Home pregnancy tests are available at most pharmacies, are based on the detection of human chorionic gonadotrophin (HCG) in a woman’s urine. HCG is a hormone that’s produced by the early developing placenta, released into the bloodstream, and then excreted into the urine.Though it’s possible to detect pregnancy as early as six days after conception, home pregnancy kits recommend waiting six to nine days after a missed menstrual period for testing. Instructions, chemicals, and equipment are provided, all you need do is supply a specimen of your first morning urine, but you should be aware of factors that can contribute to inaccuracy.Inaccurate results can occur . . .• if the test is performed – or results evaluated – too early;• if urine and/or chemicals are exposed to extreme temperatures;• if you have a urinary tract infection or recently completed taking medication for one;• if test equipment has been washed with soap (which could leave a residue and alter results);• if there are excessive amounts of protein in your urine;• if your pregnancy is ectopic (implantation occurs outside the uterus, most often the fallopian tube);Caution: Ectopic pregnancies can be dangerous. If you suspect that you’re pregnant and get negative results on your home test, I strongly recommend you see your doctor as soon as possible.• if you are on any medication, especially birth control pills, antihypertensive, or tranquillizers, which can produce false positive results;• if you have uterine cancer.Caution: Getting a positive result on your test should encourage you to see a doctor as soon as possible, not put the visit off.In all cases, a follow-up examination by a qualified physician is strongly recommended to protect your health – and your baby’s.*3/137/5*

The muscle fibres that entwine the vagina are largely under voluntary control. They may be readily contracted. The movement is similar to that occurring when suddenly shutting off the flow of urine, or cutting short a bowel action; the tighter the muscles are contracted, the more the vaginal canal is squeezed. This is worth remembering, for it can give added delight to your partner during intercourse. All males enjoy internal massage of their penis, and this is the way to do it. Alternate contracting then relaxing, contracting-relaxing of these muscles will inevitably impart a joyous sensation to him—in fact, with skill he may be soon brought to a climax.
There are other important structures closely related to the vaginal canal.
In front, the urethra runs upwards from its external opening, to join the urinary bladder. There, urine formed in the kidneys is stored until it can be conveniently voided.
Behind, the external bowel opening, called the anus, joins with the rectum where waste matter is stored until it also may be conveniently expelled. So, it is urethra and bladder in front; anus and rectum at the back. (These close relationships may become vitally important later on if the vaginal walls become weak, lax and lose their elasticity because of repeated childbirth.) The bladder may bulge into the vagina, causing an unpleasant condition called a cystocele. Behind, the bowel may also press inwards, producing a swelling called a rectocele. Bit by bit, if left untreated these may gradually pull on the uterus above, causing a condition called prolapse. Left, the entire vaginal tract and womb can literally fall out or ‘prolapse’ from the vaginal vestibule, an uncomfortable condition often suffered by older women.)
The superficial cells that line the vagina are constantly being shed and replaced with new ones. In some women, the shed cells together with normal secretions can produce a discharge that is often a little frightening. But a certain amount of moisture is quite normal, and usually inoffensive. The broken-down cells release glycogen which is converted to lactic acid, giving the fluid an add consistency. This is fortunate, for it acts as a barrier against infection. The vaginal canal, despite the thrashing it gets during normal reproductive life, remains amazingly free from infections. The copious blood supply readily replaces damaged cells and tissues; and a frequent thrashing, thrusting penis can remove millions of superficial cells.
Another capability of the lining cells is their ability to absorb chemicals; and the female hormone oestrogen, if present, is readily absorbed. This plays an important part with many women in later years when the vaginal canal tends to become dry and thin and atrophied. The insertion of creams or suppositories rich in oestrogen quickly enable a return to a normal, moist, vagina. Problems that an atrophied vagina have when active intercourse is still being pursued are legion. But treatment, is usually simple, rapid and eminently effective, as well as safe.
*7\45\4*

“My doctor thinks I’m almost recovered from endometriosis.” a thirty-year-old woman from Indiana wrote to me. “and I wonder. I’ve been trying to get pregnant for a year and a half, but have had no luck so far. My gynecologist told me mat he suspects my tubes may be blocked from the endometriosis. He wants to X ray them. Isn’t this dangerous? I want a baby, but I’m afraid of all this radiation.”

Diana’s query is one that we commonly hear from women who are recommended for special work-ups when infertility is involved. X rays should be used advisedly and infrequently, but they can be instrumental in deciding the degree of tubal damage.

Abdominal X rays will pick up only large tumors or hard masses, because these will form a shadow on the exposed film. Since endometriosis is soft tissue, it will not show up on these standard X rays. However, a hysterosalpingogram, or X ray of the uterus, used along with an injection of dye, has aided doctors in making an accurate diagnosis. The amount of radiation from a hysterosalpingogram is very low.

If Diana decides to go ahead with this X ray, she will find it pain-free. The procedure is simple. The test is performed while a woman is resting on an examining table. The doctor inserts a speculum into the vagina and the cervix is steadied with a special clamp. A small hollow tube, or cannula, is placed inside the cervical canal and will serve as the conduit for the injected dye. When the dye enters the uterine cavity, it is seen on a fluoroscope screen, and the doctor simultaneously takes an X ray. (If you refer to the illustration below, you can see that the dye has pushed into the uterine cavity, which appears to be normal. The right fallopian tube is open, indicated by dye spilling from the tube. The left tube is closed and damaged as a result of endometriosis; the dye has collected there and does not spill out into the pelvic cavity.)

Normally, the uterine cavity is small and triangular. If it is enlarged or if there is certain “intravasation”—that is, the dye fails into small pockets in the wall of the uterus—these signs might indicate a condition called endometriosis interna, or adenomyosis. Confined to the inside wall of the uterus and weakening it, adenomyosis can coexist with endometrial implants outside the uterus, or it may exist alone. Adenomyosis creates heavier menstrual flow and is responsible, in part, for continuous pain.

Sometimes, endometrial implants stick on the outside of the fallopian tubes, causing them to narrow. This X ray will outline the tubes to reveal whether or not they are open, since the dye will be pushed through the hair-thin fallopian tubes. A healthy tube shows up with the dye already expelled and spilling toward the ovary and bowel. The circumstances are different when the tube is damaged. The dye won’t escape, but will be trapped within one of its fimbriae, the ringerlike ends of fallopian tubes. Chances of pregnancy are nearly impossible with such a damaged tube.

Recall for a moment Sampsons theory. It proposed that the fallopian tubes were conduits for endometrial fragments during retrograde menstruation. The fallopian tube may be first to come in contact with the endometrial fragments outside the uterine cavity. Surprisingly, however, endometriosis is rarely found in the tubes. When there are endometrial implants on the tubes, they can be recognized by their characteristic dark blue color. In advanced cases, implants may penetrate deep into the wall of the tube, forming dense adhesions with the surrounding organs.

Tubal problems are often the cause of infertility, although it is not always endometriosis causing the problem, as it is in Diana’s case.

*50\43\4*

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Some of the mechanisms of heavy, uncontrolled bleeding are not understood. Gaining insights into this phenomenon is obviously vital if improved ways to alleviate it are ever to be developed. A small protein called endothelin, discovered in the late 1980s, has been found to cause constriction of blood vessels in many parts of the body, and may be responsible for eventually ending any episode of blood loss. Recent research has revealed high levels of this protein in the endometrium around die time that the menstrual bleed comes to an end.

While this research has been going on, the uterus has attracted increasing attention at a more general level. It has long been regarded by many people as a safe haven for a developing baby during pregnancy, but an unqualified nuisance thereafter. A 1987 editorial in the prestigious British medical journal Lancet expressed this view when it said:

for the woman who is not interested in having children, or whose family is complete, this solution [hysterectomy] is often attractive … [it promises] relief from her symptoms and other expected benefits — greater reliability at work, availability at all times for sexual intercourse, saving on sanitary protection, freedom from pregnancy and freedom from uterine cancer.

Today, views such as this are being scrutinised due to a growing body of evidence which suggests that the uterus and cervix play an important part in sexual satisfaction for some women and men. For perhaps as many as one in three women, contractions of the uterus contribute significantly to their experience of orgasm. As noted earlier, in pre-menopausal women the cervix also produces lubricative mucus for some days each menstrual cycle. This mucus, which is apparent in the days before ovulation, may be associated with increased interest in sex and less friction during intercourse. In addition, some men and women find that the tapping of the penis on the cervix during intercourse contributes to the pleasurable sensations they experience.

The uterus also seems to have psychological importance for some women, being associated with self-images of femininity and sexual attractiveness. This may be especially relevant in cultures where women’s reproductive functions are highly valued. There is also a perception among some women that their partners treat them differently (find them less sexually attractive) after hysterectomy, suggesting that some men’s notions of womanhood are closely allied to the presence of the uterus.

It is still the case — and this is controversial — that many surgeons remove both ovaries along with the uterus during hysterectomy procedures when there is no apparent ovarian disease or disorder. What’s more, some women believe that they have not been consulted about this in advance. The reason typically given is prevention of ovarian cancer, which affects about one in seventy women, mostly over the age of sixty. Ovarian cancer is diagnosed in about 900 Australian women each year and about 550 die from it. The symptoms of pain, bleeding and swelling are usually not obvious until the disease has progressed to an advanced stage.

It is hoped that research findings indicating a role for the ovaries in women’s long-term health will cause a reappraisal of this practice, especially as the risk for developing ovarian cancer in retained ovaries after hysterectomy is only about two in every 1000 women. The available evidence indicates that even post-menopausal ovaries make sex hormones. These may be of value to women’s health, particularly in helping maintain sexual interest and responsiveness, and bone strength. However the clinical evidence is inconclusive. It is clear that the long-term effect of removing the ovaries along with the uterus in the pre-menopausal years is to increase a woman’s risk of heart disease — perhaps to three times that of non-hysterectomised women. Furthermore, other research suggests that removal of both ovaries and the uterus increases the risk of osteoporosis, with increased loss of bone density and a higher incidence of fractures.

*4\198\4*

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The Pill, often known as the oral contraceptive pill or the birth control pill, is not just one drug but rather a group of many drugs first developed for use as a contraceptive in the late 1950s. Initially, they were made up of a combination of synthetic oestrogen and progestogen (synthetic progesterone) but since the 1970s various synthetic progestogen-only drugs have also been used.

The Pill was first used as a treatment for endometriosis in the late 1950s and for many years it was the main form of treatment. It has now been superseded by Danazol and the progestogen-only drugs such as Duphaston and Provera.

Nowadays, many gynecologists believe that there is no place for the Pill in the treatment of endometriosis because they feel it does not effectively eradicate the condition. However, many gynecologists believe that it still has a role in the long-term management of endometriosis because they feel that although it does not eradicate the disease it may slow down or halt its progression. Therefore it is sometimes recommended for women with mild or minimal endometriosis in an attempt to stop the progression of their disease.

How the Pill works

It is thought that the Pill works by mimicking the hormonal condition of pregnancy because it leads to high levels of oestrogen and progesterone in the body. The high levels of oestrogen and progesterone suppress ovulation and lead to changes in the endometrial implants which eventually cause them to waste away. Sometimes the Pill causes an initial enlargement and softening of the endometrial implants and cysts in the first few weeks or months of treatment, which may result in a worsening of symptoms and may occasionally cause endometriomas to rupture.

Dosages of the Pill generally used

There are many different varieties of the Pill available but not all °1 them are used for endometriosis. Initially, various high dose combinations were used but nowadays most gynecologists would recommend a combination with a low dose of oestrogen and a relatively high dose of progesterone. The progesterone-only Mini-Pills are not suitable.

Regardless of the combination used, most gynecologists recommend that the Pill be taken continuously — every day without a break, for six to twelve months. You will usually be advised to begin with one tablet per day and to increase the dosage by one tablet per day if any vaginal bleeding occurs. The final dosage will usually be the lowest dosage on which you have no vaginal bleeding and this may be three or four tablets per day.

Side effects of the Pill

Side effects when using the Pill for endometriosis are common. Many women experience a greater number of side effects and they are often more severe than those experienced when using the Pill as a contraceptive, because the dosages used for endometriosis are usually much greater.

The more common side effects include vaginal bleeding, fluid retention, abdominal bloating, weight gain, increased appetite, nausea, headaches, breast tenderness, acne, depression, changed libido and vaginal thrush.

You will usually begin to ovulate and menstruate again within four to eight weeks of ceasing treatment and any side effects usually disappear within a few weeks.

How effective is the Pill

As previously mentioned, most gynecologists these days do not believe that the Pill is an effective treatment for endometriosis. The research suggests that only a small proportion of women obtain relief from their symptoms and that the likelihood of becoming pregnant following treatment is low. In addition, the likelihood of developing a recurrence of the disease soon after treatment is high.

The Pill, pregnancy and breastfeeding

The Pill should not be used during pregnancy as progestogens derived from testosterone can cause abnormalities in the developing foetus.

The use of the brands of the Pill containing both synthetic oestrogen and progesterone while breastfeeding is not recommended. The progestogen-only Mini-Pills may be safely used while breastfeeding.

Interaction with other drugs

The Pill interacts with a number of drugs therefore you should tell your gynecologist if you are taking any other medication.

*43/41/5*

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