In a race for survival that brought her before more than 40 specialist doctors across the US, Ijeoma Isimokwenye’s life has been one of perseverance since she was diagnosed with the uncommon uterine disease known as endometriosis.
“There is little or no awareness about endometriosis in Nigeria, the reason why my case got complicated. The first time I had a lung collapse in Nigeria after a series of surgeries to remove cysts, I went to see a gynaecologist, who casually told me I had endometriosis. The series of surgeries led to me having lots of scarred tissues, which in turn worsened the endometriosis,” lamented Ijeoma, who has lived with the condition for more than 2 decades.
She encouraged mothers to give serious significance to complaints from their young daughters about painful menstruation. “Not only to administer pain relief medication but also to take the child to a gynecologist for possible early detection if endometriosis is suspected. Long-term neglect can result in significant damage if the child indeed has endometriosis,” she said in her interview.
What is Endometriosis
Endometriosis is a female medical disorder where tissues normally lining the uterus grow in other parts of the body. The condition is often associated with excruciatingly painful menstruation. (In some cases, the pain can start as early as a week before menstruation.) A woman with endometriosis may experience pain during intercourse as well, causing a strain in her sexual life. Additionally, some women experience constipation and pain during excretion.
Endometriosis, a health issue affecting approximately 10% (190 million) of women of reproductive age worldwide and 17% of women experiencing chronic pelvic pain, remains a significant health concern. In Nigeria, the prevalence of endometriosis among asymptomatic women is reported to be as high as 48.1%. These statistics underscore the widespread impact of endometriosis on women’s health globally, highlighting the pressing need for awareness, early detection, and management strategies to effectively manage the condition.
What causes endometriosis?
Although the root causes of endometriosis are investigated by science, James Ijagbemi, a specialist in gynecology at Oak Hospital, points at hormonal imbalances being implicated as potential factors.
Yet some medical experts maintain that endometriosis can arise from such factors as retrograde menstruation, where menstrual blood flows back through the fallopian tubes into the pelvic cavity rather than out of the body. This blood contains endometrial cells from the inner lining of the uterus, which may adhere to pelvic walls and organs, leading to growth, thickening, and bleeding during each menstrual cycle. Additionally, transformed peritoneal cells, believed to result from hormonal or immune factors, may mimic uterine lining cells when lining the inner side of the abdomen, potentially contributing to the rise of endometriosis.
Other potential causes include embryonic cell changes influenced by hormones like estrogen, which could trigger the growth of endometrial-like cell growths during puberty. Surgical scar complications, where endometrial cells attach to scar tissue from surgeries such as C-sections, and endometrial cell transport via blood vessels or tissue fluid systems to other parts of the body are also implicated. Moreover, immune system conditions that impair the body’s ability to recognize and destroy endometriosis tissue may contribute to the development and persistence of the condition.
The Risk involved for the affected women
In Nigeria, infertility is usually attributed to the woman’s inability to bear children, often without recourse to medical examination. Endometriosis disease, endemic to women, has been discovered to cause fertility problems.
Dr. Ijagbemi went on to buttress the assertion, he said that the disease could cause many women affected to experience issues with conception and even cause early menopause. Additionally, he said, the vaginal pain that accompanies the disease usually occurs during sex and menstruation.
Studies indicate that endometriosis increases the risk of ovarian cancer, although the overall risk is low. This risk remains relatively minimal among individuals with endometriosis. Although rare, there is a possibility of another type of cancer called endometriosis-associated adenocarcinoma occurring later in life among those who have had endometriosis.
According to Ijagbemi, it can significantly disrupt a woman’s daily life by causing chronic pain, menstrual cycle irregularities, and fertility challenges. Fortunately, symptoms can often be managed effectively with treatment.
Diagnosis and Treatment
Confirming the presence of endometriosis typically involves surgery. Before proceeding with surgery, the healthcare provider will inquire about symptoms and medical history, and conduct a pelvic exam along with possible imaging tests.
The most common procedure used to diagnose endometriosis is laparoscopy, a minimally invasive surgery. During laparoscopy, a thin tube equipped with a camera and light called a laparoscope is inserted through a small incision close to the navel. The healthcare provider can visually assess patches of endometriosis and may also perform a biopsy to obtain a tissue sample for further examination.
Ijagbemi stated that preventing endometriosis isn’t always possible. “While certain factors can lower the risk of developing the condition, endometriosis can still occur in some cases. Genetics may play a role in the development of endometriosis, so if family members like your mother or grandmother have been diagnosed with the condition, discussing your risk with your healthcare provider is important,”he said.
According to a 2023 WHO report, there is no cure for endometriosis but its symptoms can be treated with medicines or, in some cases, surgery.
Absence of Awareness in Nigeria
Ijeoma highlighted the scarcity of excision surgeons in Nigeria as a probable contributing factor to the near absence of awareness regarding the disease within the country. Despite calls from experts in 2017 for heightened awareness among Nigerian women about endometriosis, knowledge about the condition is lacking among a significant chunk of the population.
With the month of March dedicated to raising awareness about endometriosis, there arises another opportunity to intensify efforts to intensifying awareness about the disease across Nigeria’s women’s advocacy groups and within governmental institutions. This occasion presents a standpoint for educating the public and fostering support networks for those affected by endometriosis throughout the nation.
Ijeoma Isimokwenye has navigated a challenging journey through more than 40 specialist doctors across the US due to her endometriosis diagnosis. Her case was compounded by a lack of awareness in Nigeria, where initial treatments caused complications. Ijeoma stresses the importance of attentive care for young girls experiencing painful menstruation to ensure early diagnosis and prevent severe damage.
Endometriosis is a medical condition where tissues lining the uterus grow outside it, causing severe pain, especially during menstruation and intercourse. It affects about 10% of women of reproductive age globally, including a significant prevalence in Nigeria. Factors such as retrograde menstruation, hormonal imbalances, and surgical scars are believed to contribute to its development.
The condition often leads to infertility issues and chronic pain, disrupting the lives of affected women. There is also a slightly increased risk of ovarian cancer associated with endometriosis. Although there is no cure, symptoms can be managed with medication and surgery.
In Nigeria, the lack of awareness and insufficient specialized surgeons exacerbate the issue. Efforts to raise awareness, especially during designated periods such as March, are critical to educating and supporting those impacted by endometriosis.
