Having excruciatingly painful periods isn’t just a monthly inconvenience. AILEEN LALOR speaks to a medical expert about endometriosis and how to manage it.
Having excruciatingly painful periods isn’t just a monthly inconvenience. AILEEN LALOR speaks to a medical expert about endometriosis and how to manage it.
Our expert.
1 8 PER CENT OF WOMEN HAVE IT.
In other words, there are more than 40,000 sufferers in Singapore. The condition occurs when parts of the endometrium (the lining of the womb) migrate outside the womb. These are known as endometrial lesions and end up on the ovaries, fallopian tubes, bowel or the tissue lining the pelvis, which causes inflammation and scarring.
2 IT’S NOT JUST A PAINFUL PERIOD.
While a painful period is the most common sign, some women may experience pelvic pain or backache. “Symptoms can vary from no pain at all to severe pain related to menstruation, sexual intercourse, defecation and urination,” says Dr Steven Teo, obstetrician and gynaecologist at Thomson Fertility Centre. “Some women even have blood in their urine or stool when the womb lining inflltrates the bladder or intestines, but this is rare.”
3 NO GENETIC PREDISPOSITION.
Dr Teo says it’s unclear why some people suffer from the condition while others don’t. “There is no conclusive evidence that it runs in families,” he says. What is typical is it tends to strike those in their childbearing years. “The onset is most likely to be in your 20s or 30s, although we have seen adolescent girls with endometriosis,” he says.
4 IT AFFECTS FERTILITY.
Women who don’t experience symptoms like pain may only visit their doctor if they have trouble getting pregnant. “The in ammation and scarring resulting from endometriosis can distort the reproductive environment, block fallopian tubes or cause ovarian cysts to form, all of which can make pregnancy difficult,” explains Dr Teo. It doesn’t help that these women may experience pain during sex, which may put them off intercourse. However, some women with endometriosis can get pregnant naturally, adds Dr Teo.
5 LIFESTYLE CHANGES DON’T HELP MUCH.
“There is no evidence that lifestyle modifications have any conclusive benefit for endometriosis,” says Dr Teo. “However, maintaining a healthy, active lifestyle, and avoiding excessive alcohol and cigarette smoke are generally viewed as a good step for those planning to start a family.”
6 TREATMENT IS COMPLEX.
Treatment can be surgical or medical. Laparoscopic or keyhole surgery is usually performed at the time of diagnosis, and is recommended for women who still want to have kids. During the procedure, known as endometrial ablation, lesions are removed using a heat source such as a laser. Medical treatment involves suppressing ovulation, in the form of the Pill, injections or inserting a progesterone-impregnated coil inside the womb – which is why it’s not suitable for women trying to get pregnant, says Dr Teo.
7 THERE’S NO REAL CURE.
Dr Teo says that surgery is closest to a cure, but in advanced cases – where there may be deep implants on the pelvic lining and ovaries, even lesions on the fallopian tubes and bowels – it is almost impossible to remove all the lesions and the condition may recur. In extreme cases, a hysterectomy to remove the ovaries is performed. “Removal of the ovaries renders the woman menopausal, which means she stops producing oestrogen,” Dr Teo explains. Oestrogen is needed for endometrial lesions to form, so a hysterectomy prevents new lesions from developing while existing lesions shrink, although the scarring from previous disease will remain.
8 IT’S DIFFICULT TO DIAGNOSE.
While many gynaecological conditions can be detected via an ultrasound, endometriosis is most accurately diagnosed by laparoscopy, says Dr Teo. But as this is invasive, doctors will recommend it after detailed consultations and examinations – which is where the problem lies. “Endometriosis isn’t well-understood by many gynaecologists, let alone general practitioners,” says Dr Teo. “It’s important that women have the basic awareness that endometriosis exists and don’t dismiss symptoms that are suggestive of the disease.”
9 IT CAN AFFECT YOUR WHOLE LIFE.
The condition can have far-reaching effects on your sex life, social life, even your career. “Pain can result in absenteeism, impaired physical performance and avoidance of sexual intimacy,” says Dr Teo. “It’s not uncommon for patients to become depressed due to the pain, fertility issues and effects on their social life.” The medication too, may have side effects including menopausal symptoms, mood swings and depression.
10 IT INCREASES YOUR RISK OF CANCER.
Dr Teo says: “Some studies show that women with endometriosis have up to three times the risk of contracting ovarian cancer.”
“Endometriosis keeps me in bed for a week every month”
Deborah Henderson, 39, was diagnosed with endometriosis at 28. She shares how her condition affects her life.
“I grew up with relatively normal periods. I had period pain, but no more so than anyone else. But in my 20s, my periods started getting worse – I was effectively out of action for up to seven days a month. The pain shifted from period pain to something else – not only was it in my abdomen, it was in my haunches, and radiated down my back and legs. It was a dragging, all-encompassing pain.
“Along with this, I felt increasingly nauseous, had blinding headaches and felt very anxious, terrified even, as my period drew near every month.
“It took several visits to the doctor before I was given a preliminary diagnosis of endometriosis and given medical treatment. But the hormone-based coil, the preferred method of treatment, was too painful for me to tolerate because my cervix is an odd shape. Other hormonal methods gave me severe migraines.
“Finally, at 28, a laparoscopic investigation confirmed I had endometriosis, and I underwent a surgery to correct it. The procedure offered temporary relief but the pain came back within a few months.
“Almost 12 years on, I have had two more endometrial ablations, neither of which gave me any relief. The only option I have now is a hysterectomy. I’m 39 and engaged but I don’t want children, so this is an option. But I’m not psychologically ready for it as it would mean the end of my youth.
“So I continue to suffer every month, and it leaves me angry, frustrated and depressed. The burden is immense. It affects the kind of job I can do. It means that for at least a week a month, I cannot function in any normal way as I am literally confined to my bed. It is not just period pain. What it is is a lifelong, chronic, often devastating condition.
“My biggest goal now is acceptance. If I can accept that this is how it is for me, it might at least help lift my depression. I’ll keep trying – I have no other choice.” SH
