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.
Women with endometriosis seem to have a mildly increased risk for development of
certain types of cancer of the ovary, known as
epithelial ovarian cancer (EOC),
according to some research studies. This risk seems to be highest in women with
endometriosis and primary
infertility (those who have never borne a child), but the use of
oral
contraceptive pills (OCPs), which are sometimes used in the treatment of
endometriosis, appears to significantly reduce this risk.
The reasons for the association between endometriosis and
ovarian epithelial cancer are not clearly understood. One theory is that the
endometriosis implants themselves undergo transformation to cancer. Another
possibility is that the presence of endometriosis may be related to other
genetic or environmental
factors that also increase a women's risk of developing ovarian cancer.
How is endometriosis diagnosed?
Endometriosis can be suspected based on symptoms of
pelvic pain and findings during physical examinations in the doctor's office.
Occasionally, during a rectovaginal exam (one finger in the vagina and one
finger in the rectum), the
doctor can feel nodules (endometrial implants) behind the uterus and along the
ligaments that attach to the pelvic wall. At other times, no nodules are felt,
but the examination itself causes unusual pain or discomfort.
Unfortunately, neither the symptoms nor the physical
examinations can be relied upon to conclusively establish the diagnosis of
endometriosis. Imaging studies, such as ultrasound, can be helpful in ruling out
other pelvic diseases and may suggest the presence of endometriosis in the
vaginal and bladder areas, but still cannot definitively diagnose endometriosis.
For an accurate diagnosis, a direct visual inspection inside of the pelvis and
abdomen, as well as tissue biopsy of the implants are necessary.
As a result, the only accurate way of diagnosing
endometriosis is at the time of surgery, either by opening the belly with
large-incision laparotomy or small-incision laparoscopy.
Laparoscopy is the
most common surgical procedure for the diagnosis of endometriosis. Laparoscopy
is a minor surgical procedure done under general anesthesia, or in some cases
under local anesthesia. It is usually performed as an out-patient procedure (the
patient going home the same day). Laparoscopy is performed by first inflating
the abdomen with carbon dioxide through a small incision in the navel. A long, thin viewing instrument
(laparoscope) is then
inserted into the inflated abdominal cavity to inspect the abdomen and pelvis.
Endometrial implants can then be directly seen.
During laparoscopy, biopsies
(removal of tiny tissue samples for examination under a microscope) can also be performed for a diagnosis. Sometimes biopsies obtained
during laparoscopy show endometriosis even though no endometrial implants are
seen during laparoscopy.
Pelvic ultrasound and laparoscopy are also important in excluding
malignancies (such as ovarian cancer) that can cause symptoms that mimic
endometriosis symptoms.
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.
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