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AN ALTERNATIVE THEORY OVERVIEW
An alternative theory of the origin of endometriosis has been developed by David Redwine, M.D., or St. Charles Medical Center in Bend, Oregon. Dr. Redwine disagrees with those obstetrician/gynecologists who accept reflux menstruation as the cause of endometriosis. Instead, he proposes that endometriosis is actually a type of birth defect. During fetal development, cells that are destined to become part of the female reproductive organs differentiate and migrate toward the appropriate locations. But if the mechanisms that control this process do not function properly, some endometrial cells may be "left behind" in places they do not belong, where they become embedded and grow.
Initially, these bits of misplaced tissue are colorless, but over time the tissue begins to change into the lesions known as endometriosis, probably at least in part in response to stimulation from sex hormones. The lesions begin to change color and gradually become darker until they appear as classic dark-colored implants found primarily in women in their 30's. Before they reach that stage, however, they may appear white, yellow, red, or brown, and many colors in between. Thus, according to Dr. Redwine, endometrial growths only appear to spread progressively throughout the pelvis - that is, they are there all the time, even before birth, but they are not usually recognized for what they are until they take on a sufficiently dark color, a process that occurs over time.
Based on his understanding of the disease, Dr. Redwine developed a treatment for endometriosis is which the implants are physically removed through surgery. Using a laparoscope, the surgeon examines the entire pelvic cavity and the entire peritoneal surface at very close range to identify any possible endometrial lesions. Then all suspected endometrial growths are removed. Each lesion is biopsied and a tissue sample analyzed in a laboratory to determine whether or not it is endometrial in origin. With this identification method, Dr. Redwine says that he has been able to demonstrate that lesions other than the black "powder-burn" lesions normally considered characteristic of the condition have been endometrial in origin.
Many women who undergo surgery for endometriosis are diagnosed with recurrences later. This would seem to support the idea that this is a progressive disease that tends to come back despite treatment. However, Dr. Redwine maintains that the reason so many women have recurring problems with endometriosis is that only a portion of their endometrial implants are removed in surgery. Most surgeons remove only the "typical" black powder-burn lesions and chocolate cysts. Dr. Redwine estimates that a surgeon who excises only the black lesions may leave behind from 50 to 60 percent of the actual disease behind; he has found that only 40 percent of his patients have the typical lesions, while 60 percent have the multicolored, "atypical" type. He believes that endometriosis is indeed curable, as long as all the lesions - both typical and atypical, and not only within the pelvic cavity, but on the peritoneum as well - are removed. His follow-up studies indicate that after surgery, approximately 20 percent experience an improvement in symptoms so that what was disabling pain becomes only minimal pain. Only about 5 percent report no relief. Dr. Redwine's treatment is now used also by several other gynecological surgeons in the United states.
The following table outlines some of the key differences between Dr. Redwine's theory and conventional medical theory.
ENDOMETRIOSIS THEORIES CONTRASTED
Conventional Theory Dr. Redwine's Theory Caused by retrograde menstruation. Caused by a defect in embryonic cell differentiation. A progressive disease primarily of women over 30. A static disease affecting women of all ages. Associated with menstruation. Independent of menstruation. Causes infertility. May be associated with infertility, but is not the actual cause of it. Lesions bleed monthly. Lesions do not bleed. Most lesions are black. Lesions may be clear, white, pink, red, brown, black, or multicolored. Most are not black. Peritoneal implants are not considered to be endometrial in origin. Peritoneal implants have been proved to be endometrial in origin. Recurrence following removal of lesions is common. Recurrence following removal of lesions is rare if both typical and atypical lesions are removed. Hysterectomy is recommended for severe cases. Surgery provides undependable levels of relief. Surgical removal of all typical and atypical lesions is the treatment of choice for this disorder, and can provide complete relief in up to 75 percent of cases. Further information on Dr. Redwine and his approach to endometriosis treatment can be obtained by writing to the Endometriosis Treatment Program, St. Charles Medical Center, 2500 NE Neff Road, Bend, OR 97701-6015, or by calling (503) 382-6904. The website can be found at www.endometriosistreatment.org.
LINKS
MoonDragon's ObGyn Information: Endometriosis
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