The Color of Endometriosis

by, Ashley Hodges, PhD, CRNP, WHNP-BC

As a teenager I would hear friends talk about the severity of their menstrual cramps, confident endometriosis was the culprit. I am fairly certain I understood nothing about endometriosis, but soon questioned whether I too was suffering from this disease. It took nursing school for me to realize that I had been blindly following the musings of these young women and likely sounded ridiculous in my own conclusions. It was graduate school and my work as a Woman’s Health Nurse Practitioner where I learned fact from fiction and became well versed in diagnosis and treatment options.

Despite my formal education, it was not until a dear friend; we will call her Lisa, was diagnosed with endometriosis and later labeled infertile that I began to truly see all colors of the disease. My use of the word color is intentional. Read on and you will see why.

What Is Endometriosis?

Endometriosis is a chronic disease of estrogen-dependent lesions of endometrial glands and stroma found outside the uterus (Rogers, 2013).  Endometriosis is most commonly found on the ovaries, the fallopian tubes, the bowel, and the areas in front, in back, and to the sides of the uterus. Endometriosis affects approximately 5 million women in the United States. (American College of Obstetricians and Gynecologists , 2010). However, the actual numbers are unknown since endometriosis is often goes undiagnosed due to lack of symptoms and difficulty or delay in diagnosis.

Misconceptions about Endometriosis

  1. Endometriosis is fast and easy to diagnose.

FALSE. It has been estimated that the time between the onset of symptoms and surgical diagnosis of endometriosis is 6.7 years.

  1. Endometriosis is always painful.

FALSE. Not all patients with endometriosis experience pain. When women do experience pain, timing may be before, during, or between periods. Some women experience pain during or after intercourse. Others may experience pain with bowel movements, especially during the menstrual cycle.

  1. Hormonal treatments cure endometriosis.

FALSE.. There is no cure for endometriosis. Hormonal suppressive therapy does improve pain symptoms. However, recurrence rates are high after the medication is discontinued (American College of Obstetricians and Gynecologists, 2010).

  1. Women with endometriosis are infertile.

FALSE. This is not necessarily the case although up to 50% of women with endometriosis have difficulty conceiving naturally (American Society for Reproductive Medicine, 2012).

Lisa’s Story

At the age of 24 Lisa knew something was not right. Being a nurse she could only justify so much about her heavy, frequent and painful periods. Sex was painful, but maybe it was her state of mind or the bad relationship. She had moved to a new town only 2 years before, far from her less- than- thrilled parents. She was working long hard hours in the Neuro ICU and had little time for a social life. Lisa and Brian had been dating for over a year and his anger over her long hours and lack of attention to intimacy was worsening. This, she thought, was why her health was so poor.  Today, 22 years later, Lisa admits she knew something else was wrong, but denial was the easiest path at the time.

By the age of 28, Lisa’s symptoms were worsening, missed days from work putting her job at risk. She and Brian married that year. Her symptoms worsened over the next year with sex becoming unbearable. One afternoon at work she noticed blood in her stool following a painful bowel movement, but wrote it off to hemorrhoids, being on her feet all day as a nurse. That evening Lisa spoke to her mother, listing off her most recent symptoms of back and leg pain, abdominal pain, and nausea. Lisa decided it was time to see her provider and discuss her recent and recurrent symptoms. That night. Lisa woke in the middle of the night with severe lower abdominal pain which led her to seek care in the emergency department.

Lisa was taken to the OR and a right ovarian cyst the size of a softball was removed. Upon waking from surgery, Lisa was told of the ovarian cyst diagnosis. It was not until the next morning she was informed of the other findings. Lisa had severe endometriosis on her uterus, fallopian tubes, ovaries, ureters, bowel and bladder.

Lisa was told the chance of her conceiving naturally was likely nonexistent and that assisted reproduction was the only hope. Lisa underwent surgery to remove large areas of endometrial lesions and received six months of Leuprolide. She tried to conceive without any other medical intervention for three months without success. Fearful of worsening endometriosis she elected to take three months of ovulation induction medication, again without success. Lisa was given the option of moving forward with other reproductive assistance, but due to the cost, elected to wait and save money. Unfortunately, Lisa was back in the OR just six months later for additional surgery including a hysterectomy.

Today Lisa continues to struggle with complications from scarring and recurrent endometrial lesion implants. Lisa and Brian elected to adopt a child who is now 2 years old and are hoping to adopt again soon. Unfortunately Lisa’s story is not unique. More options are available for women today in the treatment of endometriosis but the struggle continues.

What is the reason behind the word “color” in this post’s title? Lisa saw many providers and sought support and guidance through more nontraditional methods. At one visit to an alternative methods provider, she was told to give a color to the endometriosis and then to not own anything of that color. She later told me that she gave endometriosis the color brown… because endometriosis was one big (beep).

Learn more about this topic at:

HodgesADr. Ashley Hodges is an Associate Professor and Assistant Dean for Graduate Clinical Programs at the University of Alabama at Birmingham School of Nursing. She is certified as a Women’s Health Nurse Practitioner and has over 25 years of experience in maternal child nursing, administration and nursing education. She was recently named in the Top 20 Outstanding Professors of Women’s Health Nursing by Nurse Practitioner Schools. Dr. Hodges served a two-year term as Board Member for AWHONN beginning in 2014 and was the 2015 Chair of the Public Policy Committee. She is currently a member of the editorial advisory board for the journal Nursing for Women’s Health. 


American College of Obstetricians and Gynecologists. (2010). Management of endometriosis (Practice Bulletin No. 114). Obstetrics & Gynecology, 116(1), 223-236

American Society for Reproductive Medicine. (2012). Endometriosis and infertility: a committee opinion. Fertility and Sterility, 98, 591-598.

Rogers, P. A., D’Hooghe, T. M.,  Fazleabas, A., Giudice, L. C., Montgomery, G. W., Petraglia, F., & Taylor, R. N. (2013) Defining future directions for endometriosis research. Reproductive Sciences, 20(5),  483-499.

Cardiovascular Disease In Pregnancy & Peripartum Cardiomyopathy

by, Julie Vasher, DNP, RNC-OB, CNS, C-EFM
Clinical Implementation Lead at the California Maternity Quality Care Collaborative at Stanford University

Janine is a 27-year-old African American woman who gave birth to her second baby without complications ten days ago. She came into the emergency room with complaints of cough and extreme tiredness. She attributes the fatigue to her new baby’s sleep schedule. She spoke in bursts because she appeared to be short of breath. Her vital signs are: blood pressure 120/60; heart rate 112 bpm; afebrile; respiratory rate 28 with an oxygen saturation of 94%; and she is considered obese (BMI 36). She has continued swelling in her feet. She is given antibiotics, steroids and breathing treatments. She feels better and is discharged home. A week later she returns to her physician with continued and worsening symptoms. The physician changes her antibiotic for an upper respiratory infection and suggests future testing for asthma.  A few days later, the patient experiences cardiac arrest at home and resuscitative attempts are not successful. Autopsy findings indicate she died from cardiomyopathy. (A composite case study representative of several PPCM cases found online)

Women are entering pregnancy with more chronic disease like hypertension, diabetes, and obesity. (CDC). Cardiovascular disease (CVD) is the leading cause of death for women during pregnancy and the postpartum period (Hameed, Lawton, McCain et al., 2015). Peripartum cardiomyopathy (PPCM) is an unusual disorder occurring in pregnancy that causes the heart to dilate and weaken, leading to symptoms of heart failure. Continue reading

Wellness for Nurses

by, Lori Boggan, RN

The closing of one year and start of a new inundates us with self improvement posts, the year’s super foods, super exercise, or super drink.  According to The Global Wellness Institute, wellness is a trillion-dollar industry worldwide that we buy, eat, and drink up.

We want so badly to find a quick solution to weight loss, health, and the pursuit of happiness.  It’s a fact that Americans suffer from stress related diseases.  According to the Center for Disease Control and Prevention, numerous studies have shown that stress in the workplace can be linked to cardiovascular disease, depression, anxiety, workplace injury, and impaired immune function, to name a few.  This is a very strong and clear indication that we are stressing ourselves to death!! Continue reading

Not your mother’s Pap smear: what women need to know about cervical cancer screening

by Sue Woodson, CNM. MSN
Certified Nurse Midwife at Jefferson Obstetrics & Gynecology, Ltd., Charlottesville, VA

Tips for Clinicians and their Patients

“What do you mean you only want to see me every 3-5 years?  I am used to coming EVERY year for my pap smear!” 

In the US, women generally think having a Pap smear is the main purpose of an annual exam as a way to screen for cervical cancer. This perception is understandable given that as a result of regular Pap screening, the incidence and mortality from cervical cancer in US women has dropped by at least 80% since the 1960’s.  Today, annual pap smears are rarely performed every year, yet, many women continue to confuse a pelvic exam (physical assessment) with a Pap smear (lab test).   To address this misperception women’s health nurses must educate women about the screening tests offered during an annual exam and why and when they are recommended. Continue reading

Top 10 Posts of 2015

When we launched AWHONN Connections in May of this year, we could not have imagined the response that we would have received from our members, nurses, parents and members of the media.

In less than a year our blog has received over 232,000 visits, from 167 countries and had 4 blogs republished on the Huffington Post! As the year comes to a close we want to say a HUGE Thank You to our readers and our bloggers.

Here’s Our 2015 Top Ten Round Up! Continue reading

6 Tips For Postpartum Care for Mom “The Patient”

by, Kristen Wesley “The Mom”

Kristen and IslaThere is a moment after labor when you realize that not only is your sweet little baby a patient, but that you are too. At least for me, that was something that hadn’t really registered. On the day that my little baby girl Isla was born I very quickly began to understand we would both need a ton of care in the hospital and at home.

You would think from all the books I read, articles I scoured, and the numerous second hand accounts from friends I received, it would have sunk in. But it just didn’t. It literally never occurred to me that I’d be a patient too during and after labor and birth. Continue reading

Take A Walk In My Postpartum Shoes (Part 2)

Dani_2See the first part of Danni’s Story posted September 1

by, Danni Star

After overcoming my PPD, I gave birth to another daughter and thought I knew what to look out for and was thankful not to experience the same intensity of symptoms again. What I didn’t realize is that PPD comes in so many different forms.

I went to lunch with a good friend after my second child was born. I don’t know why but I unloaded how I had been seeing my anxiety rise again, how bad it had gotten, my intrusive thoughts and how I literally kept thinking of worst case scenarios.

She urged me to go see a maternal mental health doctor. I took my time but the following week my anxiety was at an all-time high and I could feel myself falling apart so I called the doctor and she said she would squeeze me in that week.

A few days later I was in her office sweating profusely, heart racing so bad I felt like it was going to explode out of my chest and I couldn’t sit still. She asked a million questions and I answered them extremely honest. I told her that I felt anxious all the time, like a walking ball of nervous energy. That even at work when I am in my zone I still feel so out of place.

I told her that my biggest fears are losing my children, Slim, my husband, and Claire, my best friend.  I have literally dreamed all of their funerals repetitively- I don’t know maybe as a coping mechanism.

As I am saying these things, I still think she is going to tell me I just have anxiety and that we will get through it. I keep referring to “when I had Postpartum Depression.” I keep referencing how it felt then.

And then the bomb drops. She tells me that I am suffering from PPD. I instantly start bawling. No I am NOT, I had that before and this is different, I don’t want that. I can’t have that; it almost killed me and ruined my life and my marriage. I go to work, I laugh, I function…how is that possible?

She explains to me that all I know of PPD is the most severe, that I am experiencing moderate PPD. I feel hurt, angry, and mad at myself for not realizing, after all I have been here before. I think back to all of the things that I just described to her and I realize she’s right, if any of my friends would have told me what I told her I would have known instantly, so why didn’t I realize it about myself?

Instead, just like before, I will beat this. I will attend support groups, I will try my hardest not to only function normally at work. I will follow the doctor’s treatment plans and I will talk it out. I am scared, this is my biggest fear realized but I am going to be ok.
I WILL TO BE OK! My nemesis has returned but my fighting spirit will be its kryptonite.

Postpartum depression is my truth. An ugly truth that I just so happened to conquer and you can too. You are worthy so be open, learn what is going on and don’t be afraid to ask for help!

Danni Starr HeadshotDanni Starr
Danni Starr works daily as co-host of the nationally syndicated “The Kane Show.” Danni fell in love with radio at 19 and 11 years later, she still considers it her first true love. As a Mother and wife Danni is the “Den Mom” to the show & offers open, honest, opinions and advice.



Postpartum Support International: 1-800-994-4773 or
National Postpartum Depression Hotline: 1-800-PPD-MOMS


AWHONN’s Mood and Anxiety Disorders in Pregnant and Postpartum Women Position Statement

Take A Walk In My Postpartum Shoes (Part 1)

DaniFamily_1by, Danni Starr

An open letter to all the moms, soon to be moms or family supporting moms!

On December 31st, 2011 I gave birth to a beautiful baby girl! It was something I had dreamed about for so long. I remember the day after she was born crying on the phone with my midwife because I was so overwhelmed. She was so little and I didn’t really know what to do.

Being a little overwhelmed is common, medical specialists call it the baby blues. Post-birth, most moms (as many as 85%!) experience some form of the baby blues. This could be feeling irritable, exhausted, needing to cry for no reason or worrying that you won’t be a good mom.

I did not have that. I had something that damn near sucked the life out of me.

Once we returned home from the hospital, I rarely got off of the couch for 30 days. I got up to feed the baby and change her…I didn’t even eat. I remember just feeling so weird. Everything was robotic. Must feed baby, must change baby…I don’t even remember enjoying any of it.

I remember my husband picking me off of the couch giving me a hug and saying babe, you do not smell good…I am going to take you to the shower. He literally stripped me down and put me in the shower and helped wash me. Many times with post-partum depression (PPD) the mom is too tired to notice the symptoms, and it is a husband, partner, a family member or friend that shares that something just isn’t quite right.  I am thankful for my supportive system every day.

One night I was so tired that I actually Googled how many sleeping pills I could take without dying. I didn’t want to die, but I did want to be pretty close so that at least I would sleep for a few days. I literally had a bunch of pills laid out on the ottoman. I started to down them and then I thought. What if I am unconscious and she starts crying?! Nobody will hear her. I didn’t want her to cry and not have help. So I begged God to let me fall asleep and I threw the pills away. She saved my life.

Then the paranoia set in. I started to think that something very terrible was going to happen. So I started to place emergency items around the house. Things I would need to run away with. I made sure not to be too obvious because I didn’t want my husband to be on to me. One day he left to go to the store. I remember it so clearly, “babe I’m running to the store be back in a few.”

He stepped out of the house and I threw all of my emergency items in a bag, grabbed the baby and ran.

My grandpa was staying in a nursing home at the time and I knew nobody would look for me there so I went to his house and I hid out. I had NO contact with the outside world for days. Yes, I kidnapped my own child because at this point I was pretty unstable.

My husband and best friend were texting like crazy. Finally about ten days in I received a message from best friend which said, “I love you, but right now I have to love your baby more and I will call the police because I know you need help.” I finally told her where I was but begged her not to come. She sent a family friend who is a nurse to see me.

The nurse showed up and told me I had postpartum depression. I had no idea that 15% of new moms experience PPD which is way more intense than the blues, and encompassed so many of the things I was feeling and thinking. But at the time I didn’t know any of that, all I knew is that I just wanted to disappear. I hated everything, I couldn’t function and I was mad that I wasn’t connecting with such a precious little baby.

I never wanted to hurt my baby but I know many women who suffer from PPD do, and I would be lying if I said that I never wanted to hurt myself.

I don’t even remember when I started feeling better. There is so much about that time that scares me, so much more that I could share, but even writing about it makes me feel horrible. It’s a place I NEVER want to return to, and I would NEVER wish it upon anyone.

There were periods of time where I felt that I was bordering on insanity.

Follow the rest of my story in my Part 2 post publishing October 9th – National Depression Screening Day. Take care of yourself!
Danni Starr HeadshotDanni Starr
Danni Starr works daily as co-host of the nationally syndicated “The Kane Show.” Danni fell in love with radio at 19 and 11 years later, she still considers it her first true love. As a Mother and wife Danni is the “Den Mom” to the show & offers open, honest, opinions and advice.


The above story is adapted from Danni’s original post:

Get Support

Postpartum Support International: 1-800-994-4773 or
National Postpartum Depression Hotline: 1-800-PPD-MOMS

References and Learn More at

AWHONN’s Mood and Anxiety Disorders in Pregnant and Postpartum Women Position Statement

Postpartum Depression