It is a scourge of many women but because of its very nature, menstrual pain makes sufferers endure in silence, some missing school, work and social functions and they rarely offer explanations at the risk of job loss or social exclusion.
Such is the fact of this cyclical pain that generally begins in some girls mere months after puberty, but even as the discomfort endured serves as a regular blot on the activities of most woman, there is a much more insufferable form of the monthly agony – endometriosis.
While medical science is still unsure of the cause of endometriosis, what is known is that it never goes away. Any successful medication must be taken until menopause, and treatment bears risks for those of childbearing age who wish to have, or continue having children.
“This thing is incurable. This thing is devastating,” declared University of the West Indies lecturer, Dr Damian Best on September 11, 2018.
Delivering a lecture themed: “Painful period: could it be Endometriosis”, the Consultant Obstetrician and Gynaecologist and British Fertility Society Certified Lecturer Specialist explained that the cause of endometriosis remains a mystery.
“That’s the million-dollar question”, he said. But this most painful of pain periods is hormone-triggered and ‘wreaks havoc’ on women’s bodies.
Speaking at the Lloyd Erskine Sandiford Centre in an instalment of the Barbados Drug Service lecture series, Dr Best made clear that endometriosis is not to be confused with a lining cold, which is an infection in the lining of the uterus after childbirth.
This ailment however, has to do with the uterus, as for some reason, tissue from this area gets deposited in other parts of the body ranging from the womb, to bowel to even the nose and serves as a monthly trigger for the excruciating pain.
Like other causes of painful periods, endometriosis affects women during their monthly cycle as the lining of the uterus (endometrium) thickens with the hormone oestrogen and matures with the other hormone progesterone in preparing a place for a fertilised egg to nestle for pregnancy. If there is no pregnancy that lining falls off when the progesterone is gone and comes out through the vagina in what is commonly known as the period.
But, according to Dr Best, the endometriosis complication comes because “that same tissue has taken up residence in these very awkward places,” such as inside the uterus, in the ovary, or the pelvis.
He said that through common research, “you would hear that people have endometriosis in their belly buttons; in caesarean section scars; in their chests; in their nostrils. Endometrial tissue, that same stuff that would come out through the vagina when you have a period is elsewhere in the abdomen or in the pelvis or somewhere else and every month it’s reacting to your hormones and it has nowhere to go”.
He added, “So, if it sticks around in there and it’s reacting to your hormones, you know what it’s going to do when it does not have any place to go – it is going to wreak havoc. Your body is going to say it has a problem. It is going to react, it is going to invade. It is going to become inflamed and painful.”
Generally painful periods, or dysmenorrhoea, come in many varieties. “Somewhere between 41 and 97 per cent of all women having a cycle are going to have a painful period, and as a result, it’s a common cause for missing work or missing school,” said Dr Best.
“It tends to start with the bleeds [and] finish with the bleeds. But sometimes it may start a day or two before and may also be associated with nausea, vomiting and headaches.”
There are two types of painful periods, primary and secondary and there are drugs to block the pain of the primary version of this discomfort. Unlike the primary version which occurs in the female with a normally functioning body, the secondary version is usually caused by a number of factors. Endometriosis falls within the secondary version of painful periods.
“It takes up to 7.5 years to make a diagnosis because it is not something you could diagnose just by looking at someone,” said Dr Best who described this ailment as “invisible but not imaginary; you can’t see it on the outside”.
Another reason for the delay is because, “women hide their symptoms very often. They’re ashamed to come and say ‘I’ve been having these painful periods’”.
He said one in three women with chronic pelvic pain and about three to five out of every ten women if they’re having problems getting pregnant would be likely to have it.
In 2014, Dr Best conducted an audit of all gynaecology notes in Barbados – 1,492 files over three months – and found that “3.9 per cent of those patients being seen in gynaecology had endometriosis as a diagnosis”.
As a result of this chronic painful condition women may have low moods, reduced quality of life, and chronic fatigue. Signs and symptoms may differ in victims and some might be so lucky to never have a symptom, he said. But, “in others, what is characteristic is that when they are having their cycle once every month, they’re going to have exacerbation or worsening of these symptoms. If endometriosis is in the rectum or where stool comes, they may have painful stool every month. If [it’s] near the cervix or in the back by the vagina, painful sex during that time of month.”
All this pain stops when the period bleeding ends.
Part Two next week
Treatment and living with Endometriosis