March 02, 2021
It is a debilitating reproductive health concern for women. Still, very few persons are talking about it.
“Endometriosis affects persons from all walks of life. There is no discrimination,” said obstetrician and gynecologist, Dr Shamanique Bodie-Williams.
“There is a stigma associated with chronic pain symptoms. You are not going to usually walk around and express how painful your menstrual cycles are. Many ladies are not even aware they may have an abnormality with their period. They may think this is just a normal part of being a female. One study shows it takes an average of about 12 years to make this diagnosis.”
March is celebrated as endometriosis month world-wide. The goal is to shine a spotlight on a condition that affects an estimated one in 10 women during their reproductive years, that’s approximately 176 million women across the globe, according to the World Endometriosis Society and the World Endometriosis Research Foundation (WERF).
Endometriosis is often a painful disorder in which tissue that normally lines the womb grows outside the uterus. This misplaced tissue most commonly attaches itself to the ovaries, fallopian tubes, the tissue lining the pelvis and could spread to other organs as well. It thickens, breaks down and bleeds monthly just like a menstrual cycle, said Dr Bodie-Williams.
Unable to exit the body, this internal bleeding becomes trapped. Surrounding tissue can become irritated, leading to inflammation, pain, or scarring and adhesions that can cause tissues and organs to stick to each other. Aside from producing severe menstrual cramps, endometriosis may cause pain or discomfort during intercourse or bowel movements. Fertility problems could also develop.
Experts say the severity of pain isn't necessarily a reliable indicator of the extent of the condition. Women could have mild endometriosis with severe pain or advanced endometriosis with little or no pain.
“Many endo patients, who have a severe form of the condition, struggle to get to a point where it’s better and they can cope with their day to day lives,” said the women’s reproductive health expert who works as a consultant physician in Grand Bahama’s public health system and sees private patients at The Medical Pavilion in Freeport and at The Bahamas Women’s Wellness Centre in Nassau.
Battling endometriosis is a life changing experience for many of her patients. One decided to break her silence in a bold move “to be a part of the fight” to end the stigma surrounding the chronic, progressive condition.
“It has limited what I have been able to do. The pain is always constant. I participate in activities with great apprehension because I’m not sure what’s going to trigger the pain. I know how bad it can get and I don’t want it to get to the furthest extent,” said the 41-year-old professional whose been a patient for nearly a decade.
Things weren’t always this way. As a young lady, the patient went from no periods to very light menstrual cycles spanning three to four days.
“Somewhere in my early to mid-30s I started to have a pain I could not explain. The periods did not start heavy at that point. It was just debilitating pain that would stop me in my tracks. Of course, that was alarming, when you don’t know where to go, never having heard about endometriosis before.”
Dr Bodie-Williams assessed each possible source of pain. Finally, she suggested laparoscopy as the patient was not improving. The minimally invasive surgery evaluates whether a patient has endometriosis. A minor procedure requiring general anesthetic, doctors target trouble areas and, if possible, remove any excess tissue. In less severe cases, hormone manipulation such as birth controls may be enough to keep the disorder in check combined with holistic measures such as diet, exercise and stress reduction.
“I decided, ‘Let’s go in there and find out what’s happening.’ I remember my mom being extremely nervous. She had heard stories of not being able to obtain a diagnosis, then you have surgery only to discover it’s too far gone,” the patient recalled.
“Hearing the diagnosis ‘endometriosis’ brought a sigh of relief, but also it brought more confusion. You realize there’s really no consistency with it. It varies from patient to patient. There is no cure for it, so what am I supposed to do?”
According to Dr Bodie-Williams, the challenge with this condition is its uncertainty. Sometimes it will improve, other times it worsens. Above all, it takes a team approach to evaluate and treat the symptoms, she said.
“If you suspect you have this diagnosis have a good conversation with your gynecologist but be honest about your symptoms. Keep a symptoms diary to properly inform your physician. Pay attention to what makes it better and what makes it worse. Sometimes you may have to make changes within your own habits to have an overall improvement in your symptoms.”
Dr Bodie-Williams stressed treatment is not a “one-off thing.” It requires consistency.
“You can’t see a physician today and they are able to fix everything permanently. It is a process. It’s an ongoing relationship. You must be prepared to be in it with your health care provider for the long haul so they can give you the best care possible. It takes time to see what’s working and what is not working for you. It’s not a condition where we have a magic pill that fixes it all. Every patient is different so every treatment plan may potentially be different depending on your symptoms and depending on your endometriosis.”
Experts do not know the cause of endometriosis. However, the earlier it is identified, the quicker a treatment plan can be implemented. This could prevent the condition from progressing and help to bring some degree of normalcy.
In the case of Dr Bodie-Williams’ patient, she still prays the condition would just simply disappear.
“Barring that my hope would be to just manage the pain and to have a good quality of life, to not always be on edge, to get the pain and heavy bleeding under control because that definitely limits what you can do,” she said.
“I’d like to be able to talk about women’s health issues freely and get the support you need from your fellow endo warriors. It’s just like having any other disease or medical condition. It shouldn’t be taboo. It shouldn’t be something where persons are questioning whether this is a legitimate concern. Endometriosis is real. It is not a fiction of a young lady’s imagination.”