ENDOMETRIOSIS – A COMMON CAUSE OF UNEXPLAINED PAIN OR SUBFERTILITY IN WOMEN

         

It was a tuesday morning and I was dropping my mother to the office.  A local Kamba station was playing on the car radio;I guess her driver or car-wash guys had set it to the station the previous day . A morning show was airing and the presenter was discussing about a medical condition; endometriosis .He gave completely wrong information about it and worse still had a very chauvinistic tone in the discussion. He went on and on about it. He addressed the issue of late marriages and late childbearing as the chief cause of endometriosis and in a way blamed the women who suffered from it.This is false. Imagine a chauvinist having such a conversation in the Kamba language. It was so bad and wrong at many levels .

I was angry because I knew that this was going to cause a lot of stigma and psychological trauma to the many women suffering from it. I also knew that this was going to cause unnecessary fears among the many single women of advanced age who were yet to start child bearing . I was annoyed because he also touched on the very sensitive issue of infertility with completely wrong information. The word ‘ngungu’ should be banned from the Kamba vocabulary completely (that word is unfairly used to describe childlessness in Ukambani) . I wondered why the main stream media was allowed to air such without involving professionals yet this particular station belongs to a powerhouse media group with the capacity to do so. Would they take responsibility for depression and God-forbid suicide that could potentially result from this? How would they track the after effects of such carelessness?

I talked to my mama about the condition in detail and she encouraged me to look for the presenter and correct him. My mother believes that we should use our skills and knowledge for the betterment of society no matter how low in the ladder we feel we are in our respective professions. Once I dropped her to the office, I quickly googled the contacts of the vernacular station and demanded to speak to the said presenter. I also made sure that I dropped a few posts on Facebook and Twitter just to make sure the information reached the right people in the company. When I called, he was still live on air so they took down my number and promised that he would call me back immediately. I’m still waiting for the call ; *I’m tempted to type his name.*

I know a friend of a friend who was divorced by her husband because she had severe dysperunia (painful sex). She was being investigated for endometriosis and was yet to start treatment. She was a young mother of one in her early twenties and was divorced because of a condition she had nil control over. Her very religious Muslim husband could not bear having a wife who couldn’t engage in the ‘procreation exercise.’ What happened to ‘for better, for worse’ in marriage vows?. I remembered the many patients who came in terrified because they were ‘menstruating’ from the umbilicus ,were reassured after learning about endometriosis and subsequently treated successfully. I also remembered Njambi Koikai our strong-girl who has battled pleural endometriosis with a lot of zeal.

Endometriosis is a condition in which normal endometrial tissue (stroma and glands) is implanted in other areas other than the inner cavity of the uterus. (endometrium is the inner wall of the uterus). It is commonly a painful condition and may be a cause of sub-fertility. >>>>>> it’s basically like having many small wombs/uteruses in the wrong areas that swell and bleed during menses and are potentially painful when touched. Imagine concurrently menstruating into the lungs or through the umblicus during normal menses? I hope this paints a clear picture of what really endometriosis is.

The common sites of implantation of this endometrial tissue is the pelvic walls (pelvis is the hollow cavity that holds inner reproductive organs). Other sites include the ovaries, the fallopian tubes, the pelvic wall ligaments , the umbilicus, and in rare cases it can involve bowels, surgical scars, the urinary system, pleura (covering of lungs), the pericardium (covering of the heart ) and even brain.

The prevalence is around 6-10% in asymptomatic women,40-50% in women having pelvic pains and in 20-50% of women with subfertility. The condition has been reported in all age groups including teenagers.

Common symptoms of endometriosis include any of the following symptoms,

1.                      Mostly asymptomatic
2.                   Chronic pain which could present as;  severe pelvic pain during menstruation, severe pain during sex, pain when passing stool, pain during urination and generally recurrent abdominal pains.
3.                  . Subfertility  commonly caused by impaired oocyte pick-up and possibly fallopian tube blockage due to swelling and adhesions caused by severe endometriosis lesions. Impaired ovulation (egg production) can also occur due to endometriosis of the ovaries.     Inferility is a consequence and not a cause of endometriosis unlike what was being propagated by that radio station.
4.    Cyclical bleeding through the anus(may or may not be mixed with stool) and through urination especially during menses  . This may be accompanied by severe pain and discomfort during urination/defecation
5.       Cyclical bleeding through umbilical lesions or surgical scars during menses
6.   Other symptoms – cyclical breathlessness and severe chest pains, severe headaches and even convulsions during menses

So what causes endometriosis?????? The main cause of endometriosis is largely unknown but there are many theories to its cause.  

• 1.       Retrograde menstruation – this is backflow of menstrual blood through the fallopian tubes that can possibly carry with it some endometrial tissues that can be deposited in the abdominal and pelvic cavity. These implants subsequently develop blood supply and thrive where they are deposited.
• 2.       Abberant lymphatic or vascular spread . This where some endometrial tissue is deposited through blood vessels and lymphatic system into other areas
• 3.       Coelomic Metaplasia theory. This is basically where normal tissue in other organs converts to look and act like endometrial lining. This is the common cause of ovarian endometriosis especially in young girls who are yet to start menses.
• 4.       Mullerian remnants differentiation theory.  During the normal formation or development of a girl before birth, what would make male reproductive organs usually disappear so that a girl is born with female organs and vice versa . Sometimes these remnants of the opposite sex can remain in the pelvis and form abnormal tissue resembling the inner lining of the uterus.
• 5.       Post surgical propagation – I have not seen this in the major Gyanecology books that I read but my undergraduate professor always insisted that surgeries involving the uterus such as Caeserian Sections can lead to ‘seeding’ of some endometrial tissue outside the uterus.

There is a large genetic or hereditary predisposition in all the above theories. History of above symptoms in close family members is an important indicator of possible endometriosis.

The diagnosis of this condition is done by

1)      Physical examination – maroon/blue painful lesions may be seen in visible areas such as the outer female organs , anus, scars or the umbilicus etc

2)      Firm hard lesions can be felt on vaginal, anal  and abdominal examinations

3)      Imaging such as ultrasound or CT-scan of the respective locations

4)      Laparascopy – this is the gold-standard of diagnosis and is available in major hospitals including K.N.H and Moi Teaching and Referral Hospitals.

Treatment depends on the symptoms, the extent of the lesions and desired fertility. Pain management can be done using regular pain-medications but definitive treatment of the lesions is by hormonal treatment or surgical excision.

It’s important to see a Gynaecologist for investigation and treatment if having any of the symptoms explained above. This condition is a major nuisance but it should be remembered that nobody does anything to cause it upon themselves. It is very important for correct information to be passed around to minimize the stigma associated with the condition.

Spread the word. I will continue looking for that Kamba Radio presenter so that he gets informed and corrects the false information and mentality.