Endometriosis: The silent women's crisis

It is estimated that endometriosis, a chronic disease associated with severe pain during periods, sexual intercourse and chronic pelvic pain, affects one in 10 women and girls in reproductive age globally, according to the World Health Organisation (WHO).

Endometriosis is when tissue similar to the lining of the uterus starts growing outside the uterus, usually in the pelvis, but sometimes in places like the bowel or diaphragm. This misplaced tissue can cause inflammation and irritation, leading to pain, especially during menstruation, and even affecting fertility. Essentially, the reproductive system gets disrupted, and that’s why women with endometriosis often experience chronic pain and difficulty getting pregnant.

The pain from endometriosis is much more intense than normal period cramps because the tissue growing outside the uterus behaves as if it’s still inside the uterus. It sheds and bleeds every month, but unlike the uterine lining, there’s nowhere for that blood to go. This causes inflammation and pain.

In addition, it can also irritate nearby nerves, making the pain feel even more intense. Apart from painful periods, many women with endometriosis also experience discomfort during sex or experience pain when using the bathroom. Fatigue is another common symptom that often goes unrecognised. Some women might have no symptoms at all, while others can experience a variety of discomforts, making it a very unpredictable condition.

Diagnosing the disease can be tricky because its symptoms overlap with many other conditions, such as irritable bowel syndrome or pelvic inflammatory disease. While a doctor may suspect endometriosis based on symptoms, the only way to definitively confirm it is through laparoscopy which is usually a surgical procedure where a tiny camera is inserted into the pelvic area to look for the tissue causing the disease.

In addition, doctors might also perform a biopsy to confirm the diagnosis. While ultrasound and MRI can help spot certain types of endometriosis, they can’t always detect smaller or more superficial lesions, making laparoscopy the gold standard.

Several treatment options for managing endometriosis are available. For pain relief, simple painkillers are normally used. Hormonal treatments, such as birth control pills can help regulate the menstrual cycle and slow the growth of endometrial tissue.

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For women who have more severe cases or who want to improve their fertility, surgery may be the better option where a laparoscopy procedure is recommended to remove or burn the affected tissue.

As we mark World Endometriosis Day, it’s important to shed light on a condition that affects millions of women globally, including locally. Raising awareness helps people understand what affected women go through and the support they need.

Many live with the condition for years without knowing the cause of their pain, often misdiagnosed or told it’s just “part of being a woman.” This delay affects not only their physical health but also their mental well-being, relationships, and quality of life.

Educating the public and healthcare providers can lead to earlier diagnoses, better treatment, and improved lives. Awareness empowers women to speak out, advocate for their health, and connect with others facing similar challenges.

Dr Okemo is a Clinical Senior Instructor at Aga Khan Medical College, East Africa and Consultant Obstetrician Gynaecologist at Aga Khan University Hospital, Nairobi.