Masquerade Disease--- A Woman’s Struggle
Happy International Women’s Day!!
#EmbraceEquity #2023
No doubt it is one of the most important days of the
entire year, it is “International women’s day!!! This post is specially
dedicated to all women across the world, “Being a woman itself is a superpower”
In honor of the struggle women go through, this
article focuses on a disease that affects women and girls with most silently agonizing
through the pain considering the difficulty and limitations in the diagnosis of
this disease. Given how good this disease is at hiding, we can accurately refer
to it a masquerade disease--- Endometriosis. It is no wonder that March also
happens to be “ Endometriosis Awareness Month”
Background:
A woman’s uterus (womb) is lined with tissues called
endometrial tissue which make up the lining called endometrium. With each menstrual
cycle, a new endometrium is grown in preparation for the implantation of a
fertilized egg. In the absence of a fertilized egg, the tissues breakdown and shed
with the menstrual flow. This process repeats with each menstrual cycle.
Endometriosis is when these endometrial tissues then grow
outside of the uterus. Unlike, the tissues inside the lining, endometrial
tissues growing outside does not shed during a menstrual cycle, this leads to a
buildup of abnormal tissues outside the womb causing inflammation, scars, painful
cysts (fluid-filled sacs) and adhesion which can make the productive organs stick
together. This sounds easy to spot, however, endometriosis is very clever at
masquerading as several other conditions or even be missed due to its varying
clinical presentation.
According to WHO statistics, Endometriosis affected
about 10% (190 million) of reproductive age women and girls globally.
Symptoms:
Sadly, when endometriosis decides to present
clinically, it a chronic disease associated with severe, life-impacting pain
during periods, sexual intercourse, bowel movements, urination, chronic pelvic
pain, nausea, fatigue, depression, and infertility. Unfortunately, in cases of
excessive menstrual cramps, girls and women alike have been told it’s “normal” menstrual
pain, just like Bindi Irwin described here on CNN today, she said “ a doctor
told me it was simply something you deal with as a woman” Many young girls and
women deal with this struggle from the onset of their first period through
menopause. In some cases, endometriosis can be asymptomatic but the effects on
reproductive system still very much present.
Terminologies:
Endometriomas: are endometriosis cysts commonly found
in the ovaries filled with dark brown endometrial fluid.
Adenomyosis: this is when the endometrial tissue grows
into the muscle of the uterus (womb). Adenomyosis can occur concurrently with
endometriosis or alone.
Stages:
There
are four stages of endometriosis depending on where and how far the endometrial
tissue has spread outside the lining of the womb. Stage 4 being the most severe
is characterized by deep implants (wounds), thick adhesions (scars), large
cysts. In line with its masquerading act, endometriosis does not necessarily
progress through stages, a woman might be diagnosed as having stage 1 and
remain there whereas, a woman can have stage 4 at her first diagnosis.
On
rare occasions, the endometrial tissues can migrate to the chest cavity
(thoracic endometriosis) causing chest pain, shortness of breath around the menstrual
cycle time which can lead to life threatening complications like a collapsed lung.
Causes:
Endometriosis is described as a complex disease with
multifactorial causes, many theories have been purported such as reverse menstruation,
endometrial tissues being transported through blood flow, abnormal differentiation
of cells outside the uterus into endometrial tissues, direct transplantation of
tissues to other parts during pelvic surgery or genetics.
Risk factors: despite no known cause of endometriosis,
there are some risk factors that puts a woman at higher risk of developing
endometriosis:
·
Family history of
endometriosis
·
Abnormal womb
·
Early start of menstruation
(before age 11)
·
Shorter menstrual periods
(less than 27 days)
· Heavy menstrual flow that lasts more than 7 days
Diagnosis:
· Laparoscopy involves
a small cut in the abdomen, passing through a tube with light and camera to
check for endometrial tissue in and around the uterus.
·
Biopsy: if
endometriosis is suspected, a sample of the tissue is taken for a pathologist
to examine under the microscope.
· Ultrasound or MRI can be used to look around the reproductive organs.
Treatment:
Treatment can be with medications to stop ovarian
hormone, stop menstrual periods and endometrial tissue growth and/or surgery
depending on symptoms and the desired outcome, that is to prevent pain or treat
infertility. In some situations, surgically removing the tissue can alleviate
the symptoms and restore fertility. However, endometrial tissue may grow back
and symptoms may return.
Infertility and Endometriosis: Infertility occurs due
to the effects of endometriosis on pelvic cavity, ovaries, fallopian tubes or
uterus. ASRM reports about 24% to 50% of women with infertility have
endometriosis and as such might need to seek assisted reproductive treatments
(ART).
The hope is for endometriosis to get the necessary awareness
it requires in other to spare many women and girl the social, health and economic
agony that comes with living with this disease. Some women/girl experience
symptoms that prevent them from going to school or work affecting the ability
to have a fulfilling career. Painful sex affects sexual relationships thereby
impacting on social life. Therefore, an enhanced awareness, early and accurate
diagnosis which would ultimately lead to management of this disease will
empower women all over the world affected by this disease consequently improving
quality of life and overall well-being.
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