Frequently Asked Questions with Dr. Meshach Asimba, Obstetrician and Gynecologist at Fortis Health Care Centre, Suite II, 1st Floor, Fortis Office Suites – Upper Hill Nairobi.

What is endometriosis?

Is a disorder that affects women in the reproductive age. It occurs when lining similar to that found in the uterus called the endometrium gets deposited in other areas of the body apart from the inner uterine wall. This lining can be deposited in the fallopian tubes, ovaries, urethra or rectum but is most commonly deposited at the peritoneum – a special lining in the abdomen. These areas are not specialized enough to receive these deposits. The extent of endometriosis may be described in four stages namely: minimal, mild, moderate and severe depending on the location, number, size and depth of the deposits. Endometriosis is considered a whole body disease.

What are the common causes of endometriosis?

The exact cause is not yet known. However, it is thought that back flow of menses (retrograde menstruation) may play a role in developing endometriosis. This may be promoted by any obstruction to the normal flow of menses. Hence, the menstrual blood containing the endometrial cells flows back through the fallopian tubes and into the peritoneal and pelvic cavity instead of out of the body through the vagina.

What is the role of genetics in endometriosis?

There are some studies which suggest that genes may indeed play a part in endometriosis. This comes about through the immunological response in that particular individual. This means that women possess certain type of immunity that can help them fight the disease better than those without this form of immunity. About 8 -10 percent of women have endometriosis triggered by their genes.  

What are the common symptoms of endometriosis?

Well, it depends on where the lining similar to the endometrium found in the uterus has been deposited during menstruation.

The most common symptom is pelvic pain that precedes the menses by around 1-2 days. The pain escalates during the menses and can persist 2-3 days after. When the deposits are deeply seated behind the uterus, this can lead to pain during sexual intercourse (dyspareunia).When the deposits are around the bowels and rectum, you can experience pain when passing stool. When the deposits are on the bladder and urethra, you will experience pain while passing urine albeit in rare cases.  Other common causes are abnormal or heavy menstrual flow. Remember all this happens during menstruation, after that the pain subsides. It is also worthwhile to note that there are women who have endometriosis but exhibit no symptoms at all (asymptomatic endometriosis).

What is the difference between endometriosis and painful periods?

Endometriosis is just one of the causes of painful periods. Painful periods are called dysmenorrhea which can either be primary where the cause is not known or secondary where the cause is known for example endometriosis in this case. There are many other causes of painful periods.

Does endometriosis lead to infertility?

About 20-30 percent of patients who have endometriosis end up suffering from difficulty in conception. These deposits on the fallopian tubes and peritoneum cause adhesions hence the fallopian tubes are not free to trap the ovulated egg(ovum) leading to infertility.

How does one diagnose endometriosis?

A quick visit to the gynecologist will sort this. Your gynecologist will take your history and determine if your pain pattern reflects that of endometriosis. The standard method to diagnose endometriosis is through laparoscopy and biopsy. This is a surgical procedure used to examine the organs inside the abdomen. A biopsy is taken to the laboratory and examination may confirm endometriosis. In addition, some radiological examinations such as CT scans and MRI’s may aid in diagnosis.

How is endometriosis treated?

There are two types of treatment, medical and surgical. Medical management includes the use of painkillers, non-steroidal anti-inflammatory drugs, progestin injections, combined oral contraceptive drugs which reduce the growth of the deposits. There are also gonadotropin releasing hormone agonists which block estrogen and progesterone from being produced. This is important because it stops the endometrium deposits from growing as they depend on progesterone and estrogen.

Surgical treatment uses laparoscopy to visualize, diagnose and excise the endometrial tissues. This is a major surgery and is usually done in hospital. In severe cases and as a last resort when other forms of treatment have failed, a hysterectomy (surgery to remove the uterus) may be undertaken. It is important to remember that you cannot get pregnant after a hysterectomy.

Are there any side effects to the treatment?

Patients can exhibit temporary menopausal symptoms such as hot flushes, vaginal dryness, thinning of the bones and other effects while under medication.

How does pregnancy affect endometriosis?

Some women’s symptoms improve after pregnancy. This may occur when the endometrium deposits die off during that pregnancy period. However, once pregnancy period is over, the endometriosis will recur so it is not a cure.

Is there any cure?

There is currently no cure for endometriosis. The main aim of treatment is to excise as many deposits as possible and manage the pain through prescription drugs. If endometriosis has led to infertility, we try other methods of getting women pregnant such as in- vitro fertilization.

What are the financial implications of managing endometriosis?

It is expensive. Locally a laparoscopy procedure costs may range from Sh300,000 to Sh400, 000. The medication to manage the pain and other symptoms are also very expensive.

Where can ladies get help or resources about endometriosis apart from the internet?

Make use of your gynecologist who has a wealth of information on endometriosis. Also join support groups for endometriosis patients.