Farah Mohamed, a 32-year-old mission supervisor, had all the time assumed that the excruciating ache of menstruation was a common expertise for ladies. It was not till she fell to her knees in ache and sought medical care in 2023 that she discovered that her intense discomfort was not a traditional a part of the menstrual cycle, however reasonably a painful symptom of endometriosis.
Also called uterine lining migration, endometriosis is a continual inflammatory sickness whose trigger stays unknown, with no recognized technique of prevention or remedy, in accordance to the World Well being Group (WHO). Additionally it is characterised by debilitating ache that may happen throughout menstruation, sexual activity, bowel actions, and urination.
“Endometriosis is a situation the place tissue just like the liner contained in the uterus, which usually builds up and sheds throughout a interval, begins rising outdoors the uterus,” Abdallah Fayed, an obstetrician-gynecologist (OB-GYN), defined to Egyptian Streets. “This tissue can find yourself on the ovaries, fallopian tubes, and even areas just like the bladder or intestines.”
Endometriosis impacts one in ten girls worldwide of reproductive age, between puberty and 50 years previous, which interprets to round 190 million girls, in accordance to WHO. Whereas it impacts an estimated six to 10 % of girls worldwide, figuring out the prevalence of endometriosis in Egypt stays difficult attributable to a scarcity of documentation, in accordance to a 2018 examine by Menoufia College Hospital.
“What makes endometriosis painful is that this tissue nonetheless behaves prefer it’s within the uterus, thickening, breaking down, and bleeding with every menstrual cycle. Nevertheless, as a result of it’s outdoors the uterus, it has nowhere to go,” Fayed mentioned.
Sufferers typically expertise signs akin to continual pelvic ache, stomach bloating, nausea, and fatigue. Based on Fayed, endometriosis can have an effect on close by organs over time, typically inflicting ache past the menstrual cycle. In some circumstances, if left untreated, it could actually additionally result in fertility challenges in some circumstances, complicating efforts to conceive.
When Farah first skilled heavy bleeding and ache, her physician recognized her with a tumor within the ovaries with out working any exams or an ultrasound—a prognosis that she took with a grain of salt.
One other physician recognized her with uterine cysts, which are benign fluid sacs that develop when the uterine lining isn’t absolutely expelled through the menstrual cycle.
“After that, I lived with the ache for 2 years, ready for the cyst to vanish by itself like my physician prompt,” Farah famous.
In accordance to a 2024 survey carried out on the Girls’s Well being Hospital on the College of Assiut, Egyptian girls face appreciable delays in prognosis attributable to symptom variability and restricted consciousness amongst healthcare suppliers, with a mean diagnostic delay of 36 months. Elements akin to age, the stage of the illness, and the presence of ongoing ache additionally contribute to the extended prognosis.
Endometriosis can mimic different situations, like irritable bowel syndrome (IBS) or pelvic inflammatory illness, making it difficult for medical doctors to establish instantly, in line with Fayed.
“One time, I had horrendous ache and I couldn’t rise up straight, or sit or lie down,” Farah shared. “So I went again to the physician.”
After an ultrasound and a magnetic resonance imaging (MRI), she was recognized with endometriosis. Her physician prescribed her painkillers to handle the ache, and hormonal medicines as therapy.
“Remedy choices obtainable for endometriosis are ache relievers and hormonal therapies,” Fayed mentioned. Hormonal therapies embrace contraception tablets, hormonal (Intrauterine Gadgets) IUDs, and Gonadotropin-Releasing Hormone (GnRH) agonists, which scale back or cease the menstrual cycle, slowing the expansion of endometrial tissue.
Nevertheless, for sufferers experiencing extreme ache or issue conceiving, surgical procedure could also be a viable choice, in line with Fayed.
“By way of laparoscopy, which is minimally invasive surgical procedure, we are able to find and take away or burn away endometrial tissue to alleviate ache and doubtlessly enhance fertility,” Fayed instructed Egyptian Streets, noting that the largest problem is that the tissue can re-grow over time, placing the affected person again in the identical scenario.
Safa Adel, a 29-year-old banker, suffered that destiny after a five-year wrestle with endometriosis.
“I’m residing in fixed ache and unpredictable bleeding,” Safa shared, noting that she makes use of painkillers typically and medicine to regulate the bleeding. “Because of the illness, together with the medicines, I obtained anemia and depend on nutritional vitamins and dietary supplements.”
Girls with superior endometriosis reported considerably poorer bodily well being and functioning in comparison with these with gentle endometriosis and in comparison with girls with out endometriosis, in accordance to the 2024 survey.
Like many endometriosis sufferers, Safa skilled horrible pre-period ache all her life. On the age of 24, she went to an OB-GYN. Her physician suspected uterine cysts, “although they don’t trigger such excruciating ache,” she clarified.
But, after an ultrasound, she was recognized with uterine cysts. She was placed on hormonal medicines, typically used for contraception, however to no avail.
“I gained numerous weight, struggled mentally and emotionally, and was in ache nonetheless,” she mentioned.
In the identical yr, she sought the opinion of one other physician, who recognized her with endometriosis after an MRI and really useful further exams together with a tumor marker check— a check used to rule out the presence of cancers.
“It was the primary time I ever heard of the illness,” Safa mentioned.
Over the course of two years, her physician prescribed varied medicines, however none alleviated the ache or affected her menstrual cycle or the tumor’s measurement.
“Ultimately, my physician referred me to a specialist for a laparoscopy, and I had it in 2022,” she mentioned, including that she thought the surgical procedure was a closing and everlasting answer – one not knowledgeable that endometriosis is a continual situation, with the potential for the tissue to regrow.
Whereas the endometrial tissue grew again, it has not grown bigger than what was eliminated. Together with ache medicines, her physician put her on Zoladex, a drugs used within the administration of endometriosis ache and lowering lesions.
Based on Safa, she took Zoladex on 1 / 4 foundation and it stopped her menstrual cycle and weakened her bones and tooth. Her physician prompt the ultimate decision of eradicating her uterus after having kids.
“Nobody understands the ache I am going via or the injury the illness does to me,” Safa shared, emphasizing that most individuals don’t even know concerning the illness and the pressing want for consciousness.
Safa mentioned that the ignorance is isolating and exhausting. She can’t even take a sick depart from work when she feels drained, with out explaining what it’s.
“It nonetheless gained’t examine to coronary heart illness or a damaged leg,” she acknowledged.
Farah echoed Safa’s ideas, saying that the ache, debilitating and sudden, might hit on the worst of occasions and nobody round her would know. It might cease her from doing essentially the most mundane issues, akin to work, sleep, and even ending a chore so simple as washing dishes, and her causes wouldn’t be understood.
The prognosis of endometriosis stays some of the necessary and largest challenges that sufferers face. In accordance to WHO, early prognosis and efficient therapy are essential, but entry stays restricted, particularly in low- and middle-income nations.
“Consciousness amongst each girls and a few healthcare suppliers about endometriosis in Egypt is restricted and nonetheless growing,” Fayed instructed Egyptian Streets, noting that ladies won’t acknowledge that their ache is irregular, and medical doctors might misattribute the signs to different situations or see it as “unhealthy interval ache.”
“My every day ache shouldn’t be regular, and girls’s signs should be taken significantly,” Safa mentioned.
Cultural elements, like discomfort discussing menstrual or pelvic ache, can stop girls from searching for assist early, which delays prognosis, in line with Fayed.
Monetary boundaries additionally affect entry to diagnostic exams for endometriosis, akin to laparoscopy, which may be costly and sometimes inaccessible, notably in rural areas. Whereas consciousness is progressively rising in main cities and academia, a major hole in data and understanding stays throughout the healthcare system.
The 2024 survey emphasised the necessity for specialised endometriosis facilities in Egypt, academic initiatives to unfold consciousness, and assist teams to handle the wants of those girls and enhance their high quality of life.
“Way of life modifications, like train and eating regimen, and counseling additionally assist some handle every day impacts. Usually, a mixture of therapies works greatest,” in line with Fayed.
For Farah, the one approach to deal with endometriosis is to just accept it, settle for that there isn’t a remedy and that she won’t have the ability to have kids.
Endometriosis, although a silent affliction for too many, disrupts numerous lives, forcing girls to navigate the fixed ache, uncertainty, and isolation that comes with a ignorance.
