Endometriosis is a common condition suffered by women of childbearing age (usually between 25-40 years) irrespective of age or ethnicity. In Nigeria, there is no way of knowing exactly how many women are affected, as there is no statistics to this effect. Endometriosis only came to the fore when former Miss Nigeria, Nike Oshinowo, created awareness by being very vocal about her personal struggle with the illness. It is now better understood, and more women are seen to have this condition.
What is Endometriosis?
Endometriosis is a disease condition where cells that are similar to those lining the womb are found outside the womb. They may be found growing on the ovaries, fallopian tubes, behind the uterus, in the bowels or bladder. Every month, the female hormones cause the lining of the uterus to get thicker with tissue and blood vessels in preparation for a fertilized egg. If pregnancy does not occur, the lining of the wall of the uterus bleeds and is shed as a menstrual period. The endometrial tissues found outside the uterus also bleed; but since there is no place for the blood to go, there is inflammation, pain and the formation of scar tissues. If these scar tissues are found on the Fallopian tubes or ovaries, they can interfere with ovulation and fertilization.
Endometriosis is not really linked with difficulty getting pregnant; most women with endometriosis can get pregnant without problems. Difficulty only arises in severe cases where the displaced tissues form adhesions that cause organs to stick together.
What are the symptoms?
In some cases there are no symptoms; but when present, the common symptoms include:
- Excruciating menstrual pain/heavy periods
- Unexplained difficulty getting pregnant
- Pain during and after sex
- Pain in the lower abdomen, pelvis or lower back
- Bleeding or spotting in-between periods
Other symptoms may include:
- Persistent tiredness/fatigue/lack of energy
- Bleeding from the rectum/ blood in stool
- Pain with bowel movement
- Painful urination during menstrual periods
The symptoms may get better with pregnancy and disappear after menopause. This doesn’t happen in all cases.
What are the Causes?
What makes endometrial cells to be found where they are not meant to be? Well the cause is not known for sure; but there are some theories that have been postulated by experts.
Retrograde menstruation: This theory suggests that the womb lining (endometrium) doesn’t leave the body properly during a menstrual period; rather it flows backwards through the fallopian tubes and into the abdomen, and then implants itself on the organs of the pelvis and grows.
Metaplasia: This theory suggests that a cell can change into a different kind of cell to adapt to its environment; therefore shedding of menstrual blood into the pelvis during a menstrual period may stimulate the pelvic cells to transform into endometrial cells.
Genetics: This theory suggests that Endometriosis may be hereditary. Family history is a predisposing factor; therefore you are at risk if your sister or mother has it.
Circulatory/Lymphatic spread: This theory suggests that endometriosis cells can get into the bloodstream or the immune system network of vessels and glands.
Immune system problems: This theory suggests that women with endometriosis are found to have lower immunity to other conditions; therefore a problem with the immune system  renders it weak to fight off endometriosis effectively. However, it is unclear whether this low immunity problem is a result of endometriosis, rather than a cause.
Environmental Factors: This theory suggests that there are toxins found in the environment which can affect the immune system and reproductive system. It is believed that these toxins can cause endometriosis. An example is dioxins. Though Research has shown that animals developed endometriosis when they were exposed to high levels of dioxin; this theory has not yet been proven for humans.
Who is at risk?
You may be at risk if:
- If you have a family history of endometriosis i.e. mother, sister, or daughter had endometriosis
- If your periods started at an early age (before the age of 11)
- If your monthly cycles are short (less than 27 days)
- If your menstrual cycles are heavy and usually last more than 7 days
What are the treatment options?
Endometriosis has no known cure, but it can be managed. There are treatments that can improve symptoms. Your gynaecologist will discuss your treatment options with you and outline the risks and benefits of each. The treatment option depends on patient’s age, severity of symptoms and if the patient is interested in getting pregnant .
Treatment includes pain medication, hormonal treatments and surgery.
1. Pain Medication
Pain medications are suitable for people mild symptoms or pain. NSAIDs-Non-steroidal anti-inflammatory Drugs and Opiods are usually the preferred painkillers used to treat the pain associated with endometriosis. They help ease pain by acting against the inflammation caused by the condition.
2. Hormonal Treatment
Most hormone treatments reduce the chance of pregnancy; therefore they are only used by women who do not wish to get pregnant. Hormone treatment works by limiting the production of oestrogen which encourages endometriosis tissue to grow and shed. Hormone treatment has no effect on the adhesions that cause organs to fuse together, therefore cannot improve fertility.
Some of the main hormone treatments for endometriosis include:
- The combined oral contraceptive pill or contraceptive patch:Â Which stops eggs from being released thereby making periods lighter and less painful.
- Levonorgestrel-releasing intrauterine system (LNG-IUS): This hormone works by prevents the lining of the womb from growing quickly. This way, it can help reduce pain and greatly reduces periods. It can bring on some unwanted side effects like irregular bleeding, breast tenderness and acne.
- Gonadotrophin-releasing hormone (GnRH) analogues: These are synthetic hormones taken as a nasal spray or injection. They work by bringing on a temporary artificial menopause because they reduce the production of oestrogen. The side Side effects are the same as those of menopause- hot flushes, vaginal dryness and low libido.
- Progestogens: These are synthetic hormones that act in the same way as the natural hormone progesterone. They work by preventing the lining of the womb and any endometriosis tissue from growing quickly. The Side effects are bloating, mood changes, irregular bleeding, weight gain.
3. Surgery
Surgery is used to remove areas of endometriosis tissue, in order to improve symptoms and fertility. It is the preferred option for women with severe endometriosis. The kind of surgery to be done will depend on the location of the tissue.
- Laparoscopy: is the most commonly used and least invasive technique. It is basically a keyhole surgery that is used to diagnose, as well as remove endometrial tissue.
- Laporotomy: This is a more invasive procedure done when endometriosis is severe and extensive, or when some organs are fused together.
- Hysterectomy: This is the removal of the womb. It is a last resort because it is an irreversible. It is only done when other treatments haven’t worked and the patient has decided not to have any more children. Removing the ovaries in the process of the hysterectomy helps reduce the possibility of a return of endometriosis. If the ovaries are left in place, the endometriosis is more likely to return.
Studies have shown that there is an improved pregnancy rate after laparoscopic surgery; however, the success rate is not clear. If after laparoscopic treatment pregnancy still does not occur, in vitro fertilization (IVF) may be the best course of action to improve fertility.
Other Lifestyle changes which can improve symptoms are: Exercise, yoga, good diet, lots of water, lots of fibre.
Get support in Nigeria
The benefits of support groups can never be overestimated. If you are in Nigeria and have Endometriosis, you can join the Endometrium Support Group Nigeria, (EGSN), or visit the  Endometriosis Foundation of Africa (EFA) for more information.
Image credit: Blausen.com staff
