Endometriosis awareness in Nigeria likely to decrease the growing rate of infertility cases
Clinical scenario 1
A 32 year old female visits her OB/GYN doctor and complains of severe abdominal pain that usually starts about two days before her menstrual periods. The pain is excruciating and regular pain medications like Panadol don’t help. She also complains of constipation and pain with defecation (passing stools) as well as pain when having intercourse with her husband. She also informs the doctor that she has no children even after being married for 5 years and she is not on any birth control .
Dr Nini’s analysis
A clinical presentation such as the one this young lady is exhibiting is one that is very common in women. In fact, whenever a young lady presents with dysmenorrhea (painful menstrual periods), there are several possibilities of conditions she might be suffering from. Differential diagnosis for this person could include fibroid tumors, endometriosis, uterine deformation, pelvic inflammatory disease etc. However, her case is peculiar due to the fact that she has dysmenorrhea (painful periods), dyspareunia (pain on sexual intercourse) as well as infertility. This lady most likely has ENDOMETRIOSIS.
What exactly is Endometriosis? Endometriosis is a condition in which the endometrial glands that are normally in the uterus (womb) grow outside the uterus. The most common places where these foreign endometrial tissues grow is in the ovary! Endometriosis is the most common cause of infertility in young women! Period! But I am sure most people have never heard of it. Endometriosis is an ugly, nasty, horribly painful disease that affects millions of women! Research shows that 1 in 10 women suffer from endometriosis; this means it actually affects more people than breast cancer but still it is not widely discussed.
Symptoms: Endometriosis classically presents in women in their late 20s to early 30s as dysmenorrhea (painful menstrual periods), dyspareunia (painful sexual intercourse) dysphasia (painful bowel movements) and INFERTILITY. Usually the pain associated with endometriosis is almost unbearable except for a very lucky few who have minimal pain. This debilitating pain starts about a week before periods and just gets worse from there.
Young girls are taught that they would experience cramping during their periods and hence tend to be quiet about it. We need to correct that notion. Young girls…. Please if you are experiencing severe crippling pain during your periods, this is not normal! These are probably signs and symptoms that most likely indicate
Patients with endometriosis have decreased fertility or at an increased risk for infertility. This infertility may be due to adhesions that interfere with the normal transfer of egg from the ovary to Fallopian tubes. It may also be due to the fact that the foreign endometrial glands within the uterus (womb) make it hard for embryos to implant. I don’t understand why a disease that can destroy a young woman’s fertility, and her ability to reproduce, and essentially negatively impact her quality of life is not properly studied, diagnosed and treated.
Even though the disease presentation of dysmenorrhea, dyspareunia, infertility along with the physical exam that reveals a nodular uterus points to Endometriosis. The true diagnosis for ENDOMETRIOSIS is made by direct visualization of these endometrial implants through laparoscopy (a surgical procedure in which an instrument is inserted through a small incision in the abdomen to help view organs in the abdomen).
Treatment options include taking PAIN MEDICATIONS such as Ibuprofen to help with the pain.. HORMONAL THERAPY with drugs such as Lupron, Danazol and Progesterone help to decrease the formation of these foreign endometrial implants. Though these treatments help to control the symptoms, it does not completely solve the problem. SURGERY is the best option because surgery would help cut off all the endometrial implants and adhesions which will help restore normal pelvic anatomy. By doing this early, women with endometriosis would still have a great chance at preserving their fertility and be capable of bearing children.
Conclusion: Endometriosis is a silent disease that affects millions of women but most people are not aware of it. It is not a benign disease. If left unchecked, it has the potential to cause some real damage. It is essential to educate young girls and women about what is normal pain and what is abnormal pain in respect to their periods. Thankfully, within the last few years, there has been an increase in awareness about ENDOMETRIOSIS and also the need for early diagnosis. Certain celebrities such as ex beauty queen Nike Oshinowo, international model Millen Magese have openly come out to talk about their struggle with endometriosis. Also, several organizations such as Nordica Fertility Centre have organized walks and fundraising events just to increase awareness for endometriosis.
Still, it is not enough to just spread awareness; We need to teach them that by diagnosing and effectively treating the disease early, they can still live happy and fulfilling lives and go on to bear children. Especially in a society such as ours where a woman is sometimes seen as incomplete if she is not able to bear children. Though endometriosis is the #1 cause of infertility, 20-30% of women affected with this disease can still become pregnant subsequent to surgery. So ladies…. Let’s not just take pain medications to control the pain, Let us fight the disease itself. Talk to your OB/GYN today if you are experiencing such symptoms and check to see if you have endometriosis. If you do, talk about your treatment options especially EXCISION SURGERY!
Disclaimer: The medical information provided on here by Dr. Nini Iyizoba is provided as an information resource only. This information does not create any patient-physician relationship and should not be used as a substitute for professional diagnosis and treatment
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