Nature provided the whale and the bat with the miracle of an innate sonar system. Scientists studied the process, pretty much duplicating it for its original technological intent—wartime vigilance. During world War II, navy submarines negotiated their way through deepest waters using sonar to detect the location of enemy vessels unseen by peritcopic sighting.

Sonar is the simple process of bouncing high-frequency acoustical vibrations off solid masses. The waves then bounce back in echo patterns that appear as a picture on a specially devised screen. Sonar is the mother of sonography, or ultrasonography, known familiarly as ultrasound—a relatively new and popular diagnostic technique, gaining ever increasing acceptance for confirmation of pelvic abnormalities. It is a convenient way to diagnose both pelvic masses and fetal size (sometimes, too, the sex of the unborn child) during pregnancy. Doctors are choosing sonography over X rays for a variety of diagnoses, especially since ultrasound is completely harmless to the body.

When these high-frequency sounds are projected into the body, the reflected “echo” on the screen indicates the size and location of a tumor. Doctors can freeze the picture of a growth on the screen and measure it. The technique is especially useful in locating uterine fibroids and ovarian cysts, although occasionally, there is difficulty in sonographic diagnosis in defining the precise location of a tumor—is it growing on the side of the uterus or on the ovary? Since ovarian tumors are a more serious matter than uterine masses, laparoscopy might be necessary if sonography proves ineffective as a confirming diagnostic tool.

As with laparoscopy, sonography facilitates an accurate diagnosis when pelvic organs are lifted from view. The “lifting” here is done not with gas, but with water. That is, women prepare for ultrasound testing before coming to the doctor’s office by drinking six to eight glasses of water, thus filling their bladders. The amply filled bladder moves organs up just enough so that the doctor can see the uterus and ovaries more clearly. A practiced ultrasonographer can usually detect a cyst and identify its type (and its contents) by the echo pattern on the screen and determine if the cyst is endometriotic in nature.

Ultrasound has its benefits, but in my opinion, this technique cannot pick up endometriosis in its early stages, when many women really need help in managing the disease and when it is most adroitly treated.

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The uterus is about the size and shape of a small hollow pear with its wide end upwards. Two fine tubes, the Fallopian tubes, branch outwards from the upper part of the uterus towards the ovaries. During reproductive life, a mature egg bursts from an ovary at approximately monthly intervals. In the normal course of events, an egg travels through a Fallopian tube to the uterus. On the way there, conception can occur if the egg meets and fuses with a sperm cell. The resulting embryo may develop into a viable pregnancy if it successfully embeds in the uterus.

The largest part of the uterus, the myometrium, is strong and flexible, being composed of thick bands of muscle and elastic tissue that run in several directions. This muscular web enables the uterus to be either small and tidy, somewhat like a clenched fist or, should conception occur, to stretch and grow into a strong, flexible capsule capable of nourishing and protecting a developing baby. The lower end of the uterus, the cervix, has some specialised functions including the production of lubricative or dense secretions at different times of the menstrual cycle. These secretions help minimise friction during sexual intercourse and seem to have a role in sperm movement through the vagina and cervix. During the Pap or cervical smear test, the cervix is the tissue that is sampled.

In addition to the thick myometrium and the cervix, the other important component of the uterus is its very active inner lining, called the endometrium. This is shed during menstruation or, if circumstances permit and a pregnancy occurs, it provides nutrients to an embryo. Before a girl has her first period (an event referred to as the menarche) and after a woman has her last (menopause), the endometrium usually consists of a thin layer of cells which may grow and be shed slowly without any menstrual bleeding.

The fertile years see a big change with menstruation typically occurring for several days about once every month. In the lead up to the menstrual bleed, row upon row of endometrial cells grow rapidly, influenced by sex hormones from the ovaries (particularly oestrogen and progesterone). Recent research suggests that the shedding process requires substances produced by the endometrium itself (such as the hormone-like prostaglandins and enzymes known as matrix metalloproteinases), together with decreasing levels of sex hormones.

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Primolut N is a hormonal drug occasionally used to treat endometriosis. It is also sometimes used to treat a variety of other conditions including abnormal uterine bleeding, amenorrhoea (absence of periods) and PMS (premenstrual syndrome).

Primolut N is a progestogen (synthetic progesterone) derived from the male hormone testosterone. Its chemical name is norethisterone. It is manufactured by Schering and sold in the form of white 5 milligram tablets.

How Primolut N works

It is thought that Primolut N eradicates endometrial implants by Ppressing ovulation and interfering with the growth of the misplaced endometrial cells, causing them to slowly waste away. Most women will stop ovulating and menstruating during their course of Primolut N.

Dosages of Primolut N generally used

Gynecologists usually recommend 5 to 20 milligrams of Primolut N per day (one to four tablets per day) for four to nine months.

Side effects of Primolut N

The more common side effects are depression, weight gain, malaise, lethargy and tiredness, acne, vaginal bleeding, decreased libido and nausea.

How effective is Primolut N

There are no reliable figures on the effectiveness of Primolut N for the treatment of endometriosis.

Primolut N, pregnancy and breastfeeding

Primolut N should not be used during pregnancy as progestogens derived from testosterone can cause abnormalities in the developing foetus.

The use of Primolut N while breastfeeding is not recommended, as small amounts of progestogens have been found in the milk of mothers taking them and the effect on the child is not known.

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