Another new advance is that we now have milder treatment that can be used for long periods of time and we can start this before we get a confirmed histological diagnosis. I informed Cynthia and Rebecca of their choices and we opted to start treatment empirically. Empiric treatment is when you believe the patient has a certain diagnosis and you are unable to get a confirmation. You treat and if the patient improves you can deduce that they most probably had the disease.
In our case we started Cynthia on progesterone therapy and asked her to come back the following month to see if the symptoms had improved and if she was tolerating the hormonal treatment well. Fortunately for us at the subsequent visit Cynthia reported some improvement and minimal side effects of the medication. After about 3 months of treatment Cynthia was very happy with the treatment as she had not had to miss class during her periods and was able to function normally.
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.
The inner lining of the uterus is called the endometrium. The cells that make up the endometrium are very unique as they are the only cells in the body that shed every month and grow again. When such cells are found outside of the uterine lining we call this endometriosis. When the cells are found on the uterine wall / muscle we give this type of endometriosis a special name- adeonomyosis. As discussed for the last 5 minutes the most common symptom is killer cramps what we medically call dysmenorrhea.
We have mentioned that the gold standard is to do surgery, and typically this is done via laparoscopy. This is a form of minimal access surgery where just tiny holes are made on the abdomen and special instruments with the aid of camera are used to operate. What is interesting about endometriosis is that the surgical findings can be completely opposite to the clinical manifestations. You can have a patient with a very clean pelvis with very minimal and in some cases no evidence of endometriosis who has very severe symptoms and vice versa. Very severe changes in the pelvis with multiple lesions and literally no pain further making the disease an enigma.
Another common symptom for endometriosis is infertility. Due to some of the changes that can occur with endometriosis from pelvic adhesions( when the internal organs stick together) the tubes can get blocked or endometriomas( specific cyst in the ovary characterized by old blood which looks like a chocolate-colored fluid), which lowers the number of available follicles in the ovary. Treatment is difficult and can involve even assisted reproduction.
Some women are unable to have intercourse due to severe pain during intercourse. We call this dyspareunia.
Other women experience dyschezia, which is painful defecation or dysuria which is painful urination. Other than this some women experience cyclical bleeding from atypical sites. The most common is bleeding from the umbilicus during the periods. The bleeding however can be from anywhere- nose, eyes and we even had a celebrity the late Njambi Kaikai, who would bleed into her lung cavity. May her soul rest in eternal peace.
We thank God we live in the 21st century as modalities for treatment or management of the disease are way better. As usual we start with nothing but for those in pain this only means they continue to suffer. Some lifestyle modification works for those with early or milder forms and include diet and exercise. Many endo-warriors report improvement with gluten and lactose free diets. From diet, incorporating things like cinnamon also helps.
From my experience majority of suffers need something stronger than diet and exercise and that is where medication comes in and the arsenal is huge from simple pain killers( analgesics) to complex hormonal therapies. In some severe cases surgery is warranted and this should be done by an endometriosis surgeon.
I will end by wishing all the endosisters / endowarriors a Happy Endometriosis awareness month and I hope I have shed light on this debilitating disease. Till next time Eid Mubarak and a Blessed Easter.
Dr. Maureen Owiti is a practicing Obstetrician Gynaecologist and fertility consultant based in Nairobi. You can commune with her on this or related matters via email at: Drmaureenowiti @ gmail. com.