Before laparoscopy, culdoscopy had a reputation as being a good diagnostic aid for women who were suffering from endometriosis or infertility- Laparoscopy has gained favor as the better tool for two reasons: the use of carbon dioxide allows a dearer view of abdominal organs (culdoscopy uses no gas), and a greater number of other techniques are possible during the procedure. Culdoscopy has a few shortcomings, but is an accepted diagnostic procedure and may still be used from time to time by practitioners who are, it is hoped, experienced at it.

Culdoscopy can be a somewhat tricky procedure, requiring experience and skill. A small incision is made in the vaginal wall into the abdominal cavity and a pcriscopelike instrument if inserted through it, offering a view of the uterus, ovaries, and the fallopian tubes. To make ‘hat incision, a woman must remain in a slightly awkward position that requires some other conscious control and cooperation. Because of this positioning, she is not put under general anesthesia.

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A melanoma is a highly malignant tumour of the skin, which has a tendency to metastasize or spread widely and rapidly. Except for cancer of the lung, melanoma has the highest morbidity of all cancers. However if it is detected early the outcome of treatment is usually good; if not, it is invariably a fatal condition.

It used to be thought that all melanomas occurred in preexisting moles. The majority of melanomas, however, appear on blemish-free skin, with only about 25 per cent arising from moles.

Australia has the highest incidence of melanomas in the world. Approximately 3500 melanomas are expected to be diagnosed this year in Australia alone. In Queensland, where the majority of cases are found, the annual incidence has doubled from 16 per 100 000 population in 1966 to 33 per 100 000 in 1977. Since 1936, there has in fact been a six-fold increase. This reflects a world-wide trend.

The cause of the melanomas is unknown. However several important observations throw some light on possible causative factors. Genetic studies show that people of Celtic origin, such as the English and Irish (particularly those people with red hair, fair skin and blue eyes), are far more likely to develop a melanoma. The tumour is most uncommon in black races. Hormonal factors also appear to be involved, as females are more prone than males. Furthermore the tumour is extremely rare before puberty. Environment, as you may expect, plays an important part in the development of melanomas. There is considerable evidence that prolonged exposure to sunlight plays a central role in determining the frequency of melanoma. The closer to the Equator, the higher the incidence. This is as true in Europe and America as it is in Australia, where the incidence of melanoma in Queensland is greater than in the southern states.

The earth’s surface is partially protected from the sun’s ionizing radiation by a layer of ozone. This ozone layer is thinnest at the Equator and thickest at the Poles. Over recent years it has, however, been decreasing in thickness, due to the increased use of fluorocarbons. These gases have their sources in industry, car exhausts, spray packs, and supersonic aircraft. Also, at times of increased sunburst activity, there seems to be a concomitant increase in the frequency of melanoma.

The majority of melanomas in males are found on the back, and in females on the leg. However there is an increasing tendency to develop them on the head and neck. There seems little doubt that this distribution, and the increased incidence, must be related to changing fashions and values. Years ago both sexes wore far more protective clothing, in the form of long sleeves, skirts, and hats. Nowadays the quest is for the beautiful brown body. Consequently, the less clothing worn and the more holidays taken in the sun, the more successful you will appear in this quest. Equally, the more likely are your chances of developing this killer disease.

Since a quarter of all melanomas arise from a preceding mole, it is important to know which characteristics in a mole should arouse suspicion. One of the earliest signs of trouble may be an unusual tingling or itchiness in a normally symptomless mole.

Any colour change is suspicious. This may be a darkening, lightening, or simply a variation or irregularity in colouration. A red ring or inflammation around a mole should also be heeded. Similarly, any significant change in shape is important. This may be increased nodularity, enlargement, extension at one side, or ulceration. Obviously if a new ‘mole’ appears well after adolescence, then it should also be viewed with suspicion.

If your doctor suggests a biopsy of a suspicious mole, do not hesitate to have this done. It does not affect the course of the tumour, whether the biopsy is partial or complete. The important thing is to act quickly. When such changes as mentioned above are heeded and medical attention sought, the prognosis is infinitely better than if they go unrecognized or are ignored.

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Assessing diets is a specialised task and there are now publications available which assist in rating diets and diet plans.

In the US, the National Council Against Food Fraud4 has suggested the following criteria as a basis for assessing diet plans:

F the answer to any of the following is yes’, the program/diet should be regarded as suspect.

1. Does it promise or imply a dramatic or rapid weight loss of substantially more than 1-1.5 kilograms per week?

2. Does it promote a diet that is extremely low in energy (kilocal-ories) without the close supervision of recognised, competent health professionals? As a guide, nutritional adequacy for most micronuuients cannot be met if the daily energy intake is less than 1200 kilocalories.

3. Does it attempt to make consumers dependent upon special products rather than being able to base food choice upon foods that are easily available and part of the usual food supply?

4. Are the ‘counsellors’ actually salespeople given some in-house training to support the needs of the overfat, and do they have a conflict of interests, given profits are linked to the products they recommend and sell?

5. Do they promote unproven fat loss aids such as human chorionic gonadotrophin, electric muscle-stimulating devices, amino acid supplements, herbal supplements, spirulina, diuretics, starch blockers, passive exercise, acupuncture, body wraps, glucomannan, enzymes, sweating techniques? … The list goes On.

6. Do they claim a special technique for ‘breaking down’ cellulite?

7. Do they encourage the use of appetite suppressants, either prescribed or ‘natural’, or the use of bulking agents prior to eating in an attempt to modify appetite and hunger?

8. Do they claim that their product contains a unique ingredient or component, particularly given the increasing interest in herbs, to achieve fat loss? Many of the herbs induced in products, especially of the powdered or meal replacement type, are gastrointestinal irritants.

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Many women feel isolated and confused when they have been diagnosed as suffering from endometriosis. Who do you turn to when your family and friends do not understand? They may find it difficult to understand your feelings and are not always able to provide the support and help you need.

A support group such as the Endometriosis Association ends that feeling of being alone. You can meet and talk to other women suffering from the same condition as you.

It is a time of sharing and learning and provides an opportunity to express your thoughts when your family and friends are tired of listening. On a very practical level, joining a support group offers a chance for you to hear how other women have coped with pain, to discuss difficulties in getting a diagnosis and to learn about choices of treatment, side-effects and outcomes. Support groups can help to overcome confusion by providing easily understood information and access to relevant material which can help you to make decisions about your treatment.

Your questions are answered and your feelings of being overwhelmed are lessened. Receiving current and accurate information about endometriosis makes it easier to talk to your doctor and gives you the confidence to ask questions without feeling intimidated by the medical profession.

In a time of crisis, you can discuss your problem with other women who have been through similar experiences.

But belonging to a support group does not mean dwelling on the negatives — it is an opportunity to share the good and to provide mutual support. It is a give and take situation where women can share their own experiences with others which, in turn, helps to eliminate the myths and fears about endometriosis and its treatment.

Partners and friends are also encouraged to attend discussion sessions so they too can learn about this chronic illness.

Through a support group, you can look for ways of producing positive action to help make doctors aware of the suffering and debilitating effects this disease can cause.

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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 gynaecologists 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 gynaecologists 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 of them are used for endometriosis. Initially, various high dose combinations were used but nowadays most gynaecologists 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 gynaecologists 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 gynaecologists 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 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 gynaecologist if you are taking any other medication.

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