Her name was Laura, and she had terrible pain during her period for as long as she could remember. Some months were better than others, but when she was struck with those wicked cramps she could not even begin to describe, she would topple over on her bed and cry like a baby.
“Be strong. Some women have to bear with awful cramps during their period. There is nothing you can do about it. Have some hot tea and relax. Make sure you are dressed warm and don’t forget to wear your slippers,” her parents would say over and over again.
This kind of debilitating pain would not go away with a hot cup of anise tea; no way in hell. The horrible pain that brought tears to Laura’s eyes was due to her undiagnosed endometriosis.
So what exactly is endometriosis and why haven’t we read or heard more about it in and around town? A disorder that is frequently overlooked in Lebanon, it is an often painful and chronic condition where tissue that usually lines the inside of a female’s uterus grows outside of it; it frequently involves the ovaries, the bowels, and even the tissue that lines the pelvis. Problems arise when this displaced tissue acts the way it should within the uterus; it becomes thick, breaks down, and bleeds with the menses cycle. Others tissues in the surrounding area can become irritated resulting in scar tissue and lesions.
Dr. Joseph A. Nassif is Assistant Professor of Clinical Obstetrics and Gynecology at AUBMC and is subspecialized in Endometriosis and Minimally Invasive Gynecological Surgery. He explained to the Fit’n Style team what endometriosis entails.
In simple terms, how would you describe endometriosis?
Endometriosis is a disease of a woman’s reproductive tract with the presence of endometrial cells outside of the uterus. Normally the endometrial cells are located inside the uterus – giving menses every month - but in some cases (approximately 10-15% of women) these cells migrate outside of the uterus and implant in other places such as the ovaries, bladder, the intestines… even to the lungs and brain in some rare cases. It is a disease that causes a chronic, inflammatory reaction in the body.
Do we know the cause of endometriosis?
No, we still do not know the cause. And while there are many theories, we cannot prove any of them yet. What we can suggest is that it is likely that menstrual cells flow back into the fallopian tubes and grow in other areas of the pelvic region where they thrive and reproduce. With that said, however, this does not mean that all women with retrograde menstruation will develop endometriosis.
What are the risk factors?
While there are no risk factors confirmed, we may see a correlation of endometriosis with late motherhood, early menstruation, late menopause, and heavy menstrual flow. Pollution has also been suggested to be linked to endometriosis development; women in the city have presented endometriosis more often than those in the mountain regions.
Endometriosis is still not known to many patients as well as physicians. Many professionals believed that this condition wasn’t highly common in Lebanon, when in fact, it exists in every society. In my first year focusing on this disorder in Beirut, I conducted many surgeries for this disease and the numbers are still going up day after day. And to think that this turnout was without any awareness development. It is estimated that endometriosis affects 1 in 10-12 women.
How does this disease affect the body overall?
The majority of endometrial lesions are located within the pelvis: on the ovaries, on the bladder… and in rare cases, possibly within the lungs and brain. They can occur almost anywhere in the body. These lesions grow, lead to inflammation, form scar tissue, and cause pain on various levels. Lesions can also lead to the development of adhesions, inevitably fusing organs together. This might also lead to difficulties getting pregnant.
What are the symptoms we should look out for?
The most common symptoms are chronic pelvic pain, period pain, and pain during or after sexual intercourse. A female may also experience infertility, fatigue, pain with bowel movements and/or urination during her period, and maybe some lower back pain. Each case is different though; some have excruciating pain while others may only have mild to moderate pain, or possibly no pain at all, which makes it difficult to diagnose sometimes.
How is a woman diagnosed with endometriosis?
Some women may discover they have endometriosis when investigating infertility issues. Others may have unexplained pain and have an ultrasound to confirm the issue at hand. And because symptoms can seem to mimic other issues, such as irritable bowel syndrome, plenty of women don’t pursue investigating thoroughly. A definite diagnosis can only be achieved in the end with a laparoscopy and tissue biopsy.
How does having endometriosis affect a woman’s everyday lifestyle?
The pain can have a massive impact on a woman’s day to day life. Her personal life can be highly affected in addition to her career or education. Cycles of pain can vary from woman to woman. For those with debilitating pain, it can pose as an extreme burden. This is where we want to get the awareness out there. Diagnosis and treatment is a must.
Is there a cure for endometriosis?
Endometriosis is a potentially chronic disease which often requires long-term management. Laparoscopic surgery is utilized when endometriotic lesions, cysts, and adhesions must be removed. However, we need to relieve pain, reduce the progression of the disease, improve fertility when affected, and prevent the disease from returning after treatment is successful. Treatment options often include pain killers (NSAIDs), hormonal therapy (oral contraceptive pill), progestins and gonadotropin-releasing hormone analagues. The problem is that these treatments often do not meet the needs of all women and may only be safe and/or effective for a limited period of time. One of the latest treatments I prescribe to my patients is dienogest. It is a progestin treatment which the optimum dosing, safety, and efficacy in the treatment of endometriosis have been proven in clinical trials. It is effective and well-tolerated, and was approved by the European Medicines Agency (EMA) in December 2009.
It is so important for women to know that they do not need to suffer with pain in silence and there are treatments out there. If you or someone you know suspects they may have endometriosis, please talk to your physician.