The Pink Papers is a collection of three short stories and a novel in progress consisting of four chapters. Each piece is a work of original fiction. The preface addresses the female writer and the female voice in fiction. "Broken Clock" and "Pink Paper" are the stories of two girls coping with endometriosis. "Normal Capacity" looks at the loss of a dream through the eyes of a first-year law student. The novel in progress, titled Blanchard, OK, is set in a rural farming town in Oklahoma. The novel tells the stories of 24-year-old Robin, her Aunt Paula, and Paula's boyfriend, Sam.

Thesis (Ph. D.)--University of Missouri--Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 180-198). Also available on the Internet.

Endometriosis or the "career woman's disease" is a puzzling disease affecting women in their reproductive years. Research on endometriosis has focussed on aspects such as the personality characteristics of sufferers and its correlation with infertility (Venter, 1980). As yet, the experiential world of endometriosis sufferers and the relationships which are influenced by their disease have received little attention (Weinstein, 1987). Furthermore, endometriosis is construed as a physical disorder which is medically diagnosed and medically treated. As such, the epistemology surrounding the term "endometriosis" is an adherent to a largely non-contextual, non-systemic and intrinsically mechanistic biomedical model (Bogdan, 1984; Schwartz, 1982). By using an ecosystemic epistemology, this dissertation will attempt to describe the unique experiential world of the afflicted woman in terms of her coping strategies in dealing with endometriosis and to formulate a description of the interactional patterns between herself and significant others directly influenced by her disease. / Psychology / M.A. (Clinical Psychology)

Background: Endometriosis is a common condition in women of reproductive age, causing pelvic pain and subfertility, but little is known about its impact on health-related quality of life (HRQoL) and work productivity worldwide. Methods: In 10 countries across five continents, this study recruited 1,418 women, aged 18-45, without a previous surgical diagnosis of endometriosis, scheduled to undergo a laparoscopy to investigate symptoms suggestive of endometriosis or to be sterilised. Pre-operatively, women completed a standardised questionnaire assessing symptoms, diagnostic delay, HRQoL and work productivity using validated instruments. Surgeons completed a standardised questionnaire incorporating findings at laparoscopy including endometriosis stage according to revised American Fertility Society criteria. Results: There was a mean delay of 9.2 years (SD 8.8), principally in primary care, between the onset of symptoms and diagnostic laparoscopy. This diagnostic delay was longer in centres where healthcare was predominantly state-funded (12.8 vs. 7.6 years; p<0.001). In multivariate analyses, the delay was positively associated with the number of pelvic symptoms (chronic pelvic pain, dysmenorrhoea, dyspareunia and heavy periods; p<0.001) and a higher body mass index (p<0.001). Physical HRQoL was significantly reduced in affected women compared to those with similar symptoms and no endometriosis (p=0.012). Not being in paid employment, severe pelvic pain and moderate-severe disease were associated with reduced physical HRQoL (all p<0.001). Each affected woman lost on average 10.0 hours (SD 10.6) of work weekly, due mainly to reduced effectiveness while working. The annual indirect cost of endometriosis associated with work productivity loss ranged from US$399 per woman in Ibadan (Nigeria) to US$18,586 per woman in Boston (USA). Conclusions: Endometriosis significantly impairs HRQoL and work productivity across countries and ethnicities, yet women continue to experience diagnostic delays in primary care. A higher index of suspicion is needed to expedite specialist assessment of symptomatic women. Future research should seek to clarify pain mechanisms in relation to endometriosis severity.

Endometriosis is a common cause of subfertility and pelvic pain, affecting up to 10% of women of reproductive age. It is characterised by the presence of endometrial-like tissue outside the uterus. The development of the disease is still poorly understood and, currently, the diagnosis relies on visualisation of typical lesions during surgery. There is great interest in identifying biomarkers to assist in diagnosis and disease management. Blood vessel development is known to be a crucial feature of endometriosis, but the mechanisms involved in angiogenesis are not well described for this disease. Most vessel development relies on the proliferation and migration of pre-existing endothelial cells. However, there may also be roles for cells derived from peripheral blood (circulating angiogenic cells) and surrounding stromal cells. In this thesis, the contribution of these different cell types to vessel development in endometriosis is assessed. In chapter 2, a robust protocol was optimised to identify circulating angiogenic cells (CACs) with flow cytometry. The reliability of the protocol was verified, and the level of these cells was found not to fluctuate with the menstrual cycle in healthy women (P=0.279, F=1.359, 3 d.f.). In chapter 3, levels of CACs in women with and without endometriosis were found to be equivalent (0.0835% ± 0.0422 compared to 0.0724% ± 0.0414), demonstrating that they have no use as a disease biomarker. In chapter 4, isolation and culture of endothelial cells from the endometrium was attempted. However, a pure culture of endometrial endothelial cells could not be obtained, which may be due to contamination by other cell types or cellular transdifferentiation. Finally, in chapter 5, the contribution of endometrial stromal cells to vessel development was considered. Stromal cells were found not to differentiate towards an endothelial cell phenotype, but were able to participate in tube formation assays. However, the presence of endometriosis did not influence this behaviour.

La Endometriosis es una situación muy frecuente en nuestro medio. Para resolverla disponemos actualmente de diferentes alternativas diagnosticas y terapéuticas. Y evaluamos si el diagnostico ecográfico precede al diagnostico laparoscopico en mujeres con diagnostico de infertilidad y posteriormente luego de su tratamiento laparoscopico el porcentaje de éxito de su fertilidad Objetivo: Definir la utilidad de la ecografía transvaginal y su correlación con el diagnostico laparoscópico en pacientes con infertilidad y que fueron llevados a cirugía en el Hospital Nacional Arzobispo Loayza / -- he Endometriosis is a very frequent situation in our means. In order to solve we have it different alternatives at the moment you diagnose and therapeutic. And we evaluated if I diagnose ecográfico precedes to I diagnose laparoscopic in women with I later diagnose of infertility and after its laparoscopic treatment the percentage of success of its. Objective fertility: To define the utility of the transvaginal ecografía and its correlation with I diagnose laparoscopic in patients with infertility and who were taken to surgery in the National Hospital Loayza.

Endometrios är en kronisk sjukdom som drabbar 10–15 procent av alla fertila kvinnor. De vanligaste symtomen är bäckensmärta, menssmärta, samlagssmärta, kraftiga blödningar, infertilitet, förstoppning och diarré. Då symtomen oftast är diffusa och kunskapen om endometrios inom sjukvården är bristfällig tar det mellan 8–11 år från det att kvinnan sökt vård för sin smärta till att diagnosen är fastställd. Syftet med studien var att beskriva livslidande hos kvinnor med endometrios. Studien genomfördes som en integrativ litteraturstudie, vilket ger en djupare förståelse och en mer heltäckande bild av ett visst fenomen. Kvinnorna beskrev sitt livslidande genom att det är bristande förståelse och kunskap om sjukdomen. Detta upplevde de särskilt ifrån vården, familj, vänner, kollegor och partners. Kvinnornas livssituation och fysiska funktioner var begränsade på grund av sjukdomen, detta påverkade det dagliga livet. Utanförskapet var framträdande och att fungera i ett socialt sammanhang var svårt vilket blev till ett livslidande. Det innebar också ett livslidande att leva med ovisshet och oro inför framtiden, där det största bekymret handlade om svårigheter med att bli gravid och att få behålla barnet. En slutsats var att distriktsköterskor bör bli bättre på att uppmärksamma kvinnor med endometrios och tro på deras sjukdomsupplevelser. Mer forskning behövs för att belysa livslidandet hos kvinnor med endometrios och därmed öka kunskapen om hur distriktsköterskor kan bemöta dessa kvinnor. / Endometriosis is a chronic disease that affects 10-15 percent of all women of childbearing potential. The most common symptoms are pelvic pain, menstrual pain, intercourse pain, heavy bleeding, infertility, constipation, and diarrhea. Where symptoms are often diffuse and the knowledge of endometriosis in health care is poor, it takes between 8-11 years from the woman sought treatment for their pain at diagnosis is confirmed. The aim of the study was to describe life-suffering in women with endometriosis. The study was conducted as an integrative literature review, which provides a deeper understanding and a more complete picture of a phenomenon. The women described their life-suffering by it´s lack of understanding and knowledge about the disease. They experienced it particularly from the health care, family, friends, colleagues, and partners. Women's lives and physical functions were limited because of the disease, which affected the daily life. Many women experienced exclusion, having a social life was difficult which lead to a life-suffering. To live with uncertainty and anxiety about the future was also life-suffering, where the main concern was about the difficulties in becoming pregnant and to keep the baby. One conclusion was that district nurses should be better able to pay attention to women with endometriosis and belief in their illness experiences. More research is needed to elucidate the life-suffering of women with endometriosis and thereby improve knowledge about how district nurses best can meet these women.

Bakgrund: Endometrios är en gynekologisk sjukdom som drabbar ungefär var tionde kvinna. Sjukdomen uppstår då fragment av livmoderslemhinnan växer in i annan vävnad utanför livmodern, vilket ger upphov till många fysiska symtom där smärta är vanligast. Dessa symtom påverkar även andra aspekter av kvinnans liv.  Syfte: Syftet var att sammanställa aktuella forskningsresultat om hur kvinnor med endometrios upplever att sjukdomen påverkar dem och deras liv. Metod: En litteraturöversikt med kvalitativ ansats där elva originalartiklar inkluderades. Sökningarna genomfördes i databaserna PubMed och CINAHL. Resultat: Resultatet är uppdelat i följande teman; upplevelser av fysiska begränsningar, upplevelser av psykiska förändringar, upplevelser av sociala begränsningar och förändringar, upplevelser av begränsningar på jobb och studier och upplevelser av existensiella förändringar. Endometrios visade sig ha en stor påverkan på alla dessa aspekter av livet. Kvinnorna upplevde att sjukdomen bland annat påverkade deras mobilitet, sexuella aktivitet, självkänsla, relationer, sociala liv, arbetsliv, skola, fertilitet och livsperspektiv. Slutsats: Sammanfattningsvis påverkar endometrios alla aspekter av kvinnornas liv. Den största delen av kvinnorna upplevde en negativ påverkan på sitt fysiska, psykiska och sociala liv, arbetslivet samt existentiella frågor. Framöver behövs mer kvalitativ forskning för att vidareutveckla bilden av kvinnors upplevelser av att leva med endometrios. Detta för att öka kunskapen kring sjukdomen och därmed möjliggöra för en snabbare diagnostisering, bättre vård och en ökad livskvalitet för kvinnorna. / Background: Endometriosis is a gynecological disease that affects approximately every tenth woman. The disease develops when part of the endometrial lining implants in foreign tissue outside of the uterus, which causes many physical symptoms where pain is most common. These symptoms also affects other aspects of the woman's life. Aim: The aim was to compile current research results of how women with endometriosis experience the disease and how it affects them and their lives. Method: A review of literature research with a qualitative approach where eleven original research articles were chosen. The articles were found through the databases PubMed and CINAHL. Results: The results are presented through the following themes; experiences of physical limitations, experiences of psychological changes, experiences of social limitations and changes, experiences of limitations on work and education and experiences of existential changes. As it turned out, endometriosis had a big impact on all aspects of life. The women experienced that the disease among other things affected their mobility, sexual activity, self-esteem, relations, social life, work, education, fertility and life perspective. Conclusion: In summary endometriosis affects all aspects of the women's lives. The majority of women experienced that the disease had a negative effect on their physical, psychological and social life, work and existential questions. Furthermore, more qualitative research needs to be done to further investigate how women experience life with endometriosis. This is needed to gain more knowledge about the disease and therefore enable improvement in the diagnosis, the healthcare and the life quality of these women.

Endometrios förekommer hos tio procent av kvinnorna i reproduktiv ålder och karakteriseras av att livmoderslemhinnan felaktigt växer utanför livmodern. Det är vanligt att det tar lång tid att få en diagnos och det påverkar kvinnorna både emotionellt och fysiskt. Sjukdomen är kronisk och trots att det finns många olika behandlingsformer är symtomen ofta svåra att bli av med. Att leva med endometrios är en subjektiv upplevelse och det är därför viktigt att sjuksköterskan ger individanpassad och adekvat vård. Kvinnornas situation behöver beaktas för att kunna lindra deras lidande. Syftet var att belysa kvinnors upplevelse av att leva med endometrios. Metoden för studien har varit en litteraturöversikt. Skillnader och likheter jämfördes i de tio resultatartiklarna. Artiklarna har varit av både kvantitativ och kvalitativ design och inhämtades från databaserna PubMed, Cinahl Complete och Academic Search Complete. Ur resultatet framkom fyra teman. Det första temat var Kvinnors välbefinnande med två subteman; Fysik välbefinnande och Psykiskt välbefinnande. Det andra temat var Ekonomiska svårigheter med följande subteman; Sjukfrånvaro och Arbete. Det tredje temat var Förlust av femininitet med två subteman; Sexuell hälsa och Infertilitet. Det fjärde och sista temat var Socialt med kommande två subteman; Relationer till närstående och Betydelsen av stöd. Upplevelsen av att leva med endometrios var förenat med otillräcklig hjälp mot smärta. Hälso- och sjukvården har ett ansvar att ta kvinnans upplevelse på allvar och se till varje unik situation. Det styrks även av Jean Watsons “Human caring science nursing paradigm” där sjuksköterskan behöver arbeta utifrån ett helhetsperspektiv. / Endometriosis occurs in ten percent of the women in reproductive age and is characterized by the endometrium incorrectly grows outside the uterus. It normally takes a long time to get a diagnose which affects the women both emotionally and physically. The disease is chronic and although there are many different therapies the symptoms are often difficult to get rid of. Living with endometriosis is a subjective experience and it is therefore important that the nurse provides personalized and adequate care. The women's situation needs to be considered to alleviate their suffering. The aim was to illuminate the women's experience of living with Endometriosis. The method of the study has been a literature review. Differences and similarities were compared in the ten results articles. The articles have been of both quantitative and qualitative design and were collected from databases PubMed, Cinahl Complete and Academic Search Complete. Four results emerged from the result. The first theme was Women's well-being with two subtemens; Physical well-being and mental well-being. The second theme was Economic difficulties with the following subtemes; Sick leave and work. The third theme was Loss of femininity with two subtemens; Sexual Health and Infertility. The fourth and last theme was Social with upcoming two subtemens; Relationships with related parties and the importance of support. The experience of living with endometriosis was associated with insufficient help against pain. Healthcare is responsible for taking the women's experience seriously and see to every unique situation. It is also reinforced by Jean Watson's "human caring science nursing paradigm" where the nurse needs to work from an overall perspective.

Introdução: A avaliação da reserva ovariana em reprodução assistida (RA) busca identificar mulheres em que a exaustão folicular determine as dificuldades reprodutivas. Além da idade, a presença de causas outras de subfertilidade, como a endometriose (EDT), implica interferências negativas potenciais sobre a resposta ovariana. Objetivo: Avaliar a reserva folicular ovariana de mulheres subférteis portadoras de endometriose e determinar o melhor preditor de má resposta em RA. Métodos: Foram analisados 87 ciclos de RA em mulheres com idade inferior a 40 anos, ciclos menstruais regulares, sem patologias endócrinas e com ambos os ovários, sendo 30 ciclos em portadoras de EDT (casos) e 57 ciclos em mulheres subférteis por fator masculino exclusivo (controles). A reserva ovariana foi inferida pelas dosagens basais dos hormônios anti-mülleriano (AMH) e folículo estimulante (FSH), a contagem de folículos antrais pequenos (CFA) e a medida do volume ovariano médio (VOM). Curvas Receiver Operating Characteristic (ROC AUC) foram traçadas para avaliação da capacidade discriminatória de cada teste em identificar má resposta. Resultados: Pacientes com EDT apresentaram FSH basal significativamente maior em relação aos controles (9,13 ± 5,09 mUI/mL vs. 6,28 ± 2,45 mUI/mL; p < 0,05), sem diferenças para AMH, CFA e VOM. O número total de oócitos aspirados foi menor na EDT em relação aos controles (5,33 ± 3,43 vs. 8,28 ± 5,8; p < 0,05) e correlacionou-se significativamente com o AMH em ambos os grupos (EDT: r = 0,61; Controles: r = 0,58; p<0,0001). O FSH basal apresentou correlação significativa com o total de oócitos aspirados apenas na EDT (r = -0,48; p<0,01); também na EDT, o AMH basal foi o marcador individual com melhor potencial discriminatório para má resposta (AUC = 0,875), seguido de FSH basal (AUC = 0,682) e VOM (AUC = 0,665), enquanto no grupo controle, o AMH foi o melhor marcador (AUC = 0,8372), seguido do VOM (AUC = 0,709) e da CFA (AUC = 0,686). Conclusões: O FSH basal está significativamente maior nas pacientes subférteis com EDT e correlaciona-se com a resposta em RA apenas nas portadoras da doença. Já o AMH basal, é o marcador com o melhor potencial discriminatório de má resposta, independentemente da presença da endometriose. CFA e VOM não se apresentaram como bons preditores de má resposta. Sendo assim, a associação entre endometriose e subfertilidade deve estar vinculada a alterações do crescimento/desenvolvimento do folículo ovariano e não a prejuízos sobre a reserva folicular gonadal propriamente dita. / Introduction: Ovarian reserve evaluation in assisted reproduction (AR) aims to identify women in whom follicular exhaustion determines reproductive difficulties. More than age, the presence of other subfertility factors, such as endometriosis (EDT), implies potential negative interference on ovarian response. Objective: To evaluate follicular ovarian reserve in subfertile patients with endometriosis and determine the best predictor of poor response in AR. Methods: We evaluated 87 AR cycles of women presenting with less than 40 years of age, regular menses, no endocrine diseases and with both ovaries, divided in 30 EDT cycles (cases) and 57 cycles in women with subfertility associated to male factor (controls). Ovarian reserve was determined based on basal levels of anti-müllerian hormone (AMH) and follicle- stimulating hormone (FSH), small antral follicle count (AFC) and medium ovarian volume (MOV). Receiver Operating Characteristic curves (ROC AUC) were obtained for evaluation of discriminatory capacity of each test in identifying poor response. Results: EDT patients presented significantly higher basal FSH levels when compared to controls (9,13 ± 5,09 mUI/mL vs. 6,28 ± 2,45 mUI/mL; p < 0,05) and there were no differences in AMH, AFC and MOV between groups. The total number of oocytes retrieved was lower in endometriosis when compared to controls (5,33 ± 3,43 vs. 8,28 ± 5,8; p < 0,05) and significantly correlated with AMH in both groups (EDT: r = 0,61; Control: r = 0,58; p<0,0001). Basal FSH presented significant correlation with the number of oocytes retrieved only among EDT patients (r = - 0,48; p<0,01); in EDT patients, either, basal AMH was the individual marker with the best discriminatory potential for poor responders identification (AUC = 0,875), followed by basal FSH (AUC = 0,682) and MOV (AUC = 0,665), whereas among controls, AMH was the best marker (AUC = 0,8372), followed by MOV (AUC = 0,709) and AFC (AUC = 0,686). Conclusions: Basal FSH is significantly higher in subfertile patients with endometriosis and correlates with ovarian response in AR among these patients. Basal AMH, by the way, is the individual marker with the best discriminatory potential in determining poor response, which is not dependent on endometriosis presence. AFC and MOV did not presented as good predictors of poor response. The association between endometriosis and subfertility, therefore, may be linked to prejudice to growth/development of the ovarian follicle, but not to damage to the real ovarian follicular reserve.