Endometriosis: A Hysterical History

Endometriosis: A Hysterical History

It's anything but funny.

Leeches: so common a tool in medical history that for part of the 1800's, France was importing about 33 million leeches annually. With so many to keep track of, one journal advised doctors to count their leeches before and after a bloodletting for gynecological conditions — because a leech lost in a woman's uterus would cause not only extreme physical pain but also undue mental stress.

Yes, you read that correctly. Internal bloodletting. Leeches up the vagina. Aren't you glad to live in the 21st century?

By now, modern medicine understands that endometriosis is an extremely painful gynecological condition where cells from the endometrium — that is, the innermost layer of the uterus — show up elsewhere in the body. These growths of endometrial cells, also called ectopic lesions, cause infertility in affected women as well as inflammation and scar tissue wherever they grow. That scar tissue can turn into adhesions, sticking abdominal organs together (ow). This condition affects about one in ten women, which means a conservative estimate would be over 15 million people suffering from endometriosis in the United States alone. The only sure diagnosis is through laparoscopic surgery (inserting a camera to get a clear view of the lesions), and the only current treatment of the root cause (the lesions) is through surgery (deep tissue excision or total hysterectomy, which doesn't always help). Symptoms can be treated with painkillers and hormone therapy, but that's the same broad treatment for most gynecological conditions. Even with so many women affected, progress in understanding this disease has been slow.

A basic description of endometriosis was first given around the fifth century B.C.

The writers of the Hippocratic Corpus, of the fourth and fifth centuries B.C., narrowed down the symptoms of a gynecological disease to four main factors: pain, infertility, menstrual dysfunction and temporary relief with pregnancy. Although there was some suggestion that social class may influence the condition (that it was somehow only a condition of the upper class), these four symptoms would form a common thread connecting various seemingly distinct conditions with various names that wouldn't be connected in the medical field for thousands of years. Though we now refer to the condition as endometriosis, its most popular name for centuries was "suffocation of the womb" first coined by the Greek philosopher Plato (375 B.C.). According to him, this suffocation occurs because a uterus left too long without pregnancy starts to wander around the young woman's body, hungry for motherhood. If it wanders too far, the tubes get tangled and it is unable to breathe. Women so afflicted in ancient Greece would be treated with succession, the practice of tying the patient upside down on a ladder and shaking them until the womb returns to its proper location. The best prevention method they could come up with was to have girls get married and pregnant as soon as possible after puberty so as to satisfy this hungry and animalistic organ. This method of thinking about gynecological conditions likely contributed to the culture of early marriage for women throughout history and is actually still used in some parts of the world.

After about 500 years of descriptions of extreme pelvic pain causing convulsive fits, persistent infertility, organ adhesions and ligaments infiltrated with endometrial tissue, in the second century A.D., Galen of Pergamon concluded that on one hand, suffocation of the womb might be caused by menstrual blood flowing backwards and becoming anchored in the wrong organs (a theory still used today, called retrograde menstruation theory), and on the other hand, the condition is also likely psychological in nature because young widows simply must go mad after "their loss of sexual fulfillment."

Given centuries of medical research on this kind of pain... Meh, it's all in her head.

This was the first time that gynepathology was authoritatively linked with psychology (though the Hippocratic Corpus also vaguely suggested a link), and it was far from the last. From this seed of thought, the idea that women in chronic, invisible pain are just crazy would persist for millennia. Women would be labeled hysterical, blamed for their conditions, locked in madhouses that civilians visited for entertainment, and treated with shock therapy.

But that's up to the 19th century — let's not get ahead of ourselves. We wouldn't want to miss witchcraft and demonic possession, right?

She's a witch, and she's a witch, and she's a witch...

During the Middle Ages — or the Dark Ages of Europe — the supernatural found its way into the scientific scene. Whether a convulsive fit of pain was blamed on the woman herself being possessed, who was then exorcised, or was blamed on the neighbor across the street, who was then sent to the pillory or executed on charges of witchcraft, women got the worst of this new companionship between the mystic and the medical. Despite new observations on the anatomy of suffocation of the womb, such as an association with ulcers, treatments developed during the Middle Ages included those such as "shouting therapy" and other painful or torturous prescriptions with the idea that a malady like invisible pelvic pain is caused somehow by the woman's bad behavior, so the treatment must be karmic in response. We have to look elsewhere in the world for a bit of level-headedness. For example, it was Avicenna, the Persian polymath, who finally determined that pain was solely biologic and had zero medical benefits. Yet, with no cause of the chronic pelvic pain in sight, ideas of demons and magic as a cause of suffocation of the womb persisted through the Middle Ages and into the Renaissance. Occasionally, a physician would be called in as a witness during witchcraft trials, and it's known that Dutch physician Johannes Weyer and English physician Edward Jorden defended the women accused of witchcraft, insisting that the allegedly supernatural symptoms were in fact entirely natural conditions of the uterus.

The women were found guilty.

Women like them were found to be witches while, at the same time, physicians searched for a medically treatable cause of their ailment. There were two paths of research happening in parallel — some physicians, such as Thomas Sydenham, began to flesh out theories of a psychological cause of "hysteria," while others, like William Harvey and Johannes Vesling, looked to autopsies for a physical source of suffocation of the womb. Both of these paths would develop into the 20th century, and it appears that the treatment a woman got depended on whether she was recommended to a physician or a psychologist for her symptoms.

Physicians and psychologists gave wildly different treatments, but both would appear to have hundreds of years of research backing up their conclusions.

Women diagnosed with hysteria were held in the worst of mental institutions, including the infamous St. Bethlehem Hospital (commonly known as Bedlam), where they were physically restrained with chains and straitjackets. In France, many were held at Salpêtrière outside of Paris. The "hystero-epileptic" ward was entirely comprised of young women, the vast majority complaining of ovarian pain, yet even when the famous French psychiatrist Jean-Martin Charcot visited and made note of this common thread that should have pointed to a gynapathological condition, he concluded that the condition was psychiatric in nature. There was no reason, it seemed, to stop sending these "hysterical" women to the worst of prisons: mental institutions of the 19th century.

Meanwhile, physical signs of endometriosis were noticed most clearly in 1852 by Edward Tilt and in 1858 by Armand Trousseau, who identified the lesions on a macroscopic scale, and named the disease "catamenial hematoceles." It was finally in 1860 that Karl von Rokitansky discovered microscopic signs of endometriosis. Looking at strange tissue growths and uterine polyps, he noticed striking similarities between the growths and the characteristics of endometrial tissue, specifically the presence of glands that should only be present on the tissue inside of the uterus. These findings would be confirmed (or re-discovered) in 1921 by John Sampson, who would then coin the term "endometriosis" in 1927. Importantly, in 1887, Franz Wickel was the first to realize that it was women with very small endometriotic lesions who were most likely to be diagnosed with hysteria and sent to mental institutions, as the lesions were virtually undetectable.

20th century progress (mostly).

In the 1900's, a woman with pelvic pain but no clear cause could still be referred to psychiatrists, but progress in treatment and public awareness was rapidly increasing. Hysterectomy and specific nodule removal surgeries became more advanced with the introduction of non-video laparoscopy in the 1940's. In the 1950's, pelvic exams, previously considered a vulgar suggestion in the United States, became a common procedure with the rising awareness of cervical cancer and the introduction of the Pap smear. It was also in the 1950's that, with the vision of Margaret Sanger, the funding of Katharine McCormick, and the science of George Pinkus that the hormonal contraceptive pill was first introduced, and women with endometriosis were some of its earliest recipients. Unfortunately, the pill at that time used such high doses of estrogen that its side effects included cancers. Research didn't always move forward, though. In 1949, an investigator brought back theories from ancient Greece when he asked, "Is endometriosis principally a disease of the higher social and economic levels of society?"

Video-assisted laparoscopy was developed in the 1970's, and over time the cameras became smaller and the surgeries more precise. While surgical precision and awareness of rampant misdiagnosis have increased in the last few decades, there is still much confusion over the best treatment options for endometriosis. With only laparoscopy as a diagnostic, there is an average of seven years between the onset of symptoms and a diagnosis of the condition. Treatments now include full hysterectomy, deep tissue excision and hormone treatments — none of which tend to work on the first try. This leads women to get multiple surgeries in attempts to treat their chronic pain. Even as recently as 1995, reports have shown that over 50 percent of women complaining of chronic pelvic pain were told there was no "organic" basis for their complaints, thus leaving them forever untreated, or labeling them mentally unstable, or they're even recommended pregnancy as a treatment — the same archaic conclusion as thousands of years ago.

After thousands of years of ambiguity and belittling, it's clear that more information is needed about endometriosis.

Frustratingly, some recent researchers purport to quantify the relative attractiveness of women with endometriosis, or characterize personality traits of women with pelvic pain.

However, many researchers are taking steps in useful, foundational research, working out the molecular markers of the condition, some of which might be treatable with prescription drugs or be useful as a diagnostic red flag as an alternative to laparoscopy.

Cover Image Credit: Medarus

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To The Teacher Who Challenged Me, Thank You For Seeing My Potential And Acting On It

Thank you for taking the time out of your already busy life to care about me, to alter my life.

Dear Mentor,

Before I came to your class, I was stagnant. I was stagnant as a performer and as a student. I was content with doing the best I could with what was given to me and not looking for the opportunities to get ahead. I found a comfort zone in how to pursue my life and everything was running smoothly. I had already had enough stress from moving to a new high school my senior year and having to figure out life that way. I was perfectly content with how easy my senior year was going to be.

Then I pushed my way into your Advanced Theatre class and was cast as the comedic relief in the fall play, "The Best Man." Comedy was my strong suit. Comedic relief was the only character I had portrayed because no one else could see me as anything but the stereotypical big, funny girl. And you saw me for something else.

You pushed me to the limits in my acting abilities, and you gave me extra responsibilities to help me mature, such as being in charge of props and helping the younger theatre people with their lines and acting tactics.

You made me realize all of my potential.

You challenged me to dig deeper, especially during our competition play, "The Lost Boy." Maureen was such a distraught and serious character, it made me have to evaluate her feelings and how I would feel in her place. The closeness we all felt together during that play is where I got the inspiration for my first tattoo: "two stars to the right and on 'till morning."

Every time I look down at my arm I remember the family you built for me and how I knew I was meant to become a teacher like you for other students like me.

You are my inspiration to push others towards their full potential, towards the road that they are best suited for.

You encouraged me to become a better me and I would not be the woman I am today on the path that I'm on without your encouragement and at times, tough love.

Thank you for taking the time out of your already busy life to care enough about your students, specifically me, to alter my life. To love me like a caring mother and mentor me as no one else had before.

Thank you, Mrs. Vici Anderson, for being what I needed in my life when I thought I was happy. Every student deserves a teacher or mentor such as yourself.

Thank you. I think about your encouragement every time I dread going to my college classes and remember why this will all be worth it.

Cover Image Credit: instagram @abercombie

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20 Signs You're A Freshman At The University Of Illinois And You Wouldn't Have It Any Other Way

If you know, you know.

I-L-L-I-N-I. The place where dreams come true.

1. You either live in Bromley or hate on the people who live there

Home sweet Brom baby.

2. You Uber a block because it's too cold

Honestly, judge me. I am also judging myself.

3. Monday night Joe's is your saving grace

It truly is a freshman hotspot.

4. Waiting for 19 like…

My heart goes out to all those with summer birthdays.

5. You never knew bikers could be so aggressive

You are not entitled to run me over just because you're on a bike, sir.

6. You go home on random weekends just to see your dog

We do it because we can.

7. You have Jimmy Johns, Chopstix, and Domino's on speed dial

If you live in Bromley you’ve definitely called the wrong Jimmy John's on Green Street once or twice.

8. You probably haven't been to a football game yet

But at least you go to block every weekend!

9. You’ve walked passed Lion and whispered to yourself “one day”

Are the security guards really necessary?

10. Your friends at other schools are worried about your liver

This is not as much a freshman thing, but more like a University of Illinois thing.

11. You've bought wayyy to much stuff at Ragstock for themed parties

No one prepared me for the number of costumes I would need in college.

12. You’ve gotten a few *19* IDs taken away

"He asked me what year I graduated from high school and I freaked out and couldn't do the math."

13. You have tried to explain the squirrel situation to a non-Illini

The squirrels here are wack. I have also developed an irrational fear of them.

14. You get defensive when visitors call "block" a tailgate

"Shut up Mallory, you don't even go here. Go back to Michigan."

15. Your tongue is blue after most nights out

Shoutout to you, Kams, the true MVP.

16. You’ve cursed at yourself for not going to a warm school

I'm not even mad that I got denied from Tulane.

17. You’ve commented on the "beautiful scenery" once or twice

And on your left, you can see some more cornfields.

18. Your only friends are from Illinois, and it’s super convenient

I really don't have friends from other states.

19. You've spent a lot of your "college money" on trips to Evergreen and Hometown Pantry

I need a job.

20. You’ve realized that if you had chosen any other school you would have been miserable

Best decision I've made so far.

Cover Image Credit: Maya Kowitt

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