Global Health Asia-Pacific May 2022 May 2022 - Page 58

Pain in women regard to ovarian cysts because this increases the risk of endometriosis . They need to ask about any pain during sexual intercourse .
We can do ultrasounds and sometimes see ovarian cysts , which are related to endometriosis . If you see this and they have symptoms , it ’ s sensible enough to come to a diagnosis of endometriosis . These are simple things that can be done at a doctor ’ s clinic .
But if we want confirmation and an objective diagnosis , we need visualisation which requires a diagnostic laparoscopy where we put a scope inside the patient with a small camera and see a lesion . But it ’ s now being advocated that clinical diagnosis by history assessment , physical examination , and ultrasound is also good enough to make a diagnosis and start treatment .
Endometriosis is not difficult to diagnose .
This is where the problem lies . Many people normalise period pain and dismiss it as a physiological event even if what some women experience could actually be pathological pain . This normalisation is the root cause of delay in diagnosis and treatment . For instance , studies have shown that in many cases , from the onset of endometriosis symptoms to diagnosis , it takes nine to 12 years . By that time , the disease has already led to other complications like infertility and abnormal menstruation .
For this reason , I believe all patients with period pain need to be investigated to rule out endometriosis . Even women with normal period pain should not have to suffer . We have treatments that can relieve period pain , so women don ’ t need to bear the pain caused by menstruation .
When should physicians suspect this could be endometriosis and what kind of tests they should be doing ? Endometriosis is not difficult to diagnose . It ’ s just that women aren ’ t sure whether they should see a doctor because they ’ ve been told their entire lives that their symptoms are normal , not a disease . And even some doctors will fail to recognise that menstrual pain is not all physiological and needs further investigation and referral to a gynaecologist for proper care .
Diagnosis of endometriosis can be made through clinical assessment of symptoms , proper pelvic examination , and imaging of the pelvis by ultrasound or MRI .
The first thing is to take a good medical history . Doctors should ask patients about their period pain , at what age their period pain started , and what are the durations of pain , how severe it is , and what other pains they have , is it just period pain during menstruation or do they have pain during defecation also . They also have to look at any surgery done with
What ’ s the available treatment for endometriosis ? Since the cause is unknown , there ’ s no permanent cure .
The first line is treating patients with medications . If the pain is not severe , we can just put them on antiinflammatories , but most of the time we put women on hormonal treatment , a form of oral contraceptive pill that they have to take every day because it regulates their menstruation .
But there are times when medications don ’ t work , while there are also people who don ’ t want to be on medications in the long term as they want something fast or because they ’ re concerned about side effects . Indeed , medications can lead to weight gain and hormonal complications like bloated sensations , nausea , vomiting , water retention , and oily skin . Since endometriosis affects young women , it ’ s difficult to make sure they comply with medications .
And that ’ s when surgery is indicated . An operation can reduce pain , enhance the chances of pregnancy , and treat coexisting conditions like malignancies or fibroids that need to be removed .
I also advise therapies that can relieve stress , like yoga , as these can help reduce pain as well .
You recently participated in a seminar to raise awareness of endometriosis in the workplace . Why is this important ? Women affected by this disease are in the prime of their lives , with most in the workforce . But the pain is chronic , so they will experience it their entire reproductive lives , which will also affect their work performance .
They could have acute episodes during menstruation , and , because of this severe pain , they may have to take time off work or they may have to work while their productivity is affected . Some women may have to take medical leave every month , two to three days off or even more as the pain can last one week and even require hospitalisation . But most people have only about 13 days of medical leave a year and could use them all up just to manage their pain , and then they may need to use
56 MAY 2022 GlobalHealthAsiaPacific . com