“Tall beautiful super model walking down to an attendant at the airport catches the attention of everyman with all eyes on her, and suddenly, her key drops, she bends down to pick it up and feels a sharp pain, she falls flat, helplessly, and unable to either rise up by herself. A shout for help lets everyone gather around her and then she lands at the hospital with blood flowing from her nose and ear. Such is the tale of many beautiful ladies going through very intense and unexplainable pains whenever their monthly flow approaches.” The narration above was the tale told by Dr Abayomi Ajayi, the Medical Director of Nordica Fertility Centre and founder, Endometriosis Support Group Nigeria, (ESGN) while on why several women experience excruciating pains during menstruation such that they are unable to do anything until the flow is over.
Many women don’t know that they are suffering from endometriosis, he said. In fact, some medical doctors never think of endometriosis as the cause of the severe pains some women go through during menstruation. This is because the required attention and awareness the ailment needs have not been given to it.
What is Endometriosis
Dr Ajayi describes endometriosis as “the occurrence of misplaced endometrium (what a woman sheds every month as blood or menstruation) i.e. when it is present in any other place in the body apart from inside the shell where it is expected to be, it is referred to as endometriosis. The commonest place where this occurs is in the pelvis or the abdomen and the commonest places in the abdomen are on the ovaries, in the tube, on the intestine, etc.
Why do we have to keep talking about endometriosis?
Dr Ajayi revealed that there is a need to keep talking about endometriosis because its symptoms are varied. “Many doctors continue to miss the diagnosis of endometriosis. The symptoms could be as vague as presenting itself like epilepsy or convulsion on rare occasions but the commonest we know is that it is abdominal or pelvic pain and usually, all the problems that come with endometriosis are during the menses or menstrual period. The problem we have is that people present the thing like something doctors cannot relate with the menstrual period unless you ask. For example, you see people coughing out blood, and if that happens in this environment, we assume it is tuberculosis because that is what we were taught at the medical school but if you link it with the menstrual period, it could be endometriosis and that is the reason why the month of March is regarded as endometriosis month worldwide. In the UK for example, it has taken them about ten years to a diagnosis of endometriosis from the point where the symptoms starts to when diagnosis is made. That because of the awareness has now been reduced to seven years. We don’t know about Nigeria because we don’t have the figures yet. But we want to be able to say the average age that endometriosis can be diagnosed and the only way you can do that is when you continue to have discussions on this topic.”
How to diagnose endometriosis In Nigeria
Speaking about how to diagnose endometriosis in Nigeria, Dr Ajayi opened up by saying “About 30 years ago we were told that endometriosis does not occur in blacks but all of us know now that it is not true. The occurrence is same in blacks and white so race has nothing to do with it. Of course we know overtime that Nigerian doctors are very intelligent people, the problem we have always had is that facilities are not always available. Now narrowing it down to endometriosis, the first thing is for you to conceive the idea that it exists because the eyes does not see what the mind has not conceived. When you feel very strongly that a symptom is indicating endometriosis, you can search for someone who can make the diagnosis for you. All over the world, people are making the diagnosis ever simpler because they know that the commonest is on the pelvis and you can see the ovarian endometrial through a scan. If your scan is good enough, you can also have a strong attestation of endometriosis. But all these we can only know when we continue to discuss what is happening in other places. We know in other places now that the emphasis has been on diagnosing endometriosis early enough among school girls because we know that endometriosis starts in the teenage girls.”
Can endometriosis be diagnosed at primary healthcare centres?
Bearing in mind that the talk about endometriosis needs to be brought down ladder, Dr Ajayi opines that suspicion about the condition can only be raised at this level of health service provision in Nigeria.
“The only thing you can do at the primary healthcare level is to share information because it does not have the wherewithal to manage endometriosis; so, you can only raise suspicions for them to refer up the ladder. They must have a rough idea of what the symptoms are and everybody including men and women should also know. Because as a man, you can have a daughter, wife, sister or friend who has endometriosis; but at the primary health care, they cannot have a gynaecologist who can help with the diagnosis. So the knowledge is very important for them but they cannot manage endometriosis.
Symptoms of endometriosis
For anybody who has endometriosis, it’s like she is menstruating into the abdomen and it is not coming out.
Because of the presence of blood in the abdomen, all the organs gum together after a while and the affected person will be unable to move and that’s what causes most of the pains that they have. They can have pains when they are menstruating, they can have pains after sexual intercourse, they can have pains when they are defecating or urinating. But what characterises endometriosis is that the pain is worse when they are menstruating. These pains can affect their lives so much so that they will be on medication (pain relievers) when they are menstruating.
The second commonest symptom of endometriosis is abnormal bleeding which could occur at abnormal places for example, bleeding from the navel.
Another common symptom is heavier flow, prolonged or irregular menstruation. Some of them can just bleed from anywhere. Infertility is another common symptom of endometriosis. About 40-50% of women living with endometriosis are infertile because of the gumming together of organs. The ovaries and tubes will lose their normal relationship, the eggs released from the ovary cannot be picked up by the tubes, so they have infertility; couple with the fact that the things they also have in their abdomen will also kill sperms because they have some chemicals that are released from the blood so they have many reasons to be infertile. But the good news is that it’s not everybody that has severe cases of endometriosis. Some have mild cases but the funny thing is that the pain does not suggest whether you have mild or severe endometriosis.
’Damilare Salami
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