, so the aim was to get them as healthy as possible before the treatment started. From the mineral analysis, I could see a number of deficiencies so these were corrected before the IVF cycle started. They were successful on their first IVF attempt and now have a lovely baby girl.

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What is AIDS?

It is an illness caused by infection with a virus (germ) called human immunodeficiency virus (HIV).

Why does AIDS kill people?

Everyone’s body has a natural means of fighting disease – the immune system. The HIV attacks this system, making it impossible to fight off other serious illness. AIDS patients usually die of infections such as pneumonia, or of cancer.

Why can’t AIDS be cured?
No medicine that can kill the AIDS virus has yet been discovered, and because it destroys the immune system, the body’s natural defences can’t overcome it.

How do you catch it?

This happens when blood, semen or other material containing the virus gets into another person’s blood. (Even with young children, don’t hedge about explaining that semen is the fluid that carries a man’s/ father’s sperm into a woman’s/mother’s body to fertilise an egg and start a pregnancy, and about how it gets in.) It can be passed on by blood transfusion, injection with a contaminated needle or syringe, or sex with an infected person. A baby can catch AIDS from an infected mother before or during birth, or from breast milk from an infected mother.

How you don’t catch it

Important. You must reassure your child that AIDS can’t be caught through ordinary domestic, school or social contact.

A cyst is a fluid-filled cavity surrounded by
a well-defined wall. There are many normal cystic structures in the body, for example the ovarian follicles. The urinary and gall bladders become cystic when they не full (inflammation of these is called respectively ‘cystitis’ and cholecystitis’). An abnormal cyst develops when anything interferes with the drainage or absorption of fluid from a cystic structure.

Ovarian follicular cysts

Sometimes an ovarian follicle that doesn’t release its ovum continues to fill with clear fluid and becomes larger than the usual 1.5 cm of the normal mature follicle, so that the follicle becomes an ovarian cyst. Follicular cysts rarely become bigger than the size of a tennis ball. Small cysts usually cause no problems. They are often found by chance during a routine pelvic examination.

Follicular cysts of less than 7-cm diameter usually disappear spontaneously within a couple of months. If they cause no symptoms they need no treatment, though they’re usually checked after six to eight weeks to make sure that they’re subsiding.

Occasionally follicular cysts can become the size of grapefruit or larger, when they cause dull pelvic aching and symptoms from pressure on other organs. Urinary frequency can be a problem because the bladder has less space to expand. Surgical removal is recommended for cysts larger than 7 cm because they usually don’t go away by themselves (or take ages to do so).

Corpus luteum cysts

Sometimes, following ovulation, the ruptured follicle may fill up with fluid (often bloodstained) after it has sealed to form the corpus luteum. Corpus luteum cysts are
more likely to cause menstrual irregularities (early or late periods, or intermittent spotting or bleeding) as a result of disturbed progesterone production but, like follicular cysts, they usually disappear without treatment.

Follicular and corpus luteum cysts are often called physiological or functional cysts because they form during normal processes in the ovary. However, sometimes these simple cysts can become complicated.

A cyst that is attached to the ovary by a narrow stalk may twist or rupture, causing severe sudden abdominal pain. Rupture associated with bleeding into the abdominal cavity can cause severe shock. These are abdominal emergencies that need immediate surgery.

Occasionally a cyst can leak slowly, resulting in less acute symptoms that are often hard to distinguish (without special tests) from the symptoms of sub-acute appendicitis, pelvic infection or ectopic pregnancy. Laparotomy usually solves the puzzle.

One of the good side-effects of the contraceptive Pill is that because it prevents follicle development and ovulation, it also prevents follicular and corpus luteum cysts and the complications that may develop from them.

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Other reason for secondary amenorrhoea includes disturbance of hypothalamic and pituitary control of ovarian function.

This condition can be caused by any of the following.

• Loss of body fat, due to anorexia nervosa, starvation in famine, or any illness that causes severe wasting. Crash diets can also play havoc with menstrual regularity. If you lose 10 kg or more in a couple of months, periods often stop for a while even if you don’t become underweight. Women athletes who replace most of their body fat with muscle will also stop menstruating. Periods start again when enough fat is restored.

•Occasionally very rapid weight gain leads to amenorrhoea, probably due to disturbance of hypothalamic function.

•Profound emotional disturbances, especially bereavement, can shut down the ovarian cycle and stop menstruation. Some women don’t menstruate for months or years after the sudden death of a loved one.

• Change of environment, such as moving house or town, changing to night-shift, or travelling to a different climate can also stop menstruation. Periods usually restart spontaneously when you settle down in the new circumstances. Young women who leave the family home to live in boarding school or nurses’ quarters often stop menstruating for some months. As periods return to women living communally, they will often all menstruate during the same week of the month.

• Pituitary disorders. Overproduction of the pituitary hormone prolactin in a woman who isn’t breast-feeding will suppress the ovaries. Sometimes this is due to a benign (non-cancerous) tumour of the prolactin-producing cells of the pituitary.

• After stopping hormonal contraception, the hypothalamus and pituitary can take a while to ‘switch on’ in a small proportion of women, though menstruation usually returns spontaneously as long as no other cause (such as excessive underweight) exists.

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Artificial insemination (AI) This may be tried when the woman’s reproductive system is normal. Semen is introduced into the cervix or uterus through a tube. Concentrated husband’s semen (AIH) may be tried when the sperm count is low, but the success rate of this procedure is poor. Donor insemination (DI) uses semen from a fertile donor, anonymous or known. It is a simple procedure but the emotional and legal aspects are very complex. Careful counselling and consideration are essential. Legally, the partner is the father. He is also the birth and social father, but not the genetic parent. The mother is the genetic, birth and social parent of any child born from donor insemination.

IVF
In-vitro (in glass) fertilisation (IVF) means that fertilisation takes place in a glass dish instead of in the fallopian tube. It is tried when something interferes with the passage of the ovum from the ovary through the tube to the uterus. IVF involves taking eggs from the ovary, adding semen in the laboratory and then placing one or more fertilised eggs into the uterus. All the processes of pregnancy happen inside the mother except fertilisation and the journey through the tube.

It is now a number of years since IVF resulted in the birth of a human baby (and the technique had been used for decades in domestic animals). In the early days the headlines cried ‘Test-tube Baby’, a description that is not only false but that has created a rather nasty, inhuman, ‘science fiction’ aura about IVF. This unfair and totally unjustified reputation can be an extra source of distress for couples who have children with the help of IVF.