Endometriosis affects approximately one in ten women of reproductive age globally. Despite this widespread prevalence, however, it receives little attention in developed, high-income countries.
Known to cause infertility and severe, debilitating symptoms, endometriosis is a painful condition even for women with access to modern medicine.
In Sub-Saharan Africa, where the disease is common, endometriosis leaves tens of thousands of women bereft and scared, often unaware of what is happening to their bodies.
Combating this lack of education and gross underreporting is an ongoing problem for African women. Below we explore this condition and how awareness and advocacy help women seek help.
What is Endometriosis?
Endometriosis is a chronic condition caused when cells from the uterus lining grow outside the uterine cavity. This lining is called the endometrium.
Because endometrial tissue is highly sensitive to female hormones, as the body undergoes the natural reproductive cycle, this tissue grows, thickens, and breaks down just as it would normally do in the uterus.
This tissue is often found in the ovaries, bowel, and other pelvic areas. In rare cases, endometrial cells can be found outside the pelvic region.
Doctors refer to this growth outside the uterus as an endometrial implant – and it commonly causes irritation, scar formation, organ adhesions, and even fertility problems.
Signs and Symptoms of Endometriosis
If you suspect that you or someone you know might have endometriosis, it’s crucial to seek medical help. Awareness of the common signs and symptoms of endometriosis can help detect the condition early and manage it effectively.
The following are symptoms that may be associated with this condition:
- Pelvic Pain
- Heavy Menstrual Bleeding
- Painful Periods (dysmenorrhea)
- Pain during or after Sexual Intercourse (dyspareunia)
- Painful Bowel Movements or Urination
- Spotting Between Periods
- Digestive Problems, e.g., bloating, diarrhea, constipation, or nausea
In rare cases, if endometriosis affects other organs, symptoms may be associated with those organs. For example, if endometriosis affects the lungs, it might result in chest pain or coughing up blood.
Causes of Endometriosis
Endometriosis is a pervasive condition affecting women from their first period to menopause, irrespective of ethnicity or social class. The disease is believed to result from:
- Retrograde menstruation: Endometrial cells in menstrual blood backflow into the pelvic cavity through the fallopian tubes, leading to their growth outside the uterus.
- Cellular metaplasia: Cells outside the uterus transform into endometrial-like cells and proliferate.
- Stem cells: These can trigger the disease and spread it via the blood and lymphatic systems.
Additionally, the disease is linked to estrogen, which escalates inflammation, growth, and pain. However, the absence of estrogen doesn’t necessarily eliminate endometriosis.
Endometriosis in Sub-Saharan Africans
Because of an absence of trained medical professionals, previously, it was assumed that endometriosis predominated in high-income nations.
Even today, estimating the prevalence of endometriosis among Africans is a challenge. Some studies indicate that endometriosis occurs in 48% of Nigerian women, while others estimate the figure is closer to 30-40%.
Other studies note that it remains the most common cause of pelvic pain in the region and occurs in 20-25% of women with infertility.
Living with Endometriosis
Regardless, the uncertainty about the prevalence demonstrates the core issue: a lack of adequate medical care.
African women experience a long diagnostic delay and often do not receive appropriate care. These problems aren’t solely due to medical care but also a cultural taboo surrounding menstruation.
When the first East and Southern African regional symposium met to talk about improving menstrual health management for adolescent girls and women in 2018, a key issue was;
how cultural stigma prevents women from discussing menstrual issues freely. Fear of stigmatization led to diagnostic delay, even if symptoms were severe.
As one Nigerian woman explained, “I was 11 when I first got my period. I started having cramps when I was 13. I kept trying to toughen up, but it was a lot of pain. Later, it wasn’t just cramps. My legs would go number, and I would be unable to walk properly.”
While much of the scientific literature focuses on nations like South Africa and Nigeria, where medical treatment is most available, across the continent, many women turn to traditional herbal medicines and nutritional and behavioral therapies to alleviate the pain.
Such discomfort is unnecessary: treatments, ranging from hormonal contraceptives to basic pain medications, can alleviate symptoms in a significant number of cases.
But access to diagnosis and medical care will remain impossible unless the taboo is lifted. Organizations like the Endometriosis Association and the Pan African Society of Endometriosis (PASE) work to educate, advocate, and research this condition. Only with further support can they hope to make a difference.
Written by: Emmanuel J. Osemota