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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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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Calendar method

Using the onset of bleeding as day 1 and the day prior to the onset of bleeding as the last day of the cycle, map out your cycles for eight months. Find the longest and shortest and work out the times of ovulation in both cycles. This occurs fourteen days before the first day of bleeding in any one cycle. So if your cycle is 28-32 days long you will ovulate at some point on days 14-18 in any one month. Allow four days either side for safety. This means (continuing the example-the days will differ for different individuals) that you are unsafe from day 10 to day 21 in any month. Outside this time span you are probably safe.

Advantages

•     Costs nothing.

•     Gets around religious prohibitions on using ‘artificial’ methods of birth control.

•     No medical side-effects.

•     Makes couples more aware of the woman’s reproductive cycle and the functioning of her body.

•     Leads to couples finding alternatives to penis-in-vagina sex.

Disadvantages

•     Very unreliable.

•     Needs constant checking of cycle lengths to be sure that they are not changing.

•     Rules out penis-in-vagina sex for twelve days a month unless you are absolutely regular. Couples who don’t like making love during the woman’s period will add at least four days during menstruation to this, making half the month either unsafe or unsuitable.

•     Constant worry about timing can be unpleasant for both partners and probably leads to less sex overall.

Sympto-thermal method

A method which combines the taking of the woman’s daily body temperature and an awareness of the state of her fertility cycle through charting her cervical mucus condition. The method is complicated to do well and needs practice. In principle it works as follows:

When the cervical mucus is relatively thick and cloudy in the early days of a cycle it may be safe to have sex unless your cycle is very short.

As the mucus becomes slippery, thin and clear, ovulation is about to occur. As soon as the mucus appears to stop being thick and cloudy stop having unprotected sex. Avoid intercourse until three full days after the ‘peak’ of slippery mucus. Obviously, this takes some experience at judging.

The safest time for sex using this method is from the fourth day after the peak slippery mucus day until the first day of a period.

Advantages

•     Costs nothing.

•     Good for religious groups for whom contraception is prohibited.

•     No medical side-effects.

•     Makes a woman (and her partner) much more aware of her reproductive cycle and the functioning of her body.

•     Encourages the use of methods of love-making other than penis-in-vagina intercourse.

Disadvantages

•     Unsafe. Studies have shown that in the best hands the reliability can be near to that of the diaphragm but this can only be achieved by restricting sex to a relatively few days of the month.

•     As with the calendar method, travel, illness, drugs, stress infections and so on can all affect cycle length and so throw off the calculations. Women with irregular cycles find such methods tricky too.

•     As with the calendar method, many days every month are unsafe, and others may be regarded as unsuitable because of menstruation. This can suit the couple with a low sex drive very well but for others it means using alternative methods of love-making, many or all of which are unacceptable to some.

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