The Health Blog

List of some more commonly prescribed drugs, and the main potential side-effects.

The combined oral contraceptive pill – Given continuously, without a break for periods, for nine months, the pill has been used to treat endometriosis by preventing menstruation. It seems to be used less commonly now, as other treatments have become available.

Progesterone tablets—Examples of these are norethisterone (trade name Primolut N) and dydrogesterone (trade name Duphaston). These are generally well tolerated, although reported side-effects of Duphaston include dizziness and breast pain. Other potential but less common problems with these drugs include menstrual irregularities, abdominal discomfort, headache, fluid retention, pain in the legs, chest or groin, depression, rashes, nausea, hair growth on the face or body and acne.

Other progesterone treatments—Medroxyprogesterone can be given orally (trade name Provera) or injected (trade name Depo-Provera). Provera is like Primolut N, and the side-effect profile is similar.

Danocrine (trade name Danazoic)—This is related to the male sex hormone, testosterone. This is the most effective drug, and commonly prescribed. The fact that it is related to male hormone should not cause alarm; it does not generally have permanent effects. For the time it is taken it reverses the endometriotic process. Women are warned of the possible side-effects, including fluid retention, weight gain, increased hair growth, especially on the face, acne and oily skin, rashes, nausea, increased sweating or flushing, change in breast size, increase in the size of the clitoris, vaginal irritation, and a change (usually deepening or huskiness) of the voice. The voice change, although uncommon, is the only side-effect that may not revert when the drug is ceased. All these things sound pretty horrible, but in fact most women tolerate the treatment fairly well, and significant problems seem rare. Although it should be unlikely that a women would become pregnant while taking danocrine, because of its hormonal effect, it is advisable to take precautions against conceiving while taking it, as it is not recommended during pregnancy. Therefore, it would be advisable to use condoms or a diaphragm during the time of treatment. Setter treatments—Some of the newer treatments being tried use the hormonal pathways with the aim of altering the messages sent to the brain and the ovaries. These are synthetic forms of naturally occurring stimulating hormones which affect release of the sex hormones which in turn stimulate the endometriotic tissue.

Non-Western medicine treatments—Other practitioners, such as Chinese medicine practitioners, natural therapists, acupuncture therapists, and others have specific treatments for endometriosis. The mechanisms of action and rates of success vary, but anecdotal evidence suggests that ‘alternative’ or ‘complementary’ methods of treatment may be very helpful to some women. Specific information should be available from practitioners.

Pregnancy—This is also a treatment for endometriosis. It acts in the same way as the drug treatments in that it changes the hormonal signals to the endometrium for nine months, and the extra scattered bits remain unstimulated and, with luck, disappear. There is, however, a significant recurrence rate after pregnancy.

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Weight gain. We are told that the average weight gain during a pregnancy is 10 to 14 kilograms (1-2 kilograms in the first three months, and 1-2 kilograms a month for the next six months). That is fine, if you are average. Some women will possibly gain less over die nine months. Some will gain more. Still, it is reasonable to presume most women will add about this amount, and usually will lose it in the months after the end of the pregnancy. Extra weight put on during the pregnancy will be just as difficult to lose as at any other time.

Pregnancy is not an ideal time to try to lose weight, because restricting your diet, or drastically increasing your exercise, could make your passenger suffer, as well as you.

Fortunately, foetuses are fairly assertive when it comes to taking what they need. If there is only a certain amount of iron, for instance, the foetus will usually get it, and the woman will miss out. This means that unless you look after yourself you may not be in terrific shape (nutritionally) by the end of the pregnancy, and be unwell as a result. The end of a pregnancy, and start of motherhood is not a great time to be anaemic and poorly nourished.

Pre-pregnancy diet. Your general health and well-being is important during pregnancy, and it is probably important to enter the pregnant state in as good condition as you can. Eating sensibly prior to pregnancy will mean that your body’s stores of nutrients will be better stocked for when you need them. Beginning your pregnancy significantly overweight or underweight can increase your chances of having problems through the pregnancy.

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Dysplastic changes. The smear test is a screening test. It gives an idea of what is likely to be going on at the cervix, but does not give a definitive diagnosis. It can’t, and no one expects it to. It is, however, good as a screening procedure, with a high rate of accuracy and low rate of failures.

The actual diagnosis of a cancerous or pre-cancerous change of the cervical cells requires another technique. A biopsy (a small piece of cervical tissue rather than a smear of cells) must be examined under the microscope to determine the extent of the problem. In general, all women whose smear tests show any degree of dysplasia will be referred for further investigation.

Having a biopsy taken from your cervix involves a procedure called a ‘colposcopy’. A gynaecologist can use a specialised magnifying instrument to examine the cervix more closely. You need to have a speculum inserted, as for a smear, but often the examination will take place on a chair-type couch designed especially for gynaecological examinations. There can be a little brief ‘stinging’ feeling when the biopsies are actually taken, but in general this is short lived and not too painful. The specimens are examined by pathologists to find out what degree of dysplasia there is, and how much of the cervix it affects. The treatment depends on the results. If treatment is required, it will usually be done on a subsequent visit.

To treat dysplasia one of two different techniques may be used, but they effectively do the same thing: they destroy the abnormal cells. Laser (a special light ray which destroys tissue) and diathermy (burning via an electric needle) both sound like pretty gruesome procedures. They are performed under anaesthetic, which may be general (the patient is asleep) or local (the cervix is made numb by an injection, like the gums are at the dentist). The abnormal tissue is replaced by

healthy tissue in a few weeks as new cells grow. A check up is performed using the colposcope to make sure everything is normal, usually three to six months after treatment. Depending on the degree of abnormality and the effectiveness of the treatment, further colposcopies and more regular smears are likely to be recommended, to closely monitor the cervix. This is because women who have had dysplasia appear to be at greater risk of developing a recurrence, and regular checking can prevent this developing into cancer. Fortunately, it usually works.

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This is a particularly clever little bug. Able to infect without causing symptoms, able gradually to cause damage to unsuspecting fallopian tubes, able to render women infertile without very much fuss at all, really.

Some commentators have referred to the ‘silent epidemic’ of chlamydia. Figures from the United States suggest a conservative estimate of three to four million new cases a year there. There are varying rates reported in Australia; between 1 and 4 per cent of women of reproductive age are thought to be infected. Identified risk factors include being under 25 years of age, and having had a new sexual partner within the last twelve months.

Diagnosis. A swab test specifically for chlamydia can be performed on both women and men. In women the swab is taken from the cervix, so it is similar to a pap smear and can be done at the same time as the pap smear. If there are symptoms of infection the doctor may test for other bugs, such as gonorrhoea, as they are similar in their symptom pattern, and can be transmitted together. A swab is used to test men, too. A very fine swab is inserted into the tip of the penis.

Treatment. This infection must be treated with a full ten-day course of antibiotics. This is usually doxycycline 100 milligrams, twice a day, for ten days. The course must be finished to ensure the infection is treated, and intercourse should be avoided until both partners are fully treated. If a person is unable to take doxycycline (because of allergy, breast-feeding or pregnancy), erythromycin may be prescribed. (Remember that taking antibiotics can interfere with the absorption of the oral contraceptive pill. If you are taking the pill, extra precautions are needed during the course of antibiotics, and for at least seven hormone tablets after the course is finished.)

Because no test is 100 per cent accurate, and the consequences of infection are so significant, it is usual to treat all the people who have had recent sexual contact with a person who has a proven infection, regardless of the test results of those people. This ensures that the bug does not have the chance to spread further, or back to the person who has just been treated, as one infection does not give you immunity. Being a ‘silent infection’ means that you can’t rely on the symptoms to know if you are infected. It is better to treat every potentially infected person to be on the safe side.

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Sex is generally about feeling excited and aroused, wanting to be intimate and physically close to someone, and to share those feelings. The someone may be of the same sex or the opposite sex to you.

It is not uncommon, in fact the people in the lab coats tell us that it is almost the rule, that at some stage in our lives we will be sexually attracted to someone of the same sex. We may act on it, and share sexual experiences with people of the same sex. This often happens during our childhood and teens, and is now seen as part of a normal sexual development. The attraction may persist into, or recur in, adult life and may co-exist with an attraction to the opposite sex.

The name given to sexual involvement and attraction towards someone of the same sex as yourself is homosexuality (also known as being ‘gay’, particularly when referring to homosexual men, and ‘lesbian’, specifically referring to homosexual women). If someone is attracted to both sexes the term used is bisexuality. Attraction exclusively to the opposite sex is heterosexuality. None of these ‘-alities’ is right or wrong. Certainly the heterosexual relationship is the one best designed to make babies.

Homosexuality can be a problem for some people. Fear, guilt and insensitivity are responsible for a lot of suffering. The person who realizes that she or he is homosexual or bisexual may cope well with that, or may not. The greatest problem is usually the reactions and prejudices of other people. Society has a tendency to alienate any individual or group which does not appear to fit in with preconceived perceptions of how to behave. Many people find the concept of homosexuality frightening, often through ignorance or their own insecurities perhaps. Because of this ‘minority group’ identity, some homosexual people find it useful to band together for support. AIDS, for example, has focused attention on gay men as an identifiable group in our society. The networks and lobby groups in the gay community have become more vocal and visible over the years.

Although we feel it would be difficult to obtain accurate statistics, it has been said that about 10 per cent of the adult (male and female) population are homosexual. There are no identifying marks and characteristics universal to homosexuals. They do not all fit a stereotyped image any more than heterosexuals do. There is the same diversity of personalities, lifestyles, talents, careers, and aspirations as within the heterosexual population. It is simply that when it comes to forming relationships and having sex about 10 per cent of the population will choose a person of the same sex as themselves.

There is no reason why homosexual relationships should be any less intense, important or enjoyable than heterosexual relationships. Our society is moving a little closer to accepting this. Instead of locking up homosexual people (as the law in some states of Australia still allows), homosexuality is gradually becoming much less of a thorny issue, and people are being allowed to get on with their lives.

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