Endometriosis is inextricably linked to the simplest female biological function: menstruation. Every month, if there is no conception, endometrial cells lining the uterus slough off and exit the

body as menstrual blood. (See illustration.) When endometriosis takes hold, it is because of an abnormal “backing up” of these cells through the fallopian tubes. They “run wild,” and under certain conditions they will implant themselves on abdominal organs. If the implants stick, they can cause extreme pain. As they grow, spread, and go undetected and untreated, they can cause, among other problems, cysts, tumors, and irreversible sterility.

This is a disease that is somewhat shrouded in mystery. No one yet knows its absolute cause or why it claims the victims it does. It is also a disease that can go undetected or misdiagnosed. Endometriosis tends to show itself first as severe menstrual cramps. Often, as a result of the growing implanted endometrial cells, it may form into ovarian tumors or cause symptoms that masquerade as a bladder infection. This is just the beginning.

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Health aside, being in good physical shape is, of course, simply very pleasant. It is also, however, extremely beneficial to the health of our heart, lungs, and arteries.

In practice, though, it is quite difficult for a physician to recommend exercise as treatment. The patient simply nods, his eye on the prescription pad. Why not a pill? he is thinking. The doctor explains that he will not be as tired, or as itchy, or as itchy, if he plays more tennis, takes long walks, jogs, and so forth. As the patient puts on his shirt, he feels worse than ever. Exercise! How can I exercise when I am already too tired to get through the day? What the patient perhaps does not realize is that his chronic tiredness is a manifestation of his various anxieties and tensions, which are ‘burning him up inside’.

It has been shown that an adequate exercise programme improves not only physical fitness but also mental abilities. Carefully controlled trials have shown that speed of performance of intellectual tasks, memory, and learning ability are all improved following a ten-week exercise programme. Psychological testing following such a programme has also shown that the personality appears more content and less anxious. The mechanism by which exercise improves these factors is not known.

Exercise is most useful in another way too. It is a method of dispelling one of our most potent stresses, namely hostile aggression. This, unfortunately, is not only a collective national trait but a personal one too, lying deep within each one of us. It powers not only our careers, our games and our drama, but also the way we drive a car. The type of work most of us do involves less and less physical exertion. Hence one of the many stresses we suffer from is the stress of our own pent-up aggressive drives. One way of dispelling these is by physical exercise.

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A major deficiency of paradigms of obesity has been their omission of factors which influence both extra- and intra- individual variations in energy balance—in particular the influence of environment, biology and behavioural factors on equilibrium body fat levels.

Environmental influences. Abnormalities of biology or psychology cannot explain the big increases in obesity in modern societies. For this we need to look to the environment. Environmental influences on obesity occur either within a macro or micro environmental setting and can have either a physical or socio-cultural basis.

Macro environmental influences at the physical level are those components of the larger world such as the food supply or technology. At the socio-cultural level, the macro environment represents population and community attitudes, values and norms. The micro environment refers to the immediate physical and social environments such as in the home, amongst peers and social contacts, pressures and attitudes in the family and immediate community. All of these environments can influence body fat levels through the mediation of energy intake or energy expenditure.

Environmental influences represent the public health arm of the obesity problem. While these exist, programs aimed at influencing behaviour at the individual level could only be expected to have limited effect. Any comprehensive approach to the prevention and treatment of overfatness and obesity must then consider both the macro and micro environments.

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The use of analgesics alone often has a limited role in the relief of pain due to endometriosis. They may not be able to completely alleviate your pain and you should not use them continuously even if your pain is chronic and ongoing. You may therefore have to explore a range of options in order to manage your pain. To give you some insight as to the variety of treatments available, we have compiled a brief overview of some of those that people have found useful in helping them to manage their chronic pain.

Heat

You will probably have already discovered that heat brings some relief to menstrual pain. The faithful hot water bottle placed on the affected area can diminish your menstrual pain significantly. Other forms of heat relief include electric blankets or heating pads, a hot shower, bath, spa or sauna. The heat works directly on the nerves that transmit the pain and it also relaxes tense muscles

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Sampson’s theory of retrograde menstruation probably explains most of the cases of endometriosis where the implants are located in the pelvic cavity. However, it does not explain some of the rare cases where the implants are located in sites that are some distance from the pelvic cavity — for example, when the endometrial implants are located in the lungs, thighs or arms. In these circumstances it would appear, that living fragments of endometrium somehow enter the veins or the lymph vessels and are transported around the body to another location where they implant in the surrounding tissue.

Accidental transplantation theory-In this situation, the endometrial fragments are transferred from the uterus to the new site during gynaecological surgery or the delivery of a baby. The fragments of endometrium become lodged in the muscle or tissue at the site of the surgical

cut — such as in a caesarian or an episiotomy — where they implant. This theory explains the occurrence of endometriosis in surgical and episiotomy scars. Fortunately, this is not common.

Metaplastic theory-The last theory is known as the metaplastic theory. According to this theory, women may have dormant cells in their pelvic cavities which have the ability to be transformed into endometrial cells in certain circumstances, such as when there is repeated irritation of the lining of the pelvic cavity. This irritation may be due to the presence of menstrual blood, infections or the hormones in the body.

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