Many marriages have crashed due to endometriosis — Dr. Ajayi

says one out of 10 women has endometroisis

By Ebunoluwa Sessou



Dr. Abayomi Ajayi is a Nigerian Obstetrician/Gynaecologist. He is also the Managing Director, Nordica Fertility Centre, Lagos which pioneered the Intracytoplasmic Morphologically Selected Injection, IMSI in Nigeria; the clinic specialises in In-Vitro Fertilization, IVF and treatment of infertility.



Dr. Abayomi Ajayi
In this interview, he speaks on the emergence of endometriosis and its effect on young women in their early thirties. According to him, one out of 10 women is presented with endometriosis which has affected many marriages the world over.

The journey to Endometriosis world

I had a patient who had cough for 18 months, unfortunately, there was no solution to it until she started coughing blood and the surgeon said her chest would be pierced because it was revealed through an X-ray that the drug she was using was not going to its location so he  suggested that the chest be cut open. The lady used to work in NNPC.

One day, we got to the hospital and discovered that she had disappeared. Such a story cannot be forgotten in a lifetime. Everybody was looking for her, even in her workplace, they were looking for her as well as the hospital, Lagoon Hospital where I worked.

And then, I started Nordica. We were in VGC when I started and this woman walked into my consulting room. I did not forget her name and when I saw the name, I said to myself, this name is familiar. I was still ruminating on that when she walked into my office.

She looked at me and started smiling. She said: “Do you remember me?”, and I said, “I think so. And she said, “Yes, I was a patient in the Lagoon Hospital and I said, what happened to you, she said she went abroad and what was wrong with her was endometroisis, a condition resulting from the appearance of endometrial tissue outside the uterus and causing pelvic pain, especially associated with menstruation.

That was the pattern. Then I remember that I also had a patient when I was in UCH as a Registrar, the problem was the same way but they did a borehole for her in the brain. Actually, they thought she was bleeding in her brain. And it was then they got the sample and found out that it was endometroisis. This woman also came to me when we started Nordica. She has relocated to the United Kingdom, but she was reading some of the things I was writing. I was a columnist with the City People magazine. And so, she came and we had the operation. At that point in time, we had our own Laparascopic surgery and we were just finding endometroisis. Then, I said to myself, this is a message for me.

It all suggested that I must take endometroisis as a major case study. And so, we started 14 years ago. We discovered that the condition is right with us and there was no reason ignoring it. Fortunately, people are now diagnosing endometroisis more. It is not a problem that is peculiar to Nigeria.

Even in the UK, it takes about nine years between onset of symptoms  before diagnosis is made. And that is why we have been doing that for 14 years. It is getting louder now but it is still a whisper. Many people have not heard about it. So, what we are trying to do this year is to go to secondary schools all over the nation because we have seen that this problem usually starts when the girl-child had her first menstruation which is always in the secondary school.

Some girls have been labelled lazy, and even promiscuous especially when she is having pains during her menstruation period. Some people will say she has aborted her pregnancy but the fact is that majority of them had endometroisis. So, the commonest thing that endometrosis presents is painful menstruation. And the painful menstruation comes from the fact that there is an inner covering in the ovary called the endometrium. That is where the baby is supposed to stay but the woman sheds it every month when she is not pregnant. These people have the tissue called the endometrium in some other places apart from where it is supposed to be.

It is like displaced endometrium. So, the commonest places where it is located could be the ovary, tubes, intestine and sometimes, it could be in the chest. And that is why sometimes, they can cough out blood, and because the symptoms are not common, it could be varied. The only thing that ties them together is that the symptoms are worse during their menstrual period. Sometimes, some people bleed from the navel during menstrual period. Those people are called witches. I have seen a woman that was carried from one church to the other because she had endometroisis.

When you do not spot endometroisis on time, it becomes complicated such that when such a woman has intercourse, it becomes very painful because the organs have already gummed together. It also results to infertility. Most of the time, we see them alone because they cannot have children. And it is when we are investigating for infertility that endometroisis is discovered. Most of the time, such women have been made to bear their painful menstruation because it is normal; the parents and doctors are not aware. Some doctors say it is in their brain. They have been made to live with their pains and majority of them are not normal. Some are depressed because they are different from other people and that is why we have taken the awareness to the people by sensitizing them about the effects, symptoms, causes and solution to endometroisis.

Unfortunately, for the fact that it is not cancer, nobody is sponsoring us. Year in, year out, we gather, invite people, and people are yet to come to terms with the issue of endometroisis. It costs us about N10 million annually and we have been doing that all the way. Endometriosis is estimated to affect between three per cent and 10 per cent of reproductive-age women. Endometriosis can only be truly diagnosed by a doctor performing a laparoscopy (a surgery where a doctor looks in the abdomen with a camera usually through the belly button) and taking a sample of a suspected abnormality.

Thus, the proportion of women affected by endometriosis differs among women having surgery for different reasons. In women without symptoms who are having surgery for elective sterilisation (having their tubes tied), 1-7 per cent will actually have endometriosis diagnosed at the time of their surgery, as will 12-32 per cent of women having surgery for pelvic pain, and 9-50 per cent of women having surgery for infertility. Endometriosis is rarely found in girls before they start their period, but it is found in up to half of young girls and teens with pelvic pain and painful periods.

Causes of endometriosis

There are several different ideas of how and why endometriosis happens. One idea is that when a woman has her period, some of the blood and tissue from her uterus travels out through the fallopian tubes and into the abdominal cavity. This is called retrograde menstruation. Another idea is that some cells in the body outside of the uterus can change to become the same kind of cells that line the uterus. This is a common explanation for endometriosis at unusual sites like the thumb or knee. Another possible explanation is that the cells from the lining of the uterus travel through the blood vessels or through the lymphatic system to reach other organs or body areas. Also, endometriosis can spread at the time of surgery. For example, a woman with endometriosis that undergoes a cesarean section could inadvertently have some endometriosis cells attach to the abdominal incision so that she has endometriosis in the scar from the surgery.

Interestingly, nearly all women have some degree of retrograde menstruation, but only a few women will get endometriosis. This may be due to differences in a woman’s immune system. Also, endometriosis is much more common if a close relative also has endometriosis, so there may be genes that influence endometriosis.

Why is endometriosis associated with pain?

When a woman with endometriosis has her period, she has bleeding not only from the cells and tissues inside the uterus, but can also have bleeding from the cells and tissue outside the uterus. When blood touches these other organs, especially inside the abdomen, it can cause inflammation and irritation, creating pain. Sometimes, scar tissue can also develop from the endometriosis which can also contribute to the pain.

What is the age range of victims of endometroisis?

It starts when a young girl begins to menstruate but because it is related to infertility, it is diagnosed in the thirties. That is why we are looking at the possibility of making the diagnosis early so that before complications start coming up, it would have been addressed. Endometriosis affects one’s decision-making. I will advise anyone who has endometriosis and not ready to start having babies early to go and store her eggs. It is expected for couples to be aware of this development. Many marriages have crashed because of endometroisis.

In Nigeria, what is the percentage of women with endometroisis?

All over the world, the percentage is the same. One out of 10 women has endometroisis in different places.

If it is not easily detected, what happens? Is it a death sentence?

Of course not. It does not kill as the disease itself does not kill. It only reduces the quality of life. It could also make one to be infertile. It affects relationships. These people bleed regularly. She could be at a function and start bleeding. It affects all aspects of their lives including education, career among others.

Is the treatment affordable to all?

It has to be treated. It depends on what exactly the endometriosis presents. It is not everybody who has endometriosis that would be infertile. It is only about 30 to 40 per cent of them.Therefore, if you have infertility, you have to treat it. Three main symptoms that endometriosis can give include pain, irregular bleeding and infertility among others.

Why is endometriosis associated with infertility?

Between 20 and 40 per cent of women with infertility will have endometriosis.  Endometriosis seems to impair  fertility in two ways: first, by causing distortion of the fallopian tubes so that they are unable to pick up the egg after ovulation, and second, by creating inflammation that can adversely affect the function of the ovary, egg, fallopian tubes or uterus.

Endometriosis Symptoms

Pain, including pelvic or lower abdominal pain and pain with menses, is the most common symptom of endometriosis. Women may also have pain with intercourse. The symptoms are often “cyclical” meaning that the pain is worse right before or during the period, and then improves. Women may have constant pelvic or lower abdominal pain as well. Other symptoms include sub-fertility, bowel and bladder symptoms (such as pain with bowel movements, bloating, constipation, blood in the urine, or pain with urination), and possibly abnormal vaginal bleeding.

Diagnosing endometriosis

To  diagnose endometriosis, a doctor must perform a  laparoscopy  (a  surgery  where a doctor looks in the abdomen with a camera usually through the belly button) and take a sample of a suspected endometriosis lesion. Some physicians and patients may try to treat suspected endometriosis with certain medications to see if symptoms are improved without having to undergo surgery. Although this may be possible, endometriosis cannot be  diagnosed by improvement in symptoms with medication alone. During surgery,  endometriosis lesions are often described as looking like “cigarette burns” inside the abdomen, although there are many different variations as to how an endometriosis lesion may appear. Endometriosis can be located on and even within an ovary, causing an endometrioma or a cyst of endometriosis. These cysts are often referred to as chocolate cysts because the material inside the cyst looks like chocolate syrup.

Advice to Federal Government especially in the treament of diseases like endometroisis

The problem we have is that we lump everything at the gate of the Federal Government and the government has its plate full. Meanwhile, it is not as if the money is there. I know corruption is there but we do not have so much money.

But, there is the organised private sector that can sponsor the treatment of endometriosis. The issue with cancer is that there is donor money earmarked for the treatment. When you see many people investing in something, it is because they want to get grants. But,that is not the way to go about it. Our people have issues. And we have not even spoken about how to bring the treatment of endometriosis as well as the reason for doctors not speaking about it. Very few hospitals have the equipment for endometriosis in Nigeria. We are also training doctors to share their experiences on endometriosis, we hold the programme every year. We have doctors whose main specialisation is endometriosis in adolescent. We have reached the stage and that is why we should be looking for endometriosis in the adolescent. We can’t even pick it up in people with infertility in their thirties. It is complex and that is why we are thinking that other people should be interested in this. It is complex because many people do not understand.

Does it cease with the onset of menopause?

It gets better and sometimes, it ceases for many people. Majority of the people get better after menopause.

Can you estimate the percentage?

10 per cent. Unfortunately, it is unrecognised.

How many women attend the programme yearly?

Last year, we had about 1,000 women. We usually do it to coincide with the International Women’s Day.

Source:https://samueljackson12.blogspot.com/2019/03/many-marriages-have-crashed-due-to.html