•Dr. ABAYOMI AJAYI, NORDICA Fertility Centre CEO
Endometriosis got into the consciousness of Nigerians when Ex-beauty queen, Chief Adenike Oshinowo talked about her struggles with it. It was during her 40th birthday and she shared how she had lived with the disorder. Other celebrities have spoken about their ordeal since then. They include Nollywood actresses Zainab Balogun and Uche Elendu, and Fashion entrepreneur Tania Omotayo. To help these women and others who’re not speaking about their condition, Medical doctors have been at the forefront to educate more Nigerians about the disorder. They include Dr Abayomi Ajayi, a Consultant Obstetrician and Gynaecologist as well as MD/CEO of Nordica Fertility Centre. He says Endometriosis makes it hard for women to get pregnant. And that over 50 per cent of women living with endometriosis suffer infertility. So, how does this happen? He explains in this interview compiled by City People’s Contributing Editor, IYABO OYAWALE.
What is Endometriosis?
Endometriosis is the growth of tissues of the inner lining of the uterus in other places. Most of the endometriosis patches grow in the pelvic cavity and generally, on or over the two ovaries and behind the uterus or tissues holding the uterus, and on the bowels or bladder.
The major symptom is pelvic pain very often linked with the menstrual cycle, sometimes cramping during the period and the pain is worse than regular pains during the cycle. One of the main complications is infertility; about 30 – 50 per cent of women suffering from the disorder face difficulties in getting pregnant.
How common is this disorder?
It is especially common among women in their 30s and 40s and may make it harder to get pregnant. Several different treatment options can help manage the symptoms and improve your chances of getting pregnant.
Endometriosis can have a variety of symptoms, and that’s also one reason that it can be difficult to diagnose. But there’s also a lack of understanding about it.
With millions of women around the world living with this disorder, you would expect that it would be something that could easily be detected by physicians. But unfortunately, that’s often not the case. And consequences of not getting endometriosis diagnosed can last a lifetime.
Why does it take a long time to diagnose?
It is not a problem that is peculiar to Nigeria. Even in the UK, it takes about nine years from the onset of symptoms before a diagnosis is made. And that is why we have been doing that for 14 years. It is getting louder now but it is still a whisper. Many people have not heard about it. So, what we are trying to do this year is to go to secondary schools all over the nation because we have seen that this problem usually starts when the girl-child had her first menstruation which is always in secondary school.
Some girls have been labelled lazy, and even promiscuous especially when she is having pains during their menstruation period. Some people will say she has aborted her pregnancy but the fact is that majority of them had endometriosis. So, the commonest thing that endometriosis presents is painful menstruation. And the painful menstruation comes from the fact that there is an inner covering in the ovary called the endometrium. That is where the baby is supposed to stay but the woman sheds it every month when she is not pregnant. These people have the tissue called the endometrium in some other places apart from where it is supposed to be.
It is like displaced endometrium. So, the commonest places where it is located could be the ovary, tubes, intestine and sometimes, it could be in the chest. And that is why sometimes, they can cough out blood, and because the symptoms are not common, they could be varied. The only thing that ties them together is that the symptoms are worse during their menstrual period. Sometimes, some people bleed from the navel during the menstrual period. Those people are called witches. I have seen a woman that was carried from one church to the other because she had endometriosis.
When you do not spot endometriosis on time, it becomes complicated such that when such a woman has intercourse, it becomes very painful because the organs have already gummed together. It also results in infertility. Most of the time, we see them alone because they cannot have children. And it is when we are investigating infertility that endometriosis is discovered. Most of the time, such women have been made to bear their painful menstruation because it is normal; the parents and doctors are not aware. Some doctors say it is in their brain. They have been made to live with their pains and the majority of them are not normal. Some are depressed because they are different from other people and that is why we have taken awareness the people by sensitizing them about the effects, symptoms, causes and solutions to endometriosis.
What are the causes of Endometriosis?
There are several different ideas about how and why endometriosis happens. One idea is that when a woman has her period, some of the blood and tissue from her uterus travels out through the fallopian tubes and into the abdominal cavity. This is called retrograde menstruation. Another idea is that some cells in the body outside of the uterus can change to become the same kind of cells that line the uterus. This is a common explanation for endometriosis at unusual sites like the thumb or knee. Another possible explanation is that the cells from the lining of the uterus travel through the blood vessels or through the lymphatic system to reach other organs or body areas. Also, endometriosis can spread at the time of surgery. For example, a woman with endometriosis that undergoes a cesarean section could inadvertently have some endometriosis cells attached to the abdominal incision so that she has endometriosis in the scar from the surgery.
Interestingly, nearly all women have some degree of retrograde menstruation, but only a few women will get endometriosis. This may be due to differences in a woman’s immune system. Also, endometriosis is much more common if a close relative also has endometriosis, so there may be genes that influence endometriosis.
Why is endometriosis associated with pain?
When a woman with endometriosis has her period, she has bleeding not only from the cells and tissues inside the uterus, but can also have bleeding from the cells and tissue outside the uterus. When blood touches these other organs, especially inside the abdomen, it can cause inflammation and irritation, creating pain. Sometimes, scar tissue can also develop from endometriosis which can also contribute to the pain.
What is the age range of people living with endometriosis?
It starts when a young girl begins to menstruate but because it is related to infertility, it is diagnosed in the thirties. That is why we are looking at the possibility of making the diagnosis early so that before complications start coming up, it would have been addressed. Endometriosis affects one’s decision-making. I will advise anyone who has endometriosis and is not ready to start having babies early to go and store her eggs. It is expected for couples to be aware of this development. Many marriages have crashed because of endometriosis.
In Nigeria, what is the percentage of women with endometriosis?
All over the world, the percentage is the same. One out of 10 women has endometriosis in different places.
If it is not easily detected, what happens? Is it a death sentence?
Of course not. It does not kill as the disease itself does not kill. It only reduces the quality of life. It could also make one infertile. It affects relationships. These people bleed regularly. She could be at a function and start bleeding. It affects all aspects of their lives including education and career among others.
Is the treatment affordable to all?
It has to be treated. It depends on what exactly the endometriosis presents. It is not everybody who has endometriosis that would be infertile. It is only about 30 to 40 per cent of them. Therefore, if you have infertility, you have to treat it. Three main symptoms that endometriosis can give include pain, irregular bleeding and infertility among others.
How does Endometriosis make it hard for women to get pregnant?
Endometriosis seems to impair fertility in two ways: first, by distorting the fallopian tubes so that they are unable to pick up the egg after ovulation, and second, by creating inflammation that can adversely affect the function of the ovary, egg, fallopian tubes or uterus.
What are the common symptoms of Endometriosis?
Pain, including pelvic or lower abdominal pain and pain with menses, is the most common symptom of endometriosis. Women may also have pain with intercourse. The symptoms are often “cyclical” meaning that the pain is worse right before or during the period, and then improves. Women may have constant pelvic or lower abdominal pain as well. Other symptoms include sub-fertility, bowel and bladder symptoms (such as pain with bowel movements, bloating, constipation, blood in the urine, or pain with urination), and possibly abnormal vaginal bleeding.
How do you diagnose endometriosis?
To diagnose endometriosis, a doctor must perform a laparoscopy (a surgery where a doctor looks in the abdomen with a camera usually through the belly button) and take a sample of a suspected endometriosis lesion. Some physicians and patients may try to treat suspected endometriosis with certain medications to see if symptoms are improved without having to undergo surgery. Although this may be possible, endometriosis cannot be diagnosed by improvement in symptoms with medication alone. During surgery, endometriosis lesions are often described as looking like “cigarette burns” inside the abdomen, although there are many different variations as to how an endometriosis lesion may appear. Endometriosis can be located on and even within an ovary, causing an endometrioma or a cyst of endometriosis. These cysts are often referred to as chocolate cysts because the material inside the cyst looks like chocolate syrup.
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