Doctor speaks: Beware! Don’t ignore regular period pain, it can be endometriosis

Hyderabad: Girls are often told that period pain is a normal monthly phenomenon. Even when some girls complain of unbearable abdominal pain and miss their classes in schools or colleges, period pain is still normalized. It’s mainly because of a lack of awareness about the serious and chronic health condition called endometriosis, which affects at least one in 10 women.

On the occasion of the Endometriosis Awareness Month of March, Dr. Rooma Sinha, chief gynecologist, robotic and laparoscopic surgeon from Apollo Hospital, Hyderabad tells NewsMeter about the risk factors for the disease, the importance of early diagnosis and treatment options to arrest the progress of the endometriosis.

Non-cancerous but incurable

“Endometriosis is a painful gynecological condition affecting around 10 % of girls and women of reproductive age, from menarche to menopause. The positive thing about endometriosis is that it is not cancerous, but unfortunately, it’s not curable. At the most, the progress of the disease can be checked if diagnosed and treated early,” said Dr Rooma.

Elaborating, the doctor adds, “The lining inside the uterus called endometrium is made of hormone-sensitive tissues. Every month, a new endometrium grows during the menstrual cycle to prepare for a fertilized egg. If not fertilized, then it’s discharged from the body during routine menstrual bleeding. However, sometimes, the endometrial tissue grows outside the uterus near the ovaries, pelvis, bowels, etc.” In such cases, the tissues stick together in those areas and are not discharged with menstrual blood, leading to complications and severe pain.”

In other words, hormonal changes in the body during the monthly cycle cause the cells in the endometrial-like tissue to grow, and then break down and bleed into places where it cannot escape. While menstrual blood is discharged during menstruation, this blood remains inside, leading to inflammation and the formation of scar tissue and adhesions that can cause severe pain.

Risk factors and symptoms

“Endometriosis can happen to girls and women of any age after they attain puberty. Family history and genetics can be a risk factor and obesity too. Research is also ongoing about the possibility of environmental pollution and plastics altering the hormonal milieu causing complications like endometriosis.

While all girls who have pain during periods may not be due to endometriosis, chances are higher if they experience unbearable pain during periods every month. Sometimes, some women experience misleading Gastrointestinal (GI) symptoms like bloating and constipation during their periods, which can be indicative of endometriosis as the bowel is located very close to the uterus. Therefore, this GI pain should be examined properly to rule out endometriosis.

Since it may take 6 to 10 years for all the symptoms to manifest, it often leads to a delay in diagnosis. The earlier it is detected, the better the outcome in controlling the progress of the disease,” said Dr Rooma.

Women living with chronic conditions of endometriosis suffer from a complex range of symptoms such as severe pain during periods, sexual intercourse, bowel movements and/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes infertility apart from psychological symptoms like depression and anxiety.

Diagnosis and treatment

When patients visit doctors either with problems of infertility or severe pain during periods, an ultrasonography or MRI scan is done to detect endometriosis. “The treatment module is determined depending on if the patient just wants to get rid of the pain or wants to get pregnant as well. The pain is managed by giving contraceptive medication or hormonal injections. Sometimes, laparoscopic or robotic surgeries are required to address the pain. However, if the patient wants to get pregnant and the disease has advanced, then surgeries or IVF (In-vitro fertilization) technique is used. Contraceptive medications for pain management cannot be given in such cases. Since it’s impossible to get pregnant in case of endometriosis-induced infertility, there is no other option but to use the IVF method to have a baby,” explained the gynecologist.

Use IVF only if there is no alternative

Dr Rooma also cautioned that IVF and other artificial birth techniques should not be misused but employed only in genuine cases of infertility and where the woman has health issues that make conceiving naturally and carrying a pregnancy safely almost impossible.

“Since hormones are injected into the body from external sources, some studies point to the possible adverse effects of IVF on health in the long run, including causing hormonal imbalance, obesity, and even cancer. After delivery, women should continue follow-ups with their gynecologists, and take the prescribed medicines to keep the endometriosis-related pain under control,” said the gynecologist.