ENDOMETRIOSIS: IGNORANCE & TABOO
“The most colossal health misdiagnosis in human history”
“The chameleon of gynecology”
Ignorance by medical practitioners, and taboo by society. Ignorance, because doctors do not know much about Endometriosis to identify it immediately. Taboo, because women speak about it confidentially and not openly. When they describe their pain and discomfort to a gynecologist, it is considered psychosomatic, or merely part of their monthly menstrual cycle symptoms, despite the varying intensity experienced by every patient. It is associated with genetics, different metabolisms, or varying lifestyle habits.
Accurate statistics are unavailable. With 1 in 9 cases currently being reported, it is believed that it may be as many as 3 in 9 cases if there were less stigma and enough public awareness. It takes between 3 and 10 years to be diagnosed correctly. Therefore, it is not an uncommon disease nor is it restricted historically or geographically.
DESCRIPTION & SYMPTOMS
Endometriosis is a chronic disease, in which tissue similar to the lining of the uterus grows outside the uterus, forming growths known as lesions. This leads to inflammation, cysts, and scar tissue forming in the pelvic region and (rarely), elsewhere in the body. It can cause severe pain in the pelvic area during menstrual periods, and make it harder to get pregnant. It can start with a person’s first menstrual cycle and last until menopause.
A disease is not fatal, nor is it selective. Debilitating as it may be, one cannot separate from one’s body to avoid the pain and is compelled to cope with its trajectory and its various symptoms for as long as it lasts. With some, it lasts from one menstrual cycle to the next on a revolving basis. With others, they could have recurring menstrual cycles every fortnight. Some people have pain when using the bathroom. Others, during or after having sex. One thing remains clear, the regular woman’s “normal” is not the “Endo” person’s normal.
Endometriosis complicates the function of other organs in the pelvic area up to the thoracic cage, by compressing several organs simultaneously and rendering some dysfunctional. It may create constipation and unusual bloating, giving the impression it is a pregnancy, particularly when accompanied by nausea and ill-health. Some people pass out with no visible symptoms and have to be rushed to the emergency. Part of the symptoms are heavy bleeding during or between periods, lethargy and fatigue, anxiety or depression, and isolation. Those who have high blood pressure have to be particularly careful, to avoid coronary lesions or collapse. Students have to miss school for a few days, professionals have to abandon their jobs for a few years.
Descriptions by patients are “painful, unrelenting, debilitating, trapped, frustrating, powerless, exhausting, perplexing, frustrating, insidious, guilty”, etc.
In the Middle Ages, women afflicted with it were either murdered or considered insane because they simply could not function normally as wives and mothers. It is a global problem that dates back millenniums.
Strangely, certain people with Endometriosis may not have any symptoms at all.
STAGES OF ENDOMETRIOSIS
The ASRM classification system is divided into four stages or grades according to the number of lesions and depth of infiltration:
Stage 1: Minimal.
Stage 2: Mild.
Stage 3: Moderate.
Stage 4: Severe.
The classification also uses a point system to quantify the Endometriotic lesions.
STAGE 3
There are many deep endometrial implants in stage 3, and cysts may develop on at least one ovary. Endometrial cysts form on an ovary when the tissue attaches to it, and it then sheds blood and tissue.
STAGE 4
To remove the Endometriosis implants and scar tissue, surgery is required in stage 4, called a Laparoscopy. This can lead to fertility issues, depending on where the implants are. Those who are recommended for surgery are usually in severe pain. However, they must discuss all the implications with their doctors before accepting it.
CAUSES
The causes are unknown. At present, Endometriosis is thought to arise due to retrograde menstruation. That is when menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity at the time that blood is flowing out of the body through the cervix and vagina during periods.
TESTS
Gynecologists use an instrument to inflate the abdomen slightly with a harmless gas. After making a small cut in the abdomen, the surgeon uses a small viewing instrument with a light, called a Laparoscope, to look at the reproductive organs, intestines, and other surfaces to see if there is any Endometriosis.
On the other hand, ultrasounds can show large clumps of tissue or scarring that are likely signs of Endometriosis. They are very good at identifying it in the ovaries. But ultrasounds can’t show tiny pieces of tissue which are the most common type.
TREATMENT
There is no prevention for Endometriosis, and there is no cure for the moment. However, its symptoms can be treated with medications, surgery, and traditional therapies.
The symptoms surface at puberty with the first menstrual cycle. Other people have to undergo surgery because of its impact on the malfunction of other organs, the pain, and its effect on their normal lives. At times, they may require several surgeries.
Individuals must be aware of their condition through their accentuating symptoms, because healthcare workers may not easily diagnose them. Although not frequently, the symptoms often improve after menopause.
SELF-CARE
Raising awareness helps people to be diagnosed early, and early treatment can slow or halt the natural progression of the disease, reducing its long-term effects.
In addition to seeking emotional assistance by discussing with other women in social groups, women should make their doctors realize the impact of their symptoms on their lives, and identify or create local patient support groups to exchange these experiences for additional information and advice, particularly for the younger generation.
MEDICAL INTERVENTION
A range of medications can help manage Endometriosis and its symptoms.
· Tricyclic antidepressants (TCAs) are most frequently used for chronic pain: Amitriptyline (Elavil) and Nortriptyline (Pamelor).
· Non-steroidal Anti-Inflammatory Drugs (NSAIDs) and Analgesics (painkillers) like Ibuprofen and Naproxen are often used to alleviate pain. However, they tend to cause ulcers, GI (gastrointestinal) bleeds, and kidney problems. Aspirin and antiplatelet drugs are often associated with an increased severity of UGIB.
· The Selective Serotonin Reuptake Inhibitors (SSRIs): Fluoxetine (Prozac), Paroxetine (Paxil), and Sertraline (Zoloft), are commonly prescribed. Studies have found that SSRIs may decrease Estrogen levels while increasing Androgen (male hormone) levels in women. Particularly the antidepressant Prozac and Danazol, a synthetic androgen.
· The oral medicine Dienogest was approved in 2021 by the FDA.
· Ryego is a once-a-day tablet taken with/without food but at the same regular time daily.
· There are some injectable drugs recently approved, such as Sayana Press in 2023.
· Progestin causes the uterine lining to thin and Endometriotic implants to shrink, thereby reducing or eliminating the pain. It comes in the form of oral medication such as Norethindrone, or injectables, such as Depo-Provera.
· Hormonal medicines like GnRH-analogues and contraceptive (birth control) methods can also help control pain. These methods include: pills, hormonal intrauterine devices (IUDs), vaginal rings, implants, injections, patches — these methods may not be suitable for those wanting to get pregnant. Fertility medicines and procedures are sometimes used for those having difficulty getting pregnant.
Surgery is sometimes used to remove Endometriosis lesions, adhesions, and scar tissues. Laparoscopic surgery allows doctors to keep the incisions small. Some patients may have almost 10 surgeries, not only to remove the lesions but also to restore wholesome function to certain organs.
Discuss your treatment options with a qualified healthcare provider. Obtain advice from 2 more specialists, to make an informed decision. Treatments can vary based on the severity of symptoms and whether pregnancy is desired.
Learn more from the World Health Organization.
No treatment cures the disease for now. However, if left untreated it creates further health complications. But do not fall into the trap of continuous over-the-counter medication.
Eli Lilly & Co. is a large pharmaceutical company. The like of the notorious Sackler Group. They claim they are “turning science into healing to make life better for people around the world.” They pay the scientists, and they create quick-fix healing remedies, with severe side effects that do NOT MAKE LIFE BETTER, but are capable of knocking down an ox! Beware of Big Pharma’s biggest brands. They are excellent at marketing. Their advertising budgets often surpass the annual budget of an entire country. With such money, they work their way around legislation, skirt regulations, bribe regulators, and rapidly establish their drugs on the market place seizing the demand. Dissatisfied, they exaggerate the demand statistics to sell more “around the world”.
TCM: TRADITIONAL CHINESE MEDICINE
Acupuncture is an effective option, with the following points targeted:
Baihui (top of the head).
Yintang (halfway point between the eyebrows).
Guanyuan (lower abdomen).
This combination treats the chronic symptoms of fatigue, pelvic pain, headaches, and painful menstruation.
AYURVEDA
In Ayurveda, Endometriosis corresponds to a type of gynecological disease called Udaayartinee, with the symptoms of painful and delayed menstruation, the relief of symptoms after menstrual flow, and retrograde menstruation.
The Ayurvedic treatment is Vatai Yoni-Vyapad:
· Vata Anulomana: the downward movement of Vata Dosha.
· Lekhana: scraping out adhesions and excess Kapha Dosha.
· Srotoshodhana: clearing the channels.
For less pain during sexual intercourse and intimacy and to avoid pain during initial penetration, foreplay is recommended to help stimulate natural lubrication. Natural lubricants are useful for added comfort. If pain should occur during extended or deep penetration, it is recommended to experiment with various positions until the partner is least uncomfortable.
Mindful meditation with regulated breathing and yoga may not cure Endometriosis, but it certainly takes the edge off the pain and helps to deal more easily with the everyday discomforts caused by this condition.
Untreated, Endometriosis can affect the ovaries and reproductive system adversely, affecting a person’s fertility. It can cause profuse menstrual bleeding, and digestive distress, and affect a person’s well-being, leading to lethargy, CFS (chronic fatigue syndrome), and depression. If it leads to withdrawal symptoms, there is an acute risk it may lead to suicide.
CURE
There is no cure for Endometriosis. In some cases, the condition resolves on its own, without treatment. Hormone therapy can slow the progression of the condition and reduce pain, and surgical procedures can lessen pain. However, symptoms often recur after these treatments.
Inflammation and high estrogen levels can worsen the symptoms. A good diet plays an important role in assisting the body fight inflammation and balance estrogen. This has been proven by many people who carve the right diet for themselves.
If left untreated, Endometriosis can get worse, just as sometimes, it can get better by itself. The best option is to identify the symptoms and monitor them. If they get worse, obtain treatment immediately. Obtaining support from international self-help groups can be very useful, to manage this condition. One can learn a lot from their exposure and experience.
GENERAL
FERTILITY
Endometriosis does not necessarily cause infertility but there is an association with fertility problems, although the cause is not fully established. Even with severe Endometriosis, natural conception is still possible. It is estimated that 60–70% of those afflicted can get pregnant normally.
MENOPAUSE
Endometriosis is largely considered a premenopausal disease with symptoms often improving during menopausal transition. However, undergoing hormone replacement therapy may cause worsening symptoms. Of postmenopausal women, 2%–4% are affected by Endometriosis symptoms. A person with the disease should be aware of possible menopause symptoms that may develop, such as mood swings and vaginal atrophy. It is sad for a woman with persistent fertility problems, to discover she had this disease just before entering into menopause because of an ill-informed gynecologist.
Some women’s menstrual cycles revolve around the same persistent and agonizing symptoms. The anticipation of their periods creates so much anxiety that their body collapses before time. Or their anxiety may lead to depression, and in extreme cases, to suicide.
Mothers, particularly single-parent mothers afflicted with Endometriosis, would do better to educate their children early, and not to appear neglectful when they undergo such symptoms as lethargy, chronic fatigue, fever, etc. Children are sympathetic, cooperative, and understanding when they are aware of the underlying problem. Otherwise, they may interpret such behavior as emotional neglect.
CONCLUSION
Endometriosis is not fatal, but it may lead to life-threatening complications if left untreated. It can negatively affect a person’s quality of life and may introduce adverse mental health conditions. Treatment manages the symptoms to relieve the pain and discomfort, providing the individual with a more productive life.
Suppose gynecologists and health practitioners allocate more time listening attentively to their patients and recording their symptoms, they can make more qualified decisions and disseminate more information, instead of flatlining this problem by considering that women experience their menstrual cycles in various intensities and symptoms.
Governments, schools, and the media must take an active role in educating and disseminating information. The medical sector responds with more research and development in finding a cure.
Sammy RNAJ
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