ENDOMETRIOSIS – A WOMEN’S HEALTH HAZARD

In recent years, the conversation on menstrual health and hygiene has been kept going and it is gradually gaining momentum in highlighting key women’s issues. We are witnessing women’s effort in speaking out and through persistent call for awareness, erasing the taboos surrounding issues concerning women’s reproductive health. However, even in the bid to create platforms for women’s issues to be heard and prioritized, there are still aspects of women’s health that are still not discussed enough. The limited access to information on these issues is endangering the lives of women and eating them up from the inside out. One such issue is endometriosis.

Endometriosis is a chronic gynecological condition in which there is abnormal growth of uterine tissue (which is meant to grow only on the internal uterine walls) outside the uterus causing pain before, during and after menstruation. This results in inflammation and growth of scar tissue that forms outside the uterus and spreads to the ovaries, fallopian tubes, rectum and even the appendix. It can affect adolescent girls as well as women within child-bearing age. Additionally, this condition is specific to individuals that have a uterus implying that it can also affect transgender folks particularly FTM trans people. 

The most common symptoms include; heavy menstrual bleeding (also known as menorrhagia), pain during and after sexual intercourse, pain in the lower abdomen, menstrual pain that interferes with daily life activities, constipation/ diarrhoea / blood in urine or stool during menstruation, pain when passing urine or a bowel movement during menstruation, difficulty getting pregnant, severe pelvic pain.

The exact cause of endometriosis is still unknown and there are no preventive measures or treatments to deter the disease.

Endometriosis is particularly difficult to diagnose because not only do the symptoms vary from patient to patient, but they are also closely similar to symptoms of other related gynecological conditions like fibroids and pelvic inflammatory disease. The obstacles in proper diagnosis can be attributed to limited research about the condition especially among women of African descent. In fact, it has commonly been assumed that endometriosis is rare among African women and not as prevalent as it is among Caucasian women. For instance, according to the World Health Organization, endometriosis affects at least 10% of girls and women of child-bearing age (at least 190 million). However, with further insight into the issue, more African women than previously anticipated are suffering from this disease. 

Endometriosis is diagnosed through undergoing a procedure called a laparoscopy. A laparoscopy is a medical procedure that involves using a thin lighted tube with a video camera to check organs in the abdominal region. It can also check a woman’s pelvic organs. It requires making an incision on the belly through which the tube is inserted into the body.

Besides limited research which is due to the under representation of African women in medical reproductive health studies, the little to non-existent awareness and knowledge on endometriosis among the general population and health care practitioners is also fueled by conservative taboos. These taboos related to preservation of ancient culture and tradition discourage open conversations about women’s reproductive and menstrual health. This has led women to struggle in silence and even opt out of consulting medical practitioners while experiencing symptoms of endometriosis like very painful periods, heavy vaginal bleeding. This often leads to a delay in diagnosis and thus resulting in women being faced with advanced stage impacts of the condition like infertility, or even the necessity of invasive procedures like hysterectomy to curb the disease.

Endometriosis has extreme impacts on both the physical and mental health of the patient. Women suffering from endometriosis are prone to having difficulties getting pregnant and infertility. They are also likely to experience depression, moodiness, frustration and challenges in their sexual life.

Just like there isn’t a known cause, there is also no cure for endometriosis. It is a long-term chronic disease; hence all treatments are aimed at providing temporary remedies for the symptoms. These include prescription of painkillers, hormone treatment, surgery (to cut away patches of the scar tissue) and removing affected organs like hysterectomy to remove the uterus, even other parts like the appendix, rectum, ovaries and fallopian tubes.

One of the main setbacks is that there is still little to no awareness of endometriosis in most communities especially here in Africa. This has resulted in insufficient information on the disease and potential treatment options, limited access to treatment, inaccurate diagnosis and unresolved misconceptions about the condition. Another challenge is the unavailability of resources to administer proper treatment. A laparoscopy which is the known accurate procedure for diagnosis is very costly in private healthcare facilities and requires patients to wait long periods for a slot and for results when they are attended to in public facilities. According to an article by the Health Journalist Network in Uganda (2022), a laparoscopic surgery cost about 4-5 million Uganda shillings (1,000-1,300 USD) in private facilities and 1 million Uganda shillings(260 USD) in government funded hospitals. It also reported that out of 300 patients approved for laparoscopic surgery every month in Mulago Referral Hospital, only 36 could be operated on due to inadequacy of relevant resources like surgical equipment.

On the side of the patients, the difficulties don’t end at their immunity being altered by suffering from a chronic illness, but also it seeps into other areas of their lives. Firstly, the financial strain from having to afford hormone treatments and multiple routine hospital visits out of pocket is very distressing. Having to cater for a condition that has no cure and deal with the simultaneously rising prices of menstrual hygiene products pushes these women to a dead-end and leaves them in the face of poverty. Furthermore, patients also have to deal with unsupportive partners; as already mentioned, endometriosis evidently has adverse effects on one’s sexual activity which could potentially result in withdrawal from participation in sexual intercourse. While some patients’ partners are open to discussing solutions and treatment alternatives, others only invalidate this condition as a reason to not engage in sexual activity and even go ahead to subject these women to violence.

It is going to take collective effort to highlight and propel this issue to the forefront in conversations about women’s health. This will encourage women to share their experiences without the shame or guilt or even fear of being faced with stigma. In turn, this will urge policy makers and researchers to prioritize women’s reproductive health issues and derive solutions that will support the wellbeing of women and girls that are living with endometriosis. Undoubtedly, centering discussions on menstrual health and hygiene is a stepping stone to achieving awareness and resource mobility for programs that support folks in our community affected by endometriosis.

Note: Endometriosis is mostly considered a premenopausal condition. However, there is still a possibility that women in the postmenopausal stage can still suffer from the condition. 

BY ATUKUNDA NOELINE