Sunday March 17, 2013
It’s not okay, it’s endometriosis
By Dr KALPANA NAYAR
Endometriosis is still fairly unknown, despite being a common female disorder.
IT is not okay to miss a part of your life because of cramps and discomfort during menstrual periods. It is not okay to be experiencing pain during sexual intercourse. It is not okay to be bed-ridden for two to three days every month. It is not okay if you are having difficulty in getting pregnant.
All of the above can place a heavy burden on a relationship. Living with chronic recurrent pain may lead to depression, fatigue and irritability, and can affect your daily activities.
Many women who experience these symptoms would eventually discover that they have endometriosis.
Period pains are so common, women generally only go to the doctor when their pain becomes worrying. On top of that, many doctors do not automatically think of endometriosis when a woman describes her symptoms.
This means that it is typically only diagnosed many years after symptoms first arise. Women often first seek medical help if they are finding it difficult to get pregnant.
Endometriosis is still a fairly “unknown” illness, despite the fact that it is one of the most common gynaecological problems. About 25% to 50% of infertile women have endometriosis, and 30% to 50% of women with endometriosis are infertile.
What is endometriosis?
Endometriosis occurs when the tissue that normally lines the inside of your womb – the endometrium – grows outside your womb, and most commonly affects the ovaries, bowel or the tissue lining your pelvis.
Rarely, it may spread beyond the pelvic region. The displaced endometrial tissue continues to act as it normally does, thickening and breaking down with bleeding in each menstrual cycle.
Having no way to exit the body, the menstrual blood becomes trapped, irritating the surrounding tissues and eventually developing scar tissue and adhesions – abnormal tissue that binds organs together. This process can cause pain, especially during your period.
Endometriosis can affect any menstruating woman. We don’t know the exact cause of endometriosis but researchers are exploring many theories such as retrograde menstrual flow, hormones, genetic and environmental factors.
Although endometriosis is typically diagnosed between the ages of 25 and 35 years, the condition probably begins about the time that regular menstruation begins.
Common signs and symptoms of endometriosis may include:
● Painful periods (dysmenorrhaea). Pelvic pain and cramping may begin before and extend several days into your period and may include lower back and abdominal pain.
● Pain with intercourse. Pain during or after sex is common with endometriosis.
● Pain with bowel movements or urination. You’re most likely to experience these symptoms during your period.
● Excessive bleeding. You may experience occasional heavy periods or bleeding between periods.
● Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
● Other symptoms. You may also experience fatigue, diarrhaea, constipation, bloating or nausea, especially during menstrual periods
What are the complications?
The most common complication is infertility, mainly because of the scarring of the reproductive organs caused by endometriosis, which prevents a fertilised egg to implant itself into the uterus.
It is advisable for women with endometriosis not to delay having children because the condition may worsen with time. The longer you have endometriosis, the greater your chance of becoming infertile.
Rarely, endometriosis may cause blockages in the gastrointestinal and urinary tracts, adhesions, and ovarian cysts.
The doctor will ask you to describe your symptoms, including the location of your pain and when it occurs. This will be followed with a general check-up and pelvic examination. Ultrasound is a useful tool in identifying cysts associated with endometriosis.
The only way for your doctor to know for certain that you have endometriosis is by a laparoscopy. This involves an operation performed in the abdomen or pelvis through small incisions with the aid of a camera, so that there is a direct visualisation for signs of endometrial implants.
Treatment of endometriosis
The treatment approach will depend on the severity of your signs and symptoms and whether you hope to become pregnant.
Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort. These may include:
● Pain medications such as ibuprofen or naproxen may be recommended to relieve menstrual cramps.
● Hormonal therapies: Using combined hormonal contraceptives – especially continuous cycle regimens – can reduce or eliminate the pain of mild to moderate endometriosis.
Gonadotropin-releasing hormone (Gn-RH) agonists such as leuprorelin blocks the production of ovarian-stimulating hormones, which prevents menstruation and dramatically lowers oestrogen levels, causing endometrial implants to shrink.
Other hormone therapies like synthetic progestogens (medroxyprogesterone acetate and norethisterone) may be prescribed.
Antiprogestogens include danazol and may not be the first choice of treatment because it can cause unwanted side effects.
● Conservative surgery: If you are trying to become pregnant, surgery to remove endometrial implants may increase your chances of success.
● Hysterectomy: As a last resort, surgery to remove the uterus and cervix (total hysterectomy) as well as both ovaries may be the best treatment.
Please consult your doctor if you are experiencing any signs or symptoms of endometriosis. Consider getting screened for endometriosis if your mother or sister has been diagnosed with endometriosis, or if you are unable to become pregnant after trying for one year.
Left undiagnosed or untreated, endometriosis can be a frustrating condition. To cope with the illness, it is important that you receive good medical care and support.
Though endometriosis is common, diagnosis is mostly delayed because the awareness is lacking.
Women’s International Day fell on March 8 with the theme “The Gender Agenda: Gaining Momentum”. There is global momentum for championing women’s equality, and over time, we have celebrated the many achievements of women.
Yet, though such a long period of innovation in science and technology has passed, the health of a woman remains a major concern.
As I end this, I leave you with a quote from the actress Susan Sarandon on endometriosis awareness: “Suffering should not define you as a woman! And just because you’re a man, it doesn’t mean that it doesn’t affect you! HELP HER to remove the taboos and the loneliness surrounding this disease, be understanding, show empathy, and don’t accuse her of being sensitive, delicate, or overly dramatic – this is a big opportunity for you guys to show that you care and to be a real man!”
This article is contributed by Dr Kalpana Nayar, medical manager with AbbVie Malaysia. This information is provided for educational purposes only and should not be taken in place of a consultation with your doctor. AbbVie Malaysia and The Star disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.