Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Most women who have endometriosis, in fact, do not have
symptoms. Of those who do experience symptoms, the common symptoms are pain
(usually pelvic) and infertility. Pelvic pain usually occurs during or just
before menstruation and lessens after menstruation. Some women experience painful
sexual intercourse (dyspareunia) or cramping during intercourse, and or/pain
during bowel movements and/or urination. Even pelvic
examination by a doctor can be painful. The pain intensity can change from month
to month, and vary greatly among women. Some women experience progressive
worsening of symptoms, while others can have resolution of pain without treatment.
Other symptoms related to endometriosis include:
lower abdominal pain,
diarrhea and/or
constipation,
low back pain,
irregular or
heavy menstrual bleeding, or
blood in the urine.
Rare symptoms of
endometriosis include chest pain
or coughing blood due to endometriosis in the lungs and headache and/or
seizures due to endometriosis in the brain.
Endometriosis is the abnormal growth of cells (endometrial cells) similar to those that form the inside of
the uterus, but in a location outside of the uterus. Endometrial cells are cells that are shed each month during menstruation. The cells of endometriosis
attach themselves to tissue outside the uterus and are called endometriosis
implants. These implants are most commonly found on the ovaries, the Fallopian
tubes, outer surfaces of the uterus or intestines, and on the surface lining of
the pelvic cavity. They can also be
found in the vagina, cervix, and bladder, although less commonly than other
locations in the pelvis. Rarely,
endometriosis implants can occur outside the pelvis, on the liver, in old
surgery scars, and even in or around the lung or brain. Endometrial implants,
while they can cause problems, are
benign (not cancerous).
Who is affected by endometriosis?
Endometriosis affects women in their reproductive years. The exact prevalence of endometriosis is not known, since many women may have the condition and have no symptoms. Endometriosis is estimated to affect over one million women (estimates range from 3% to 18% of women) in the United States. It is one of the leading causes of pelvic pain and reasons for
laparoscopic surgery and hysterectomy in this country.
Estimates suggest that between 20% to 50% of women being treated for infertility
have endometriosis, and up to 80% of women with chronic pelvic pain may be
affected.
While most cases of endometriosis are diagnosed in women aged around 25-35 years, endometriosis has been reported in girls as young as 11 years of age. Endometriosis is rare in postmenopausal women. Endometriosis is more commonly found in white women as compared with African American and Asian women. Studies further suggest that endometriosis is most common in taller, thin women with a low body mass index (BMI). Delaying pregnancy until an older age is also believed to increase the risk of developing endometriosis.
What causes endometriosis?
The cause of endometriosis is unknown. One theory is that
the endometrial tissue is deposited in unusual locations by the backing up of
menstrual flow
into the Fallopian tubes and the pelvic and abdominal cavity during menstruation
(termed retrograde menstruation). The cause of retrograde menstruation is not
clearly understood. But retrograde menstruation cannot be the sole cause of
endometriosis. Many
women have retrograde menstruation in varying degrees, yet not all of them
develop endometriosis.
Another possibility is that areas lining the pelvic organs possess primitive
cells that are able to grow into other forms of tissue, such as endometrial
cells. (This process is termed coelomic metaplasia.)
It is also likely that direct transfer of endometrial tissues during surgery
may be responsible for the endometriosis implants sometimes seen in surgical
scars (for example, episiotomy or
Cesarean section scars). Transfer of
endometrial cells via the bloodstream or lymphatic system is the most likely
explanation for the rare cases of endometriosis that develop in the brain and
other organs distant from the pelvis.
Finally, some studies have shown alternations in the immune response in women
with endometriosis, which may affect the body's natural ability to recognize and
destroy any misdirected growth of endometrial tissue.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Menstrual cramps (pain in the belly and pelvic area) are experienced by women as a result of menses. Menstrual cramps are not the same as premenstrual syndrome (PMS). Menstrual cramps are common, and may be accompanied by headache, nausea, vomiting, constipation, or diarrhea. Severity of menstrual cramp pain varies from woman to woman. Treatment includes OTC or prescription pain relief medication.
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus. The majority of ectopic pregnancies occur in the Fallopian tube. Symptoms include abdominal pain, amenorrhea, and vaginal bleeding. Treatment options include observation, medication, or surgery.
Though uterine cancer's cause is unknown, there are many factors that will put a woman at risk, including: over age 50, endometrial hyperplasia, using hormone replacement therapy, obesity, using tamoxifen, being Caucasian, having colorectal cancer. Symptoms of cancer of the uterus (endometrial cancer) include abnormal vaginal bleeding, painful urination, painful intercourse, and pelvic pain. Treatment depends on staging and may include radiation therapy or hormone therapy.
Ovarian cysts are fluid-filled, sac-like structures within an ovary. Causes of ovarian cysts are numerous. Symptoms of an ovarian cysts may be pain in the belly or pelvis. Treatment of an ovarian cysts depends on type of cyst.
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions.
Infertility is the diminished ability to conceive a child. The primary cause of infertility in men is a sperm disorder. In women, the primary cause of infertility is an ovulation disorder. Most forms of infertility can be treated. Conventional infertility therapies include drugs or surgery.
Menstruation (menstrual cycle) is also referred to as a "period." When a woman menstruates, the lining of the uterus is shed. This shedding of the uterine linking is the menstrual blood flow. The average menstrual cycle is 28 days. There can be problems with a woman's period, including heavy bleeding, pain, or skipped periods. Causes of these problems may be amenorrhea (lack fo a period), menstrual cramps (dysmenorrhea), or abnormal vaginal or uterine bleeding. There are a variety of situations in which a girl or woman should see a doctor about her menstrual cycle.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Menstrual cramps and premenstrual syndrome (PMS) symptoms include abdominal cramping, bloating, a feeling of fullness, abdominal pain, mood swings, anxiety and more. Treatment for menstrual cramps and premenstrual syndrome (PMS) symptoms include regular sleep, exercise, smoking cessation, diet changes, and OTC or prescription medication depending on the severity of the condition.
Sexual dysfunction refers to a problem that arises during any phase of the sexual response cycle, preventing an individual or couple from experiencing sexual satisfaction. Physical, medical, and psychological conditions may affect sexual functioning, resulting in inhibited sexual desire, inability to become aroused, lack of orgasm, and painful intercourse. Treating the underlying physical and psychological problems usually resolves most female sexual problems.
Trying to get conceive, or become pregnant can be challenging, frustrating, and an emotional rollercoaster for some couples. There are things you can do to chart progress, which may ultimately lead to a successful healthy pregnancy, or, when necessary, lead to discussions with a fertility specialist. Being aware of your menstrual cycle, charting your fertility pattern, knowing the reasons for infertility, and treating infertility are key points to discuss with your partner and physician.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Surgical menopause happens when a premenopausal woman has her ovaries removed in a surgical procedure called a bilateral oophorectomy. An abrupt menopause follows, with women often experiencing more severe menopausal symptoms than if they were to go through natural menopause. Chemotherapy and pelvic radiation therapy may also cause menopause by damaging the ovaries.
The uterus (womb) is lined by a special type of tissue known as the endometrium. Endometrial biopsy, or endometrial sampling, is a technique of removing a piece of tissue from the inner lining of the uterus. The sample of tissue is analyzed under a microscope in the laboratory by a pathologist, a doctor with special training in diagnosis of diseases based upon tissue examination.
Why is endometrial biopsy done?
An endometrial biopsy is most often performed to help determine the cause of
abnormal uterine bleeding. It can also be done to help evaluate the cause of infertility, test for uterine infections, and even monitor the response to certain medications.
Endometrial biopsy has many advantages over the more complicated procedure known as
dilation and curettage (D&C), which is a more extensive removal of the uterine lining that requires dilation of the cervical opening with special instruments. ...
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