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Saturday, November 30, 2013

Endometriosis: A Health Challange

Strong women, says Harriet Morgan, wear their pain like stilettos. No matter how much it hurts, all you see is the beauty of it, she further points out.
The above, no doubt, can be said to be true of the 49-year old former Miss Nigeria, Nike Oshinowo, who has had endometriosis almost all her life, yet has borne her pain silently until recently and is still radiating her beauty as ever.
The former beauty queen has taken it upon herself to create awareness about this health condition that affects women of reproductive age (15-44 years) worldwide. Through her, many Nigerians are getting to know about this health condition for the very first time. A lot of women too are getting to know the health challenge that has been the cause of their worry and agony. She has been sharing her experience and educating women who may be victims on how to carry on with their lives despite the pains they go through.
Endometriosis, according to a renowned gynaecologist, Dr. Abayomi Ajayi, “is a health disorder that occurs when cells from the lining of the womb (uterus) grow in other areas of the body. This can lead to pain, irregular bleeding and problems getting pregnant.”
Ajayi said patients with this condition had 20 per cent less chance of having children, pointing out that dealing with endometriosis as a female could be difficult and debilitating.
A medical literature describes endometriosis as a ‘masquerade’ because of its unpredictable presentation in the body. It says patients experience bouts of severe pelvic pain and can also suffer from infertility.
A major symptom of endometriosis is recurring pelvic pain. The pain can range from mild to severe cramping or stabbing pain that occurs on both sides of the pelvis, in the lower back and rectal area, and even down the legs.
The amount of pain a woman feels correlates poorly with the extent or stage (1 through 4) of endometriosis, with some women having little or no pain despite having extensive endometriosis or endometriosis with scarring, while other women may have severe pain even though they have only a few small areas of endometriosis.

Symptoms of endometriosis-related pain may include:
dysmenorrhea – painful, sometimes disabling cramps during menses; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis
chronic pelvic pain – typically accompanied by lower back pain or abdominal pain
dyspareunia – painful sex
dysuria – urinary urgency, frequency, and sometimes painful voiding
Throbbing, gnawing, and dragging pain to the legs are reported more commonly by women with endometriosis. Compared with women with superficial endometriosis, those with deep disease appear to be more likely to report shooting rectal pain and a sense of their insides being pulled down. Individual pain areas and pain intensity appear to be unrelated to the surgical diagnosis, and the area of pain unrelated to area of endometriosis.
The Minister of Health, Prof. Onyebuchi Chukwu, defined endometriosis disorder as “characterized by ectopic endometrial tissue that bleeds into the peritoneal cavity and triggers local inflammation in response to hormones which regulate the menstrual cycle.”
According to him, common sites of implants include the ovaries, utero-sacral ligaments, rectovaginal septum and peritoneum.
Endometriosis is said to affect one in 10 women in the general population, as it has been discovered that over 70 million women worldwide suffer from it.
Yet little is known about this debilitating condition, its cause and prevalence or risk factors other than the risk increases with age and with exposure to menstruation and is said to decrease with oral contraceptive use.
The health minister said at the moment, there was no reliable data of women suffering from endometriosis which could be used for policy.
He disclosed that endometriosis had not received sufficient research attention among the African population and that there was sparse level of understanding about its existence in Nigeria, which he said could easily influence evidence-based information and interventions for Nigeria’s setting.
The major challenge of women suffering from endometriosis is the delay of recognising the disease and diagnosis by physicians.
Medical experts say that several health facilities do not have capacity for prompt diagnosis of endometriosis. For instance, the average amount of time it takes for a woman to get an accurate diagnosis from the onset of symptoms is about 10 years. At this time, the adverse effect of the disease progression is enormous and may be difficult to treat, according to them.
 Even in developed countries, Dr. Abayomi Ajayi said a woman might have suffered from the condition for up to eight years before proper diagnosis could be made.
“In Africa, the situation is worse because very little is known about the condition. Therefore many women live with it without ever being diagnosed as the condition was believed not to be common among blacks before now. Over the years, it has been discovered that no race is left out of this excruciating ordeal,” he further pointed out.
Ajayi who is also the medical director, Nordical Fertility Centre, Abuja, noted that as an estrogen-dependent process, endometriosis could persist beyond menopause and could also persist in up to 40 per cent of patients following hysterectomy.
While there is no known cure for endometriosis, Ajayi, however, said “there are two types of interventions: treatment of pain and treatment of infertility. In many women, menopause (natural or surgical) will abate the process. In patients in the reproductive years, endometriosis is merely managed: the goal is to provide pain relief, to restrict progression of the process, and to restore or preserve fertility where needed. In younger women with unfulfilled reproductive potential, surgical treatment attempts to remove endometrial tissue and preserve the ovaries without damaging normal tissue.”
The health minister explained that since prevention and treatment of infertility and sexual dysfunction is one of the components of reproductive health, the federal government alone could not bear the entire burden, while soliciting the support of the academia, professional bodies and private sector in dealing with the condition.
He also tasked professional bodies like the Society of Obstetrics and Gynaecology of Nigeria (SOGON) and Nigeria Fertility Society to embark on cutting edge research to unravel the myth surrounding the disease so that Nigerian women could live a happy and productive life.
He said the federal government would be willing to support such initiative through the tertiary health institutions and designated departments in the ministry, adding, “I strongly believe that findings from such studies will positively influence policy and programmes in the country.”
Winifred Ogbodo

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