Gyn Chronicles
Endometriosis
By Dr. Maureen Owiti
Although this is an April 2025 publication, I am penning this column piece in the month of March. What is peculiar about March? For those of us in Reproductive Health or Obstetrics and Gynaecology we celebrate this month as Endometriosis awareness month.
And even if she wasn’ t I believe it must have crossed many students minds that the girl was acting or malingering. I’ m not sure what type of treatment they received from health care providers then as the notion of endometriosis was not yet that widespread. by her mother who was very concerned. Her mother had just been called to school to come fetch Cynthia as she was unable to continue with class because of pain. Rebecca( Cynthia’ s) mum was very confused but understanding as she had similar experience in school.
Strange name and invariably jargon unless of course you are a sufferer of the disease. Before I delve into the scientific journey of demystifying what Endometriosis is I would like you to go down memory lane and take us all back to high school. Do you remember there would always be that girl( s), who every month would be very dramatic when their visitors aka periods came and they would not be able to go to school because of the severe menstrual cramps that they experienced? I’ m sure every class had someone like that. Some of us were in day school so we would notice their absence and for those of you in boarding I’ m sure they would spend those days in the sanatorium or have parents called to take them to hospital.
Being typical teenagers, I’ m sure majority did not understand what was happening and unfortunately the young girl( s) may have been the but of some cruel jokes.
I would like to take this opportunity to have us all apologize to these girls who are probably women now and pray that we were not part of making their school lives very miserable. We had 3 such girls in my class. For me I just thought they were malingering and would like to formally apologize for the same.
So, what is endometriosis? Endometriosis is a debilitating disease in some case that is characterized by very severe menstrual cramps. In the classical presentation, warriors as they refer to themselves typically present with pain that actually starts before the onset of actual period. This is followed by an increase in the intensity of the pain once the bleeding actually starts and the pain stops with resolution of the period.
Cynthia not her real name was a high school student and came in escorted
The hallmark of the menstrual cramps in a patient with endometriosis is that they are usually unable to function and go about their daily activities. If you have such symptoms or know someone with such issues please hurry and see your gynae and if you don’ t have one you are certainly welcome for a visit.
Being a typical teenager she was very shy and I asked her whether she wanted her mother to stay during the consultation. I don’ t know whether I put the underage patient in a box but I don’ t know how else to go about the same. She was more comfortable having her mum stay on. From history this was not the first time Cynthia had to miss school because of her symptoms and she had the classical presentation. She started experiencing pain about 3-4 days prior to the periods and this was the first day and the intensity of the pain had increased like 10-fold. She felt as if something was being ripped out of her stomach. The nurse had given her some paracetamol and it was not having any relieving effect on her pain. She had previously been given some ponstan( a very strong pain killer) and this had some minimal effect on her pain. Cynthia was literally in tears and could not even sit up straight and was holding her stomach.
I took a detailed history, did the physical examination, and sent her for some tests that included the ultrasound. In typical fashion majority of the tests came back normal with some mildly raised inflammatory markers. I however explained to the mother that she most probably had endometriosis.
To date the gold standard of diagnosing endometriosis is surgery( laparoscopy), with a biopsy and histology results, though with current advances in imaging there are certain signs when picked up on ultrasound can help identify endometriosis. The only challenge is being a high schooler and not yet sexually active we were unable to perform a transvaginal scan for her.
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