Endometriosis: Suffering in silence

Menstruation in India is still considered a taboo subject, so much so that its effect has cast a shadow on ailments related to it.
Express Illustration
Express Illustration

BENGALURU:  It’s just period pain for some women. For others the pain is acute, like a knife piercing the body, not only while menstruating but sometimes mid-cycle too. “For 15 years, I have suffered from this excruciating pain and did not know what caused it. Intolerable to the extent where I landed in a hospital at 3am because I could not bear it,” says  Lakshmi Sharath (49), a travel blogger from Bengaluru who has been suffering from endometriosis for more than 30 years.

Menstruation in India is still considered a taboo subject, so much so that its effect has cast a shadow on ailments related to it. Endometriosis is one such disorder women suffer in silence, despite its high prevalence, and lack of awareness of it is causing delayed diagnosis.

Endometriosis affects over 42 million women in the country, which is as common as diabetes. However, medical professionals too do not know the exact cause of the disorder with no permanent cure available either. It is a condition when tissues similar to the lining of the uterus grow outside it, causing severe pain in the pelvis. Pain is also experienced during sex, while urinating or defecating, apart from nausea, bloating or fatigue by women suffering from it.

Lack of knowledge about the disease among health care professionals also affects early diagnosis and treatment. “I was diagnosed with endometriosis at a time when even gynaecologists were not well aware of the disease and hence they were not efficient with treating it too. I have undergone multiple surgeries and hormonal treatments which were not just expensive, but mentally torturous at times,” said Sharath. She was diagnosed with the disease at 35 and was already in stage 3. The chronic medical condition led to severe mental health issues along with infertility which induced menopause also.

Sanjiv Navangul, MD of Bharat Serums and Vaccine Ltd, said, “Two areas where the data is not great are for endometriosis and for women entering the menopausal stage (in the 40s). Despite high incidence, nobody understands what the actual figures are and how treatment can be provided.”

Rising Incidence
“Recent observations in Kerala have revealed an alarming increase in the incidence of extensive endometriosis cases. Disturbingly, even teenagers are now affected by this condition, leading to prolonged suffering. 

The early onset of endometriosis in teenagers raises concerns about the long-term effects on their reproductive health and quality of life,” said Dr Geetha P, senior consultant  (obstetrics and gynaecology), KIMS Health, Thiruvananthapuram.

Dr Sheela Murali Chakravarthy, director (internal medicine), Fortis Hospital, Bengaluru, explained that the incidence of endometriosis has increased over time. “Of late, around 10% of all cases complaining about pain during menstruation are diagnosed with endometriosis. However, difficulty in diagnosis and no permanent cure makes it hard for doctors to identify people prone to it and suggest precautionary measures.”

“Gynaecologists can diagnose it easily as women with severe pain and infertility are suspected cases for endometriosis. If it is not diagnosed and treated timely, it will require a higher end of management and that will also lead to other complications. If treated properly at the primary stage it can be cured,” said Dr C Sumathi, director, Government Kasturba Gandhi Hospital for Women and Children in Tamil Nadu.

The problem with this disease is that its symptoms take around seven to nine years to appear and there are a lot of misconceptions even in the medical fraternity regarding its proper diagnosis and treatment, said Dr GSS Mohapatra, senior consultant at Apollo Hospital, Bhubaneswar, who is an endometriosis excision specialist.

Since routine ultrasound or MRI may not be able to detect early signs of endometriosis, by the time a patient comes to the doctor, she already has severe symptoms. Although oral contraceptive pills and progesterone are being prescribed to treat the disease, it cannot halt or reverse the disease process.

Endometriosis can be managed in two ways - medical and surgical - based on the severity of the disease. “The treatment is planned depending on the severity of the disorder. Endometriosis is classified into four stages. It can be easily treated by a gynaecologist with birth control pills in the early stage to stop periods. It will heal when the period is stopped,” Dr S Vijaya said.

If it is not responding to medicines, then they have to opt for surgical management. “It becomes difficult to treat when it spreads to other organs. Extensive endometriosis will spread to the bowel, bladder, urethra and surrounding organs. Later stages need prolonged hormonal therapy and surgery. To remove it surgically in an extensive spread, a multi disciplinary team should be involved as its spread to other organs,” said Dr Vijaya, former director at the Govt Institute of Obstetrics and Gynaecology in Chennai.

“The only current cure is laparoscopic excision of all visible endometriotic tissue - known as Lapex surgery. We are also conducting robotic surgery for all advanced endometriotic surgeries for better precision and outcome. 

The patient must choose her endometriosis excision specialist carefully because the first surgery should be the final surgery otherwise relapse can be very fast,” Dr Mohapatra said.

Lifestyle and Diet

Lifestyle changes and diet play a crucial role in managing endometriosis. A person should avoid or limit food causing inflammation like alcohol, caffeine, gluten, red meat, saturated and trans fat

Consume antioxidant-rich food like fruits and vegetables like oranges, berries, beetroot or spinach and fatty acid-rich food like salmon, trout, walnuts, chia and flax seeds

Obesity is associated with increased oestrogen levels, which can worsen endometriosis symptoms

Women must maintain a healthy weight and a balanced diet along with regular exercise promoting overall well-being

With inputs from Unnikrishnan S (T’puram), Sinduja Jane (Chennai) and Hemant Kumar Rout (Bhubaneswar)

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