How to Cure Chronic Pelvic Pain

Endometriosis Bible & Violet Protocol

Being developed by Zoe Brown a nutrition specialist, health consultant and former endometriosis Endometriosis Bible And Violet Protocol is the latest endometriosis treatment that is claimed to be able to teach sufferers how to finally eliminate endometriosis forever. The e-guide contains 303 pages which cover all fundamental information about endometriosis that can helps you pinpoint the root causes of your endometriosis condition and abolish typical symptoms of this problem. Zoe Brown also uncovers that connection between some specific foods and endometriosis. She also guarantees that most of you do not acknowledge 70-80% of the facts presented in her program. Read more...

Endometriosis Bible & Violet Protocol Summary


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I've really worked on the chapters in this book and can only say that if you put in the time you will never revert back to your old methods.

My opinion on this e-book is, if you do not have this e-book in your collection, your collection is incomplete. I have no regrets for purchasing this.

Treating Your Endometriosis

Treating Your Endometriosis is written by Shelley Ross. It is an ebook explaining a safe, simple method to treat endometriosis naturally. Endometriosis is a condition where the uterus lining actually develops on the outside of the uterus. This abnormal growth is not just a nuisance it can be potentially dangerous if not treated properly. In this eBook Shelly does a wonderful job in showing you how to get your body to function as nature intended, a very important aspect if you are trying to get pregnant and suffer from endometriosis. Learn how a few simple changes in your diet can dramatically reduce your endometrial implants from spreading. You will also find more information on nutritional supplements, stress reduction techniques, best exercises to reduce endometriosis symptoms, and much, much more! Read more...

Treating Your Endometriosis Summary

Contents: Ebook
Author: Shelley Ross
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Price: $37.77

Female Infertility Treatment

20 may present with combined aetiologies, including tubal blockage as well as ovulatory or immunological disorders, cervical factors, coital problems and endometriosis. Seventeen per cent present with 'unexplained' infertility where no specific aetiology has been identified. Donation of oocytes depends upon the availability of willing oocyte donors, which is restricted in most countries. IVF surrogacy can be used for patients who can produce mature oocytes for fertilization, but are unable to carry a pregnancy to term the patient's own oocytes are fertilized with her partner's sperm, and resulting embryos transferred to a host surrogate after appropriate counselling and informed consent (Lass, 1999).

Sireesha Reddy Definition and Epidemiology

Endometriosis is a condition that is characterized by the presence of functional endometrial glands and stroma outside of the uterine cavity. This condition is found to be highly prevalent in women of reproductive age. However, the exact prevalence of endometriosis is unknown. It is believed approximately 20-50 of cases undergoing laparotomy reveal endometriosis at the time of surgery. The median age of women who have endometriosis is 37. Because 15 of these women are under the age of 30, endometriosis can also occur in the younger adult women and also in adolescence especially when there is an association with uterine anomalies. Although endometriosis is considered an estrogen-dependent disease with treatments focusing on this mechanism, rare cases have been identified in both premenarchal and postmenopausal females.

Gonadotropin Releasing Hormone Analogs

Gonadotropin releasing hormone analogs (GnRH) cause a temporaty medical menopause resulting in hypogonadism and hypoestrogenism by acting on the pituitary to reduce gonadotropin synthesis and secretion. Most of the side effects experienced occur because of the hypoestrogenic state including hot flashes, vaginal dryness, mood lability and decreased libido. The GnRH agonists have been shown to work well in reducing pain symptoms associated with endometriosis such as dys-menorrhea, dyspareunia, and noncyclic pelvic pain. GnRH agonists are often initiated with the onset of menses, but a more rapid response is observed with mid-luteal administration. A limit of 6 months per treatment course is required due to loss of bone mineral density during therapy, but this can be extended via the addition of 'add-back' therapy with estrogens. Retreatment with these drugs is supported by limited data. Several investigators have studied the use of GnRH agonists as surgical adjuncts. Their use...

Sexually Transmitted Diseases

The importance of safe sex practices and a discussion of the risks associated with the range of sexually transmitted diseases pertinent to the destination should be included as part of the pretravel visit (Hawkes and Hart, 1998). Women should be reminded that they are at a higher risk of acquiring a sexually transmitted disease from an infected partner owing to the fluid dynamics of sex. In general, women suffer disproportionately to men from the long-term complications of sexually transmitted diseases. Complications include pelvic inflammatory disease, chronic pelvic pain and infertility.

In Vivo Functional Activity

Sometimes there is no adequate or usable disease model however, a suitable surrogate marker may be available to give an approximate readout of potential in vivo efficacy. Surrogate markers also serve to simplify and speed-up compound evaluation because they avoid the need to use a full-blown disease model. An example of this is the GnRH field described previously. Here, rather than use models of prostate cancer or endometriosis or some other indication for GnRH agonists or antagonists, one need only monitor testosterone levels in male animals or estrogen levels in females to see whether the compounds are effective or not.

Gynecological Causes of Acute Abdominal Pain

Adnexal Mass

Ovarian cysts usually result from failure of involution during the normal menstrual cycle. They may cause acute lower abdominal or pelvic pain in pre-pubertal and pubertal girls if they are complicated by rupture, torsion, or hemorrhage, or if they become significantly enlarged. Transabdominal US in uncomplicated cysts usually show a thin-walled, well-defined, echo-free ovarian mass, and excellent through-transmission (CARtY 2002). Simple cysts may be quite large, but most of them resolve spontaneously, only requiring clinical and sonographic follow-up. Rarely, there is a complication, the most common being ovarian torsion. Functional cysts may also rupture and result in free fluid in the pelvis. Despite the high frequency of presentation of these cysts, they should not be assumed to be the cause of the acute symptoms until other pathologies, especially appendicitis, have been excluded. and are filled with pus, which may spill over into the peritoneum causing peritonitis. If the...

Surgical Treatment of Female Infertility

Posterior Cul Sac

Laparoscopy should only be performed after complete investigation of infertility such as semen analysis, hysterosalpingogram and assessment of ovulation. In the era of assisted reproductive technology, laparoscopy is not a routine test. However, it is indicated in young women with an abnormal hysterosalpingogram or a history of salpingitis, sexually transmitted disease, previous pelvic surgery, or endometriosis. The incidence of abnormal laparoscopic findings in infertile females with a normal hysterosalpingogram ranges from 21-68 . Abnormal findings can usually be corrected at the same laparoscopic setting. During the course of a diagnostic laparoscopy for infertility, the pelvis is carefully surveyed for the presence of endometriosis, adhesions and uterine abnormities. Tubal patency is checked by injecting dilute solution of methylene blue into the uterine cavity through the cervix. Tubal patency is indicated by the passage of the blue dye from the fimbriated end of the tube. Pelvic...

An Overview of Female Infertility

Medical Algorithm

When evaluating a patient for infertility, ideally the medical history and physical exam are obtained from the couple. One must obtain a complete obstetrical and gynecological history from the female. The menstrual history is an excellent indictor of ovulatory status. A complicated obstetrical history may suggest the need for maternal fetal medicine consultation prior to initiating therapy, especially if the planned infertility treatment predisposes to multiple births. The gynecologic history can give clues about risk factors for tubal scarring (Chlamydia infection, surgery for endometriosis) or cervical factor infertility (ablation for abnormal Pap smear). The sexual history is obviously relevant. The sexual history should include frequency of coitus especially in the periovulatory period. Complaints of sexual dissatisfaction are common among infertile couples who often feel that spontaneity is lost in striving to achieve pregnancy. Dyspareunia may suggest that endometriosis is the...

Assisted Reproductive Technology

Recurrent pregnancy loss, endometriosis, birth defects, premature ovarian failure Tubal ligation, ovarian cysts, endometriosis, pelvic infections, appendectomy, D&C As mentioned previously, IVF is the most common ART procedure performed. Although IVF was originally designed to treat tubal disease, it is now utilized as a treatment for many causes of infertility. In addition to tubal factor infertility, other indications include endometriosis, male factor infertility, ovulatory disorders, unexplained infertility, ovarian failure, and a history of inheritable disease. Endometriosis Endometriosis accounts for approximately 6.7 of indications for ART in the US. Mild, moderate, and severe endometriosis has been shown to decrease fertility rates in women undergoing both IUI and IVF Pregnancy rates in patients with endometriosis have been demonstrated to have an approximate 45 reduction in pregnancy rates with IVF. Women with moderate and severe disease have a worse prognosis than those with...

Epidemiology of Chlamydia Gonorrhea Syphilis and Corrections Overlapping Populations

Chlamydia and gonorrhea can lead to serious long-term sequelae in women, including chronic pelvic pain, pelvic inflammatory disease, infertility, and ectopic pregnancy (Hook & Handsfield, 1999 Stamm, 1999). Additionally, these infections increase the susceptibility and transmissibility of HIV infection (Fleming & Wasserheit, 1999). Annual chlamydia screening of sexually active women aged 25 and younger is recommended (CDC, 2006b), but there are no guidelines for screening men. Because most chlamydial and gonococcal infections in both females and males are asymptomatic (Hook & Handsfield, 1999 Stamm, 1999), screening and treatment of asymptomatic infections is essential for disease prevention and control. Large-scale screening programs that have been in place for several years have decreased both community chlamydia prevalence and disease outcomes (Addiss et al., 1993 Mertz et al., 1997). The most effective method to control chlamydia is routine screening in high- volume,...

Spectct Imaging Systems

Precise characterization of increased 18F-FDG uptake and retrospective lesion detection on CT, after PET CT. The patient is a 35-y-old man, 22 months after treatment of colon cancer, with negative high-resolution contrast-enhanced CT and normal levels of serum tumour markers, referred for PET scan for assessment of pelvic pain. The coronal PET images (left) show area of increased 18F-FDG uptake in left pelvic region (arrow), interpreted as equivocal for malignancy, possibly related to inflammatory changes associated with ureteral stent or to physiological bowel uptake. Hybrid PET CT (right) transaxial image (top) precisely localized uptake to soft-tissue mass adjacent to left ureter, anterior to left iliac vessels. Mass (arrow) was detected only retrospectively on both diagnostic CT and CT component of hybrid imaging study (bottom). Patient received chemotherapy, resulting in pain relief and decrease in size of pelvic mass on follow-up CT. Reprinted with permission from...

Diagnosis of Local Recurrence

Usual symptoms of a recurrent tumour are pelvic pain (sometimes with radiation to lower extremities), rectal bleeding and change in bowel habits. For easier classification and assessment of treatment and prognosis, we can divide patients into groups according to symptoms as S0, asymptomatic S1, symptomatic, without pain S2, symptomatic with pain 9 .

Can We Learn Something About Ovarian Cancer Biology From Pace4 Mutant Mice

Function and infertility lead to atrophy of the endometrium and secondary Mullerian system 70 an association of increased risk for EOC occurs with a history of infertility and some conditions including endometriosis 71 . There is significant evidence that the majority of cases of ovarian endometriosis likely represent a metaplastic alteration of the OSE 72 and ovarian endometriosis may undergo a variety of cytologic alterations 73-75 , including tubal ciliated alteration and 'hobnail' alteration, similar to those identified in the Pace4- - mice. Future work will attempt to elucidate mechanisms by which there is an increased risk of ovarian and endometrial cancer with infertility and aging. We are continuing to evaluate ovarian and uterine morphology to develop a more complete picture regarding the nature of the alterations and determine the timing of the changes in cellular morphology in the Pace4- -animals.


Dinulescu DM, Ince TA, Quade BJ, Shafer SA, Crowley D, Jacks T (2005) Role of K-ras and Pten in the development of mouse models of endometriosis and endometrioid ovarian cancer. Nat Med 11 63-70 73 Lauchlan SC (1966) The cytology of endometriosis. Am J Obstet Gynecol 94 533-535 74 Czernobilsky B, Morris WJ (1979) A histologic study of ovarian endometriosis with emphasis on hyperplastic and atypical changes. Obstet Gynecol 53 318-323 75 Fukunaga M, Ushigome S (1998) Epithelial metaplastic changes in ovarian endometriosis. Mod Pathol 11 784-788


Two main theories attempt to explain how endometriosis disseminates outside of the endometrial cavity and at almost all body sites (1) the retrograde menstruation theory, whereby, endometrial cells via menstrual flow efflux through the fallopian tubes to implant and develop in ectopic sites and (2) the metaplastic theory, whereby peritoneal serosa or the Mullerian remnants spontaneously differentiate into endometrial tissue in ectopic locations. Endometriosis is a slow and progressing condition which justifies its classification into three types (1) superficial endometrio-sis, which may start as papules that turn red and finally black (2) ovarian endometrio-mas (3) deeply infiltrating endometriosis. Several factors such as anatomical defects (uterine anomalies), environmental toxins (dioxin), defects in immune regulatory cells (diminished clearing by macrophages), elevated inflammatory mediator expression (elevated prostaglandin levels) and recently, growth mediators (elevated...


Goals of treatment should involve addressing patient's primary complaints as well as reproductive wishes. The most comprehensive treatment plan will include relief of symptoms, removal of all endometriotic lesions, and restoration of pelvic anatomy and delaying progression of the disease. Despite important advances in treating endometriosis, the optimal therapy has not been yet identified. Medical and surgical therapies, individually or in combination, may be needed to achieve the appropriate treatment plan.

Medical Treatment

The mainstay of medical therapy focuses on the principle that endometriosis is an estrogen-dependent condition. Many clinical observations show that estrogen is essential for the growth of endometriosis. Endometriosis has been shown to regress and become inactive in states of amenorrhea and menopause. Therefore, treatment of endometriosis often relies on drugs that suppress ovarian steroids and induce a hypoestrogenic state that causes atrophy of ectopic endometrium. The most widely used agents to achieve this goal are oral contraceptives and GnRH agonists. The evidence-based support for medical therapy is mostly observational.

Oral Contraceptives

This regimen may be used for women who suffer from dysmenorrhea or pelvic pain. Symptomatic relief can be achieved in 75-100 of women in observational studies. Continuous use of OCs prevents the cyclic fluctuations of serum levels of ethinyl estradiol and progestogen and, hence, the cyclic variations of metabolic serum parameters. Although the long-cycle regimen is initially associated with an elevated rate of irregular bleeding, the total number of bleeding days that require sanitary product protection is lower than during conventional OC treatment. Many physicians tend to prescribe extended OC cycles for postponement of menstruation or reduction of frequency of regular bleeding.

New Therapies

Mifepristone, an antiprogestogen, is currently being studied. This appealing therapy to treat endometriosis may work without suppressing ovarian function. Aromatase inhibitors may have similar characteristics as they can inhibit estrogen production selectively in endometriotic lesions without affecting ovarian function an observational trial in a small group of women who had exhausted all other medical therapies including GnRH agonists showed reduction in pain symptoms. Levonorgestrel intrauterine device has proven effective in relieving dysmenorrhea associated with endometriosis, as well as pain associated with rectovaginal endometrio-sis. This approach is promising in the long-term management of endometriosis as it limits systemic absorption of hormones, minimizing side effects. The most current research has targeted anti-inflammatory mechanisms and modulators of the immune system. TNF-binding protein-1 and IL-12 have been shown to be effective in reducing endometriotic lesions in...

Surgical Treatment

Often surgical treatment is considered when medical therapy has failed. With advances in laparoscopy, this technique has become the method of choice in the surgical evaluation and treatment of endometriosis. Laparotomy may still be used in cases of severe endometriosis which may involve other major organs and if adhesive disease is suspected. However, in all other cases, laparoscopy offers both diagnostic and therapeutic capabilities by confirming the presence of endometriosis and then the option to resect if reasonable. Laparoscopy also has many advantages (1) being an outpatient procedure (2) minimizing hospital stay (3) lowering morbidity (4) smaller incisions and (5) superior visualization of lesions. Although there is controversy concerning the optimal approach to the treatment of endometriosis, the general opinion is if surgery is being performed then resecting as much of the visualized endometriosis as possible should be the goal. Laparoscopic resection of endometriosis...

Natural History

FGS symptoms and signs are nonspecfic and may be confounded by those of other pelvic disease irregular menstruation, pelvic pain, vaginal discharge. Lesions can grow for months and years. If in the vagina or vulva they may lead to hypertrophy and obstruction. They can be painful or painless.

Ovulation Induction

Polycystic Ovarian Syndrome Etiology

Unexplained infertility Endometriosis Male-Factor infertility IVF Gonadotropins may be used in regularly ovulating women in order to increase their fecundability. Gonadotropin therapy is often used in conjunction with IUI in patients with unexplained infertility, mild male-factor infertility, and mild moderate endometriosis, with improved pregnancy rates. In women with endometriosis, gonadotropin treatment with IUI resulted in a 5-fold increase in pregnancy rates when compared to no treatment. In unexplained or male-factor infertility, gonadotropin treatment with IUI resulted in a 1.7-fold increase in pregnancy rates when compared to IUI alone. Controlled ovarian hyperstimulation is often performed with a fixed-dose protocol, starting stimulation on cycle day 3 at an FSH or hMG dose of 150-225 IU day for 5 days. Ultrasound and estradiol monitoring is then performed every 1-2 days once a follicle 10 mm is identified. Criteria for follicular maturation with hCG are identical to other...


As for other causes of abnormal vaginal bleeding, pregnancy-related bleeding may occur in both abnormal and essentially normal pregnancies, and thus the possibility of pregnancy must always be considered prior to intervention. In particular it is important to make a diagnosis of an ectopic pregnancy as early as possible, allowing for early medical or surgical treatment. The abnormal bleeding that occurs vaginally during a tubal pregnancy is nearly always a consequence of endometrial shedding secondary to abnormal corpus luteum function. This bleeding often precedes pelvic pain symptoms which are generally a consequence of tubal rupture and or intrapelvic bleeding. ovulatory women using the LNG-IUS continue to ovulate regularly. Interestingly, despite continued ovulation, women with endometriosis and ovulatory DUB have reduced dysmenorrhea symptoms after LNG-IUS insertion. Furthermore, women with abnormal bleeding attributed to myomas also experience decreased bleeding after LNG-IUS...


Diagnosis of endometriosis is often problematic. Although patients classically present with pelvic pain, dysmenorrhea, dyspareunia, pelvic mass and infertility, there are also many patients who are asymptomatic. It has been found that 25 of all women who experience pelvic pain and 40-50 of infertile women have endometriosis. Most symptoms that women experience are a result of local infiltration of endometriosis into the pelvis pelvic pain, dyschezia (painful defecation), abdominal bloating, dyspareunia, back pain, dysuria and suprapubic pain. Menstruation can greatly accentuate these symptoms. Because of the poor correlation between these symptoms and the diagnosis of endometriosis, there should be a careful clinical evaluation in combination with judicious use and critical interpretation of laboratory tests, imaging techniques, and, in most instances, surgical staging combined with histological examination of excised lesions. A thorough medical history should be taken focusing on...


Progestins can cause suppressed gonadotropin levels to induce a hypoestrogenic state. Because of its direct action on the endometrium resulting in atrophy and decidualization, it is believed the mechanism of action is similar on endometriosis. Medroxyprogesterone acetate (150 mg of the Depot product every 3 months) can be used as a treatment for endometriosis. The side effect of slow return to ovulation is often seen as an undesirable side effect in women desiring fertility.

51 Tips for Dealing with Endometriosis

51 Tips for Dealing with Endometriosis

Do you have Endometriosis? Do you think you do, but aren’t sure? Are you having a hard time learning to cope? 51 Tips for Dealing with Endometriosis can help.

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