Medicine: The Career Woman's Disease?

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Each month K.C. Esperance, 31, a San Francisco nurse practitioner, suffered menstrual cramps so agonizing that she would take to her bed, curl up and pray that she would live through the next couple of days. Doctor after doctor gave her the same ineffectual advice: rest, take some codeine and bear with it.

During her teens, Maria Menna Perper, 42, a New Jersey biochemist, suffered intestinal problems around the time of her period. By her late 30s, she felt "excruciating, burning pain" in her colon every month "like clockwork." Eventually the pain became continuous, and it was impossible for her to work or even sit down.

For Anne Hicks, 29, a Portland, Ore., real estate property manager, there were no obvious signs other than her inability to become pregnant.

Despite their differing complaints, each of the women eventually discovered that she suffered from the same insidious condition: endometriosis, an often unrecognized disease that afflicts anywhere from 4 million to 10 million American women and is a major cause of infertility. The condition is caused by the spread and growth of tissue from the lining of the uterus (or endometrium) beyond the uterine walls. These endometrial cells form bandlike patches and scars throughout the pelvis and around the ovaries and Fallopian tubes, resulting in a variety of symptoms and degrees of discomfort. Because endometriosis has been associated with delayed childbearing, it is sometimes called the "career woman's disease." But recent studies have shown that the disorder strikes women of all socioeconomic groups and even teenagers, though those with heavier, longer or more frequent periods may be especially susceptible. Says Dr. Donald Chatman of Chicago's Michael Reese Hospital: "Endometriosis is an equal-opportunity disease."

How the disease begins is something of a mystery. One theory ascribes it to "retrograde menstruation." Instead of flowing down through the cervix and vagina, some menstrual blood and tissue back up through the Fallopian tubes and spill out into the pelvic cavity (see chart). Normally this errant flow is harmlessly absorbed, but in some cases the stray tissue may implant itself outside the uterus and continue to grow. A second theory suggests that the disease arises from misplaced embryonic cells that have lain scattered around the abdominal cavity since birth. When the monthly hormonal cycles begin at puberty, says Dr. Howard Judd, director of gynecological endocrinology at UCLA Medical Center, "some of these cells get stirred up and could be a major cause of endometriosis."

If anything about endometriosis is clear, it is that once the disease has begun, it will probably get worse. Stimulated by the release of estrogen, the implanted tissue grows and spreads. Cells from the growths break away and are ferried by lymphatic fluid throughout the body, sometimes, although rarely, forming islands in the lungs, kidneys, bowel or even the nasal passages. There they respond to the menstrual cycle, causing monthly bleeding from the rectum or wherever else they have settled.