The elusive but treatable gynecological disorder

“This is a common disease, but lack of awareness leads to a significant delay of diagnosis."

By JUDY SIEGEL-ITZKOVICH
Doctor consultation at hospital. (illustrative) (photo credit: INGIMAGE)
Doctor consultation at hospital. (illustrative)
(photo credit: INGIMAGE)
About 10% of women of reproductive age suffer from a chronic gynecological disease called endometriosis, which can affect quality of life and even fertility. Dr. Elad Berkovitz, who runs a new endometriosis clinic in Maccabi Health Services’ central district, said recently, “This is a common disease, but lack of awareness leads to a significant delay of diagnosis. Many women and girls suffer from severe pain for years, and some suffer from fertility loss. It is very important to diagnose the disease as early as possible.”
Many women do not associate endometriosis with the common symptoms from which they suffer, including severe pain during menstruation and sexual intercourse, digestive and urinary complaints, fatigue, depression and more.
Endometriosis is caused by the presence of cells of the lining of the uterus and in the pelvic and abdominal cavities, adhering to and even penetrating various organs and triggering an inflammatory process around them. There are many theories that attempt to explain this phenomenon, but to this day it is not clear what causes the condition.
Endometrial cells are located in the pelvis around the ovaries, inside the ovaries (in the form “chocolate cysts” colored by thick, dark blood trapped in them) and in the abdominal cavity. Sometimes these cells can enter the urinary tract, bladder or the intestinal wall.
In such cases, adhesions and internal scars may occur that affect the functioning of the organs on which they are located.
The initial diagnosis is made after asking the patient questions, a physical examination, ultrasound and an MRI if needed. A final diagnosis is performed by minimally invasive laparoscopic surgery in which tiny abdominal incisions are made and a camera and delicate instruments are threaded into the holes. There is no cure, but there is treatment. Only in some cases is surgery necessary; most women improve from conservative treatment whose aim is to improve the quality of life and make pregnancy possible.
Treatment depends on how severe your symptoms are and whether you want to get pregnant. If you have pain only, hormone therapy to lower your body’s estrogen levels will shrink the cells and may reduce pain. If you want to become pregnant, having surgery, infertility treatment, or both may help. If you have pain or bleeding but aren’t planning to get pregnant soon, birth control hormones (patch, pills, or ring) or anti-inflammatories (NSAIDs) may be all that is needed to control pain. Birth control hormones are likely to keep endometriosis from getting worse.
Berkovitz said that half of women with unexplained infertility actually suffer from endometriosis.
“It is a disease that without proper treatment continues to worsen and may manifest itself in the spread of its lesions in various organs in the body that can lead to complex medical conditions.”
A clinic that specializes in the condition will increase awareness of endometriosis and benefit women.
THE THREAT OF STATIONARY BACTERIA Bacteria in tap water can multiply when a faucet isn’t used for a few days, such as when a house is vacant over a week’s vacation, according to a new study from the University of Illinois. Its engineers have proposed a new method to show how microbial communities, including those responsible for illnesses like Legionnaires’ disease, may assemble inside the plumbing systems of homes and public buildings.
Their findings were published recently in Nature’s ISME Journal: Multidisciplinary Journal of Microbial Ecology.
Fresh tap water is teeming with harmless microbial life, and water that sits for a few days inside pipes can contain millions of bacteria. Although incidents of waterborne infections resulting from indoor plumbing are rare, the new model may help public health authorities assess drinking-water quality.
“Previous studies have relied on reproducing the conditions of a stagnant plumbing system within a lab setting,” said co-author and civil and environmental engineering Prof. Wen-Tso Liu. “We were able to collect samples in a real-life situation.”
It is critical to pinpoint where in the plumbing network water samples have come from in order to determine the source of microbes. Since it is impossible to sample water directly from plumbing without ripping up pipes and knocking down walls, the researchers came up with another way to determine sample locations.
The team collected tap water samples from three closely monitored dormitory buildings while closed during a school break. Taking steps to prevent outside contamination from plumbing fixtures or sampling equipment, they took samples from sink taps before building closure; while the water was fresh from the city supply; and again after the water sat in contact with the interior plumbing for a week.
The lab results indicated the post-stagnation samples closest to the taps contained the highest concentrations of bacteria. The team also found that bacteria concentrations decreased significantly as the distance between the tap and pipe location increased. However, none of the samples in the study contained microbial species or cells concentrations that present a public health risk.
“Our results suggest that the increase in bacteria in the post-stagnation samples is a result of something occurring in the interior plumbing, not the outside city source, and in pipe segments closest to the taps,” Liu said.
Bacteria that live in tap water exist in two communities – those that float freely in the water and those that live in the films that line the sides of pipes (which are called biofilms). The team, which developed a model to test water quality inside almost any building, found that bacterial concentrations are highest in the first 100 milliliters of tap flow. Liu recommends that people run taps for a few moments before using the water after being away from home for a few days.
“It is contrary to what we have learned about conserving water, but I like to think of it as just another basic hygiene step,” Liu said. “We have made a habit out of washing our hands; I think we can make a habit out of running the tap for few moments before use as well.”