For women who experience excessive bleeding during menstrual periods, or a lot of pain while urinating, fatigue, diarrhoea, bloody urine and constipation, chances are high that they could be suffering from endometriosis.

Medical experts define endometriosis as a problem that affects a woman’s uterus (the place where the foetus grows when a woman is pregnant). This happens when the tissue that normally lines the uterus forms outside the uterine cavity.

Which age group is at risk?

"The peak prevalence of endometriosis occurs in women aged between 25 and 35. However, the disease rarely occurs in young girls who have not yet started having menstruation and in 2 to 5 per cent of women in post-menopausal period. In women with endometriosis, approximately 80 per cent presented with pain, 25 per cent with infertility, and 20 per cent with a mass on their ovaries,” explains Dr Theodomir Sebazungu of University Teaching Hospital of Kigali (CHUK).

Sebazungu says although the exact cause of endometriosis is not known, expert suggest some hypotheses.

"Retrograde menstruation, where instead of coming out through vaginal canal, menses containing endometrial cells flow back through the fallopian tubes and into the pelvic cavity, is a likely cause. Displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle,” he says.

Sebazungu adds that after a surgery, such as Cesarean section, endometrial cells may be displaced from uterine cavity to a surgical incision.

He notes that both retrograde menstruation and surgical scar implantation could explain why endometriosis mainly affects female in their reproductive age. Sebazungu, nevertheless, says the above hypothesis cannot explain the endometriosis in women out of reproductive age. Experts also suggest that hormonal or immune factors may promote transformation of peritoneal cells that line the inner side of your abdomen into endometrial cells. This is known as induction theory. The blood vessels or lymphatic system may also transport endometrial cells to other parts of the body.

Signs and symptoms

According to Dr Stephen Rulisa, an obstetrician gynecologist at CHUK, the cause is generally not known, but it is hypothesised to be due to retrograde flow of menstrual debris through the fallopian tube to the pelvis. One of the symptoms is general abdominal pain, especially during bowel movements.

"Whenever a woman feels much pain while urinating, during sexual intercourse , heavy blood flow in menstruation periods ( where cramping may begin before period and carry on into the period time which cause lower back and abdominal pain), there is a possibility that she is suffering from endometriosis,” says Dr Iba Mayele, an obstetrician gynecologist at Gynecology Clinic Galien, Kimironko, Kigali.

Mayele adds that, fatigue, diarrhoea, constipation, bloating, delayed parity alcohol, caffeine abuse and infertility (due to fallopian tube damage) are signs of endometriosis that should not be taken lightly.

Complications

"Endometriosis is recognised as a benign disorder, but there is an increased risk of malignant transformation especially ovarian tumors. While endometriosis is diagnosed in reproductive age, there is a higher prevalence of it among Caucasian and Asian races compared to black race. However, if there is delayed treatment, the main potential complication is impaired fertility since one-third to one-half of women with endometriosis have difficulty getting pregnant,” Mayele explains.

He adds that delayed treatment affects the bladder, uterus, fallopian tube, ovaries; causes thrive pain, delays conceiving and also damages the intestines.

Treatment

Mayele says the goal of therapy in patients with endometriosis is to alleviate the pain and infertility and rule out the rare co-existence of the ovarian cancer, to relieve the pain, non steroidal anti-inflammatory like knac.

"Progestin therapies such as medroxy progesterone and GnRh induce amenorrhea and suppress endometriosis-related pain. The use of GnRh is limited to a maximum of 6-12 months,” he says.

Sebazungu says treatment of endometriosis varies from patient to patient, and depends on the presentation, that is, whether the patient has pain, mass or infertility.

"The extent of the disease and location, severity of symptoms, patient’s age, reproductive desires, medication side effects, surgical complication rates and cost of treatment, are all taken into account during treatment,” he says.

Sebazungu notes that the disease can be treated with anti inflammatory drugs (for example Ibuprofen) or/and contraceptive hormone therapy (like oral contraceptive pills normally used for family planning).

"The patient can also be operated depending on the extent of condition if the mass needs to be surgically removed. This is a chronic disease and the goal of treatment is to make the patient free of symptoms,” he explains.

Rulisa says that the treatment is usually hormonal contraception which helps line pills, but when severe, the commonest treatment is danadol.

Rulisa urges women to always go for regular medical check-ups whether sick or not as this would alert them of any illness they may be suffering from early, hence better chances of successful treatment.