Health News

Sharon’s story: “Looking back on a five-year problem that had me hospitalized tour times for laparoscopics, I find it shocking that my now-diagnosed endometriosis could have been overlooked by a count of ten out of twelve doctors! What is amazing is that the first laparoscopy showed endometriosis, and some of the adhesions were cauterized at that time. Unfortunately, the doctor who said it was endometriosis attributed the adhesions to an infection, even though a blood test showed no such thing.

“Four months later, the pain started again and the doctor did a second laparoscopy. His words were ‘no findings,’ meaning that he couldn’t see the endometriosis, not necessarily that it wasn’t there. J went to another doctor, this time traveling to a big medical center in the Midwest, and he had vague explanations about my pain after giving me a third laparoscopy. For about five months, I started to improve by some miracle. I was taking pain pills until last summer and then the crash came. The pain was so intense I couldn’t stand up I was put on antibiotics again. The doctor said my case was ‘too peculiar’ and he increased the dosage of painkillers.

‘A cousin sent me to her doctor. He actually listened to all of my symptoms (no one else really heard them when I recounted them) and he diagnosed endometriosis, but sent me to another doctor to have a fourth laparoscopy to be sure. It showed endometriosis, with one big implant near my left tube and another two implants on my right ovary.

“What is really disturbing to me is mat all these doctors were highly recommended. The third doctor even told me that if the second doctor found nothing after a laparoscopy, then nothing was there! The doctor who gave me the fourth laparoscopy put me on Danocrine for four days, but I had such bad reactions to the drug that he decided birth control pills would be better. I was still in pain after taking these pills, so be changed the brand. Now he wants to do a fifth laparoscopy ‘to get an objective view of the pain/ and if mat’s not enough, he wants to perform a laparotomy!”

Sharon’s chance for treatment and possible cure was sabotaged by her first doctor’s misdiagnosis. Sadly, it set her on an unwitting course that would be repeated again and again with other doctors. As it happened, the first laparoscopy revealed adhesions—fibrous bands that can bind organs. Adhesions arc unrelated to pelvic infections, but they do signal the possible presence of endometriosis.

Endometriosis can sometimes be detected during a pelvic examination if the masses are large enough to be felt. In Sharon’s case, the ‘hidden disease” had infiltrated pelvic tissue and was detectable with the aid of a laparoscope. Since its nature is also to implant itself on organs and go unseen endometriosis can be missed by doctors who are not familiar with identifying and treating the disease. This happened to her three times.

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Private

Legally, a private health practitioner’s files are her or his own property. A woman has no legal right to see or get copies unless they are subpoenaed by a court.

X-rays and test results are paid for by you so you have the right to request them. In private practice, you may have to use powers of persuasion to get the information you need. If you wish to have your X-rays and test results then discuss this issue at the outset of the relationship. Make it clear you want copies of records, specialists’ reports, etc. and explain why you think it is in your best interests to obtain copies of your records. For example, you may want to get a second opinion or you may plan to move interstate and would need to see another doctor. Your doctor has every right to refuse your request.

Public

The Freedom of Information Act (Vic. 1982; NSW 1989; ACT 1989) gives everybody the right to obtain any of their medical records held by public hospitals. A fee is usually levied for access and copies.

Access to your medical records varies in other Australian states so if you want access to them contact the hospital concerned. If this proves unsuccessful then contact the health department in your state to find out what your rights are.

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Depo-Provera is the long-acting injection form of Provera, also manufactured by Upjohn, which is sometimes used in the treatment of endometriosis. It is also used to treat endometrial cancer (cancer of the uterus), breast cancer and, in some countries, is used as a contraceptive agent.

An injection of Depo-Provera consists of thousands of very small crystals of the drug suspended in a solution of water. When the drug is injected into the body the crystals are slowly released into the bloodstream over a period of weeks or months. The time that the drug remains in the body depends on how fast it releases the crystals and how fast the body removes the drug from the bloodstream.

There has been considerable controversy over the last decade regarding the unapproved use of Depo-Provera for contraceptive purposes. However, Depo-Provera has long been approved in this country for the treatment of endometriosis.

How Depo-Provera works

Depo-Provera presumably eradicates endometrial implants in the same way as Provera.

Dosages of Depo-Provera generally used Dosages vary. Some gynaecologists recommend one injection every two weeks for the first two to three months followed by one injection every month for the rest of the course of treatment. Others recommend one injection every two weeks throughout the course of treatment. The recommended length of treatment may vary from six months to a year.

It is important to remember that because Depo-Provera is a long-acting injection, any side effects will persist until all the crystals of the drug have been removed from the body. There is no way to remove the drug from your body once you have had an injection and there is no antidote.

Some gynaecologists suggest that you try taking a short-term course of Provera tablets before you embark on a long-term course of Depo-Provera as this should enable you to find out how your body responds to the drug and whether or not the side effects are likely to cause problems.

Side effects of Depo-Provera

Side effects of Depo-Provera include vaginal bleeding, weight gain, depression, headaches, nausea, lethargy and tiredness, decreased libido, acne, abdominal discomfort and breast tenderness.

Vaginal bleeding is common and may be troublesome. The bleeding may be heavy and prolonged, or erratic with episodes of light bleeding or spotting. The bleeding may sometimes persist after the course of treatment has finished.

Weight gain is also common — usually only about two or three kilograms but sometimes more.

Most women will start ovulating and menstruating again within several months of their last injection. Depo-Provera sometimes causes a prolonged delay in the return of menstruation and a few women will not menstruate for more than a year following their last injection. Depo-Provera is not recommended for women who may wish to become pregnant soon after their treatment has ceased.

How effective is Depo-Provera

Studies indicate that Depo-Provera relieves the symptoms of endometriosis in 60% to 80% of women and that approximately 50% of women desiring pregnancy will conceive. There are no figures on the rate of recurrence of endometriosis following treatment.

Depo-Provera, pregnancy and breastfeeding

The manufacturers state that Depo-Provera should not be used if there is any possibility that you may be pregnant, as progestogens may cause abnormalities in the developing foetus. However, some gynaecologists believe that Depo-Provera causes no risks to the foetus.

The use of Depo-Provera while breastfeeding is probably safe.

Interaction with other drugs, alcohol or foods

There are no known interactions of Depo-Provera with any foods, alcohol or other drugs.

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Duphaston has been used to treat women with endometriosis in Australia for over 25 years. It has also been used to treat a variety of other conditions, including amenorrhea (absence of periods), dysmenorrhoea (painful periods), PMS (premenstrual syndrome) and abnormal uterine bleeding.

Duphaston is a progestogen (synthetic progesterone) which is very similar to the naturally occurring progesterone produced by the ovaries.

Duphaston is manufactured by Ethnor in the form of small, white tablets, each of which contain 10 milligrams of Duphaston. It is sometimes also known by its chemical name, dydrogesterone.

How Duphaston works

It is not known precisely how Duphaston eradicates endometrial implants because, unlike the other drugs used in the treatment of endometriosis, it does not stop menstruation and it does not usually stop ovulation at the dosages that are most commonly used. It is thought that Duphaston probably works by inhibiting the growth of the misplaced endometrial cells in some way, causing them to gradually waste away.

Dosages of Duphaston generally used

There are several approaches to the use of Duphaston for the treatment of endometriosis. The dosage recommended will depend largely on the practices of the gynecologist and, to a lesser degree, on the severity of the condition and the woman’s response to the treatment.

The majority of gynecologists will recommend 10 to 30 milligrams of Duphaston daily (one to three tablets daily) for six to twelve months. A few gynecologists will recommend taking the tablets cyclically from the 5th to the 25th day of the menstrual cycle each month for six to twelve months.

At these relatively low dosages most women will continue to menstruate and many will continue to ovulate regardless of whether the Duphaston is taken daily or cyclically.

In contrast, some gynecologists will recommend significantly higher dosages of Duphaston because they believe that the treatment is more likely to be effective if menstruation is stopped. These gynaecologists will generally recommend 30 to 60 milligrams of Duphaston a day (three to six tablets a day) for six to twelve months. The dosage recommended will usually depend on the response to the drug, the final dosage usually being the minimum required to stop menstruation and ovulation.

Although the usual length of treatment with Duphaston is six to twelve months there is no evidence that prolonged or repeated courses cause long-term side effects.

You should make an appointment to visit your gynecologist about six to eight weeks after you start your course of Duphaston so that you can discuss how the treatment is progressing.

Thereafter, you should visit every two to three months for the remainder of your course of Duphaston.

Duphaston can only be supplied under the Pharmaceutical Benefits Scheme for endometriosis if you have been definitely diagnosed during a laparoscopy or laparotomy and if your doctor fills in a special prescription form known as an ‘Authority’. If this is done one month’s supply of Duphaston will only cost you the maximum cost of a script under the Pharmaceutical Benefits Scheme as opposed to its full cost.

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