More than five million girls and women in North America suffer every month with blinding, excruciating and debilitating pain that robs them of the joy of every day living. They are suffering with endometriosis, an incurable condition caused by the spread and growth of tissue from the lining of the uterus (called endometrium) outside the uterine walls, typically in and around the pelvic and abdominal areas where it should not grow.
According to Sanjay Agarwal, M.D., Director of the Center for Reproductive Medicine at Cedars-Sinai Medical Center and board-certified in Reproductive Endocrinology and Infertility, any menstruating woman from the start of her first period to menopause can develop this condition. It occurs most commonly in women between ages 25 and 40 who have not yet had children. Approximately 30% of women with endometriosis suffer with infertility problems. Yet with all that is known, this disorder is still commonly misunderstood by patients and too often overlooked by the medical community.
That was the case for 42-year-old Camille Kimball, a journalist from Phoenix, AZ. After suffering with the severe pain and other symptoms of endometriosis since age 12, Kimball was finally diagnosed just 10 years ago.
"I never even heard the term endometriosis until I was about 26," she recalled. "All that time I just thought I was a wimp because I could not handle the crippling pain. I thought my pain was what every woman felt each month. I did not know what normal period pain was."
Over the years, her journey to find a treatment for her condition included visiting a wide variety of physicians for testing, a growing course of ever-stronger pain medications and even surgery. While the surgery lessened her symptoms for a short time, the pain came back and started to hit her in between her cycles. Facing a life filled with continuous, agonizing pain and not wanting additional surgery, Kimball contacted Dr. Agarwal, who is also a board-certified obstetrician and gynecologist. He began treating her with a COX-2 inhibitor anti-inflammatory oral medication, originally tested as an arthritis treatment that has shown tremendous benefits in pain management. Additionally, it is a non-invasive treatment that is not addictive.
"Several studies in Europe and the United States indicate that women often suffer for at least a decade before a diagnosis of endometriosis is made," Dr. Agarwal noted. "Living with such severe pain very negatively impacts a woman's quality of life and such suffering does not have to continue. The good news is that there are increasing number of medical options for women with endometriosis today."
Dr. Agarwal explained that improvements in the medical management of endometriosis would likely come from two areas in the future -- an improved finesse in the use of current medications such as birth control pills or GnRH agonists and with the availability of new classes of medications. "As our understanding of the disease improves over time," he noted, "further classes of medications may also become available to patients."
Early diagnosis is essential, says Dr. Agarwal. "Any woman who experiences disabling menstrual pain and excessive bleeding, vomiting, extreme pelvic, lower back pain and/or gastric pain each month and requires time off from work and her daily activities, should see a medical expert to discuss endometriosis," he advises. "No woman should think that these symptoms are normal. They are not a normal part of being a woman."
Today, Camille Kimball has found her life again. She knows it is not a cure but remains optimistic about her health. "This treatment has enabled me to get back to living my life again and I am so very grateful," she concluded. "With relief from the pain, I feel like a new woman."
Cedars-Sinai is one of the largest nonprofit academic medical centers in the Western United States. For the fifth straight two-year period, it has been named Southern California's gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and superlative medical education. Named one of the 100 "Most Wired" hospitals in health care in 2001, the Medical Center ranks among the top 10 non-university hospitals in the nation for its research activities.
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