by Dr. Nor Ashikin Mokhtar
Have you ever had menstrual periods so bad that you dread them in the days leading up to your cycle? Do you skip several days of work or school every month because you can not stand the pain? Do you suffer pelvic pain even during sexual intercourse?
You may have a condition called endometriosis. Millions of women around the world suffer from this disease, which not only causes severe, debilitating pain, but may also lead to infertility.
For this reason, women, especially girls in their teens, should not brush off serious period pains. Getting medical advice and treatment at an early stage will prevent future problems, especially in conceiving a baby.
Growths Outside the Uterus
Every month, during your menstrual cycle, the lining of your uterus (endometrium) builds up with blood vessels and tissues, in preparation for a fertilised egg to be implanted on the wall. However, if the egg from your ovaries is not fertilised by sperm, the hormones in your body will signal your uterus to shed the blood and tissues, which results in your monthly period.
In some women, tissue that looks and acts like the endometrium starts growing outside the uterus – creating abnormal growths on the outer surface of the uterus, the ovaries, the fallopian tubes, the ligaments that support the uterus, the intestines, the bladder, the internal area between the vagina and rectum, and the lining of the pelvic cavity.
These growths are made up of the same kind of tissue and blood vessels as the endometrium, therefore they also react to the hormonal changes of the menstrual cycle. But unlike normal endometrial tissue that is released as menstrual blood, the tissue in the abnormal growths have nowhere to go.
Thus, with each menstrual cycle, the growths get larger and larger, causing the symptoms to get more painful each month. The build-up of blood and tissue also causes inflammation and internal bleeding.
The most common symptom of endometriosis is lower abdominal pain, especially before and during menstrual periods. Some women may even experience pain throughout the menstrual cycle. The periods tend to be heavy and may even be erratic.
Some women also suffer from painful sexual intercourse, which may be caused by the stretching of the endometrial tissue behind the vagina.
One common complication of endometriosis is infertility, with an estimated 30 to 40% of women having difficulty conceiving.
Infertility can be related to several factors. For instance, the scar tissue from endometriosis can form adhesions around the ovary and restrict the available surface area of the ovary for egg release. Adhesions affecting the fallopian tubes may interfere with their ability to pick up an egg released by an ovary and transport it to the uterus.
Occasionally, endometriosis affects the inside of the fallopian tube, resulting in blockage, and making fertilisation impossible. Endometriosis can also disrupt the ovaries' normal cycle of egg development and release.
The most invasive form of treatment for endometriosis is a hysterectomy. A hysterectomy is an operation to remove the uterus (sometimes the cervix is removed too). More than 100,000 women in the United States undergo hysterectomies each year due to endometriosis.
However, a hysterectomy has serious repercussions on a woman's sexuality, sexual function, ability to conceive and her quality of life, as it will cause premature menopausal symptoms.
Young women of reproductive age should only consider hysterectomy after exploring other options for treatment.
Hormonal medication may also be able to reduce the activity of the endometrial tissue. You should only take hormonal medication as prescribed by your gynaecologist.
Anti-inflammatory medication can relieve the pain of endometriosis, but it has to be taken before the pain begins so that it is able to block the production of prostaglandins that produce the pain.
These painkillers have be to taken every six hours. However, taking these over the long-term can cause other complications, so get your doctor's advice.
Finally, do not discount the effects of exercise and rest. These can improve overall immune system function and will contribute to relief from endometriosis.
Physical activities release endorphins, which act as a natural painkiller in the body. Rest and relaxation can relieve stress due to work and other factors, which is important as stress can lead to hormonal changes and increased levels of pain.
Endometriosis is not an easy condition to live with, and it may cause you to feel frustrated and depressed. But take comfort in the fact that you are not alone, and that you can share your experience with other women.
Most importantly, you do not have to live with the pain every month – talk to your gynaecologist and explore options that will help you regain your quality of life.
More info on ENDOMETRIOSIS here.
by Dr. Nor Ashikin Mokhtar