March is Endometriosis Awareness Month
Endometriosis: Causes, Complications and Treatment
Endometriosis is one of the most serious, potentially progressive chronic diseases` related to uterine lining that women can face in their lifetime. It causes incapacitating pain, marital disharmony and infertility.It has devastating effect on the quality of women's life.
Endometriosis affects an estimated 1 in 10 women and about 200 million women worldwide. Due to widespread misinformation, lack of education and awareness about endometriosis, diagnostic delays continue to average up to 6-10 years.
Although there are many theories the exact cause of endometriosis is unknown and there is no cure. With timely intervention at expert hand and early detection patients can manage their symptoms. There are some risk factors for endometriosis.
1) Genetic : Endometriosis run in families. The risk is about six time higher if mother/ sister had endometriosis.
2) Hormones : The hormone estrogen seems to promote endometriosis.
3) Menstrual period problem: Some women experience retrograde menstruation flow in which some of the tissues shed during period flow backwards through the fallipian tubes into the pelvis.
4) Environmental exposures : Certain chemical mediators have been shown to have higher risk of endometriosis.
Hopeful fact is that Endometriosis is becoming more of a household word and now a days young girls are growing up knowing about this illness and understanding its warning symptoms.
Endo awareness is improved in recent years. March is Endometriosis Awareness Month which is observed worldwide each year through activities like education, medical conferences, fund raising for research and marches all across the globe with a mission to raise awareness about the disease."The world Endometriosis Association" began Endometriosis Awareness Month in March 1993.
" Endo March" is a fund raising organization started by an Iranian family interested in medicine wanted to help find a cure for the disease." Endo March" has grown to be the largest, internationally coordinated endometriosis coalition in the world. It's first campaign was started in 2014.This year a worldwide event will take place on Saturday, March28, 2020.The aim of Endo March is to ensure improved treatment options, timely diagnosis at the onset of symptoms, non invasive diagnostic test and fast track toward a cure and better care for Endometriosis sufferers.
Actually beliefs can be a form of blindness. Although the time for stigma and taboo concerning menstruation is over, till today we have some social misconception. We consider that painful periods are always normal. The most difficult reality is that many times the society do not believe her pain and doctors do not suspect her symptoms. Sometimes we consider that women's pain is the expected part of the wall paper of life. When a teen ager girl roll over in her bed due to incapacitating pain they are told " All girls and women have cramping pain during period time. It is usual. You should try not thinking about it or you are making it a bigger deal."
We demand so much from women's minds, souls, and bodies. But when women's health issues come to the forefront we remain deadly silent or many people seem to turn away as it is women's issue. If we are so concerned about a woman's ability to nurture and care for others then why don't we confront a disease that takes away precious hours, days, months, years from a woman's life, lost to pain and sickness. We need to come together and discuss about the disease openly.
What Does Endometriosis pain feel like?
We should remember that pain with basic biological function is not normal and deserves to be investigated properly by physicians.
Patients associated with endometriosis can vary widely from patient to patient. Some women experience no symptoms. Others experience severe pelvic pain that can interfere with regular activities ike bowel movement, urination and during and after sexual intercourse and get worsen during menstruation. The severity of the disease is not related to the degree of pain. Pain can be much worse even in a very early stage than women whose disease is much more advanced. The level of pain depends on several things. They are :
A) Location : If the endometriotic implants are in an area rich in nerve endings, the pain will be more intense.
B) Proximity : If the implants release substances into the blood stream that will cause more pain.
C) Scarring : Scarring caused by the implants increase pain levels.
As Gynecologist in our daily clinical practice we found many endo warriors who have experienced cramping and intense throbbing pain during her period days. Some describe the pain as sharp, stabbing pain that leave her breathless. Some of them describes the pain as an electric shock. Some may experience a dull, throbbing pain around the time of ovulation.
Most of the married women with endometriosis have sensitive problems like severe discomfort and unbearable pain during and after sexual penetration. Sex is a super challenging issue for them. Actually sex does not hurt. But when a woman complaints of pain and try to avoid intercourse, her husband should address the problem and give her support and assurance. But very often many men have no idea about endometriosis. They found it hard to realize. They consider it as an excuse, ignore the complaints and force to penetrate. They consider her pain is psychological, not physical. Many husbands feel unsatisfying as their life partner can't fulfill their physical demand as they desire. Many women with endometriosis have got divorce on this issue.
Women with endometriosis may have GI distress, bloating, cramps, occasionally accompanied by diarrhea, constipation.
Symptoms usually worse during menstruation. There may be painful bowel movement due to irritated surrounding tissue. There may be neuropathy because of swelling and scarring of tissue.
Endometriosis have negative effect on fertility. About 40? women with endometriosis have infertility problem. The pathogenesis of infertility is dependent on the stage of the disease. In early stage it is hypothesized that this is 2ndary to an inflammatory response that impairs various aspects of conception. Whereas in later stage disease distorted pelvic anatomy and adhesion contribute to impaired fertilization.
Stages of endometriosis
The stages of endometriosis depend on the extent, location and depth of penetration of the endometriotic implants. There are 4 stages.
" Stage 1: Minimal disease
" Stage 2: Mild disease
" Stage 3: Moderate disease
" Stage 4: Severe disease.
1) Laparoscopy is the gold standard method to confirm endometriosis. Laparoscopy is a surgical procedure where a camera is used to look inside the abdominal cavity to see the extent and severity of endometriosis. During laparoscopy surgical therapeutic intervention can be taken at the same sitting like ablation,fulgerization of endometriosis deposits,cystectomy,adhesiolysis,restoration of tubo ovarian relationship and chromopertubation to see tubal patency.
2) Ultrasound: Use of pelvic ultrasound can identify endometriotic ovarian chocolate cysts.
3) MRI: Use of MRI is another method to detect endometriotic lesion in a non invasive manner. But MRI is not widely used in our country due to its cost and limited availability.
4) Tumor markers: CA-125 is a biomarker which is used for endometriosis.
5) Histopathology and immunohistochemistry are useful in diagnosis of endometriosis.
Prevention of Endometriosis: Limited evidence indicates that use of combined oral contraceptives can reduce the risk of Endometriosis.
Modification of life style by doing yoga, physical exercise, avoidance of alcohol, caffeine are also considered as preventive measures.
Management of Endometriosis
There is no complete cure. While the disease can't be totally irradiated, the pain and other symptoms can be managed by modifying life style, following healthy diet chart avoiding high daturated fatty food, alcohol, caffeine, Reducing stress.
As pain medication NSAID, opioids, hormone therapy are found promising.
Laparoscopic surgery is preferred method of surgery if facilities are available. Surgical removal of endometriosis deposits are useful for pain control. It is more effective for addressing endometriosis associated with infertility. Surgery helps to remove endometriosis deposits, preserve the ovaries, restore tubo ovarian distortion. IVF are effective in improving fertility in women with advanced stage endometriosis.
In conclusion we hope that while a young girl or women of reproductive age group come to seek medical attention endometriosis will be in every doctors mind while searching for an answer and the diagnosis time will not prolong any more. The endo warriors deserve timely diagnosis at the onset of symptoms, non invasive diagnostic tools and improved treatment access to improve their quality of life. Through selfless dedication, hard work and advocacy the gynecologists can end their nightmare.
Dr Nadira Haque
Kuwait-Bangladesh Friendship Govt. Hospital