Endometriosis, Invisible Illness of Female Anatomy


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THE PAINS ARE often rippling and indescribable. Not even the pangs of childbirth can be compared to the excruciating pains that many young women in their reproductive years go through to experience their monthly flow.

Former Miss Nigeria, Chief Ms Adenike Osinowo describes her experience thus: “it is often sharp, piercing and crushing almost at the same time. You don’t really know what could bring respite you only just wish the pain would end”.

Welcome to the world of Endometriosis, the silent but debilitating illness of the female anatomy.

Researchers are yet to fully understand the pathophysiology of endometriosis beyond the recognition that it is a disease that affects many women mostly during the reproductive period of life.

The female reproductive organ anatomy can be subdivided into the internal and external genitalia. The internal genitalia are those organs that are within the true pelvis. These include the vagina, uterus, cervix, uterine tubes (oviducts or fallopian tubes), and ovaries.

The external genitalia lie outside the true pelvis. These include the perineum, mons pubis, clitoris, urethral (urinary) meatus, labia majora and minora, vestibule, greater vestibular (Bartholin) glands, Skene glands, and periurethral area.

Endometriosis according to the Medical Director Nordica Fertility centre, Lagos, Dr Abayomi Ajayi, “occurs when tissue similar to the lining of the womb is found elsewhere – most commonly on the ovaries, in the recto-vaginal septum, bladder and bowel.

“The tissue behaves like the lining of the womb where monthly bleeding occurs and these tissue also mimic the linin bleeding every month, causing severe and chronic pain to the woman”, said Ajayi.

Endometriosis and the female anatomy

Explaining to HealthStylePlus Online, Consultant Gynaecologist and Head of Department Obstetrics and Gynaecology, Lagos State University College of Medicine and Lagos State University Teaching Hospital (LASUCOM/LASUTH), Dr Abidoye Gbadegesin noted, “It is not a problem visible to the eyes. Self-appraisal is therefore difficult for an individual.

“Presentation however is usually as a result of complaints of pelvic pain which may be associated with backache and lower abdominal pain. Pain during sexual intercourse, pain during defecation or micturition. It is also associated with irritable bowel; a condition associated with bouts of diarrhea and constipation. Some may not have disturbing pain but only present themselves because of desire to get pregnant (Infertility) or heavy monthly blood loss during menstruation.

“Each of these complaints carry some differential diagnoses which only investigations will sort out. With the cardinal symptoms, such as pelvic pain, bleeding disorders, and infertility, the disease has a tremendous impact on women’s well-being and health”, said Gbadegesin.

There has also not been accurate data of how many women are affected especially in Nigeria but it is estimated that one in ten women of reproductive age group are affected hence its invisibility and description as ‘women’s trouble’, observed Ajayi.

Perhaps more worrisome is the fact that Endometriosis which is as invisible but debilitating has been known to be responsible for almost 50% of infertility in women.

Although it is not a lifestyle disease because it is not acquired as a result of lifestyle practices, but it has been established to affect mostly young women the adolescents, at the prime of their lives when they are expected to be active, sociable, economically viable and productive; “and they almost often end up struggling with painful sexual intercourse without understanding why or the cause”, said Ajayi.

Endometriosis and Fertility Challenges:

Since many sufferers are never seen early in facilities, most get into adulthood battling with how to cope with several issues including painful sexual intercourse, heavy and unusual bleeding from orifices in the body, excruciating pains during menstruation but more importantly inability to fall pregnant-infertility.

According to the Chairman, Governing Council, Institute of Fertility Medicine, LASUTH, Professor of Obstetrics and Gynecology LASUTH, Adetokunbo Fabamwo, “One of the complications of endometriosis, treated or untreated is infertility. The presence of endometriotic lesions in the pelvis is usually associated with severe adhesions which may lead to tubal blockage”.

Fabamwo explained to HealthStylePlus Online, “The disease is not easy to diagnose because aside clinical examination, “the definitive diagnosis involves an invasive procedure which is usually carried out under general anaesthesia and most General Practitioners may miss the diagnosis hence prolonged suffering and years of non-detection that could lead to infertility is some women”, said Fabamwo.

Disclosing the outcome of a ten-year (2004-2010) localised study at the Nordica Centre, Lagos, Ajayi revealed, “the coincidence that we found among most of the 61 women who presented at the IVF Clinic and agreed to a Laparoscopy to be suffering from severe Endometriosis made us to draw the inference that there could indeed be a link between Endometriosis and infertility after all”.

“Although studies have shown that not all women who suffer from Endometriosis would find it difficult to get pregnant, it is only between 30-50% of those who suffer from Endometriosis that would not fall pregnant.

“It is instructive that almost all the 61 women whose ages ranged between 31 and 40 presented primarily at the IVF Clinic but on initial examination were found to share Endometriosis in common.

“We then progressed to carry out Laparoscopy on them which later confirmed most to suffer from severe Endometriosis” said Ajayi.

Diagnosis and Treatment:

Oftentimes, when a woman presents with severe menstrual pain, the diagnosis of Endometriosis is usually not the first option. Hence many women are missed.

According to Fabamwo and Gbadegesin, “Diagnosing endometriosis require a high index of clinical suspicion. Endometriosis is a largely under-diagnosed disease because it is really a “masquerade” and presents in many different forms. A practitioner needs a high index of suspicion in making the diagnosis.

In the words of Gbadegesin, “The diagnosis of endometriosis is largely based on history, pelvic examination, Ultrasound scanning and laparoscopy. That is why we still need the treaining of more specialists on how to identify and treat patients with Endometriosis since the condition cannot be prevented or cured, only manageably treated.

“Treatment or alleviation of the pain is by use of prescribed medication which may have to do with the symptoms and the reproduction desires of the patient. There are ranges of medications that can be used. All these will relieve pain as well as help in the total management of the patient. Surgery may also be considered for demonstrable enlargement, endometrioma, or completion of family size”. Added Gbadegesin.

What Needs to be done?

On what can be done to reduce the burden of Endometriosis in women, Ajayi observed the importance of education, enlightenment and awareness campaign.

“There is still a high level of quackery in the country especially in the business of fertility treatment and no one is immune especially women who suffer the double agony of endometriosis and infertility”, averred Ajayi.

The Fertility expert therefore suggested, “The best time to build knowledge capacity is in age of Adolescence.

“This is because Endometriosis begins at age of Adolescence and if the young ones know ahead of time that it is expected that the first few months of menstruation be painful but once monthly flow is characterised by monthly pains which aggravates each month, it is no longer normal.

“ A young woman must learn to speak up and the mother or Guardian must take appropriate steps to seek medical attention from a Gynaecologist to ascertain if it is Endometriosis or not so as to receive appropriate treatment and reduce the burden of pains”. Concluded Ajayi.

3 thoughts on “Endometriosis, Invisible Illness of Female Anatomy

  1. Having read through the various contributions I am compelled to add a few missing points.
    1. Endometriosis can involve the skin around abdominal scars in rare cases post Caesarian sections. It can also be seen in the umbilical region with the woman classically presenting with monthly pains and bleeding from the navel. This history is so classical that the diagnosis should not be missed. A biopsy sample sent to a Pathologist will at microscopy reveal endometrial glands with accompanying stroma embedded in the skin tissue.
    2. Endometriosis can many times be asymptomatic and it is only revealed when the Pathologist is microscopically reviewing organs removed at surgery for other reasons. It is not uncommon to find it incidentally in a uterus that was removed in the course of treating fibroids.

    Liked by 1 person

    • Thank you so much for this contribution. I will surely post it as a welcoming contribution. I will also like to ask following what you said, do you think it is in order to always send tissues like fibroid, endometrium linings etc for histopathology examination after these are surgically removed?
      What exactly would be the lessons to be learnt if this is done.
      Do I make sense with my line of thought?


  2. Actually all tissue removed from the human body should be sent to the Anatomical Pathologist for histopathological diagnosis. Unfortunately this is not done by clinicians for various indefensible reasons. Histopathological assessment by th pathologist will achieve a number of things:
    1. Confirm or perhaps disprove a clinical diagnosis. Should the latter happen, it will offer the patient another alternative treatment protocol and even protect the clinician.
    2. Reveal an additional diagnosis or an incidental finding which might or might not attract additional treatment.
    3. Provide relevant disease epidemiological data of public health significance.
    4. Confirmation of a negative clinical observation can save the surgeon (or other clinician) a lot of legal headaches.

    Liked by 1 person

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