Fibroids usually do not pose any long-term dangers to a woman. However,
they could cause the following:

Heavy menstrual flow could lead to blood loss and low blood levels.
In some cases, the lady may need a blood transfusion.

Dysmenorrhea. Painful menses could affect the quality of life of the
client by causing severe pains during menses.

RISK FACTORS
As many as 4 in 10 women may have fibroids in any population, and by
age 50 years about 70 – 80 % of women will be found to have fibroids.
Several factors may increase a woman's risk of developing fibroids. They
include:

Genetic factors
Fibroids tend to run in families and are common in families where a
mother or aunt is found to have fibroids. It is also commoner in black
women.

Obesity
Fibroids are more common in obese women because of the conversion
of fat to estrogen. Fibroids feed on estrogen for their growth.

SYMPTOMS
Most persons with fibroids have no symptoms. When symptoms occur, the
client complains of:

Shifting abdominal mass. Most women describe it as regular
movements within the abdomen.
Heavy menses with the use of additional pads
Abdominal pains during menses.
Difficulty urinating [if the fibroid is compressing on the lower part of
the urinary bladder].

LOCATION OF FIBROIDS

The location of a fibroid could determine if a fibroid would cause symptoms.
The different locations include:

Intramural fibroids
They are located in the muscular walls of the fibroid and may enlarge
inwards or outwards. Small intramural fibroids generally do not cause
symptoms.

Subserosal fibroids

They are located on the external surface of the uterus.

Pedunculated fibroids

These are fibroids that grow outside the surface of the uterus and
develop a stalk.

Cervical fibroids

They are located in the wall of the cervix (neck of the uterus).

Parasitic fibroids

These fibroids are usually pedunculated and then develop blood vessels
from other structures

Submucosal fibroids

These are protrusions of fibroid into the uterine cavity thus distorting it
and increasing its surface area for bleeding. They usually cause heavy
bleeds.

FIBROID AND INFERTILITY

Fibroids rarely are a cause of infertility except in rare cases when it
occludes both fallopian tubes.
They could lead to pregnancy losses if a pregnancy implants on a
submucous fibroid. it could lead to pregnancy loss.
Women who get pregnant with fibroids could be at risk of:

Pains during the 2 nd trimester of pregnancy [when the fibroid
undergoes degeneration]
Poor growth of the developing baby, a term called intrauterine growth
restriction
Preterm delivery
Heavy bleeding after delivery

PREVENTION

There are no ways of preventing uterine fibroids as most cases have a
genetic potential. However, you may be able to reduce your risk slightly by
maintaining a normal weight.
Regular check-ups with your gynecologist are necessary if you have been
diagnosed with uterine fibroids to monitor their growth.

DIAGNOSIS

Diagnosis of uterine fibroid usually begins with a history of abdominal
swelling or heavy menses. However, in many cases, it is picked up during a
routine pelvic examination or an ultrasound scan for another medical
condition.

Laboratory tests may be required and examination done may include:

Full blood count. This checks for the presence of anemia [low blood
level], and the platelet count. It could assist in detecting blood
disorders.

Clotting profile. It helps to check for problems with blood clotting.
A 3D ultrasound scan will help confirm the diagnosis including the
numbers of fibroids and their location.

In some cases, an MRI may be indicated when planning for treatment or
surgery for women with large fibroids to get more details about the sizes
and locations of the fibroids, to ascertain that they are not cancerous.

TREATMENT

When a doctor makes a diagnosis of uterine fibroid, the plan to treat will be
determined by the symptoms. Modalities of treatment include:

1. Expectant management
Women without symptoms usually do not require any treatment. They are
counseled to have regular checkups.

2. Medical Treatment
Medications are used for the treatment of some of the symptoms of fibroids
or to temporarily reduce the size of the fibroids. They include:

NSAIDs. These drugs are used to relieve painful menses. Examples
are Ibuprofen, Brustan, Cataflam.

Mefenamic acid. Used to reduce the amount of bleeding during
menses.

Oral contraceptive pills. They are used to reduce the amount of
menstrual flow.

Mirena [progesterone IUD]. This is an insert implanted into the
uterus to reduce menstrual blood flow.

GnRH agonist. They are injections used to induce a state of
reversible menopause in a woman thus temporarily shrinking the
fibroids and reducing blood flow. They are used for a maximum of 6
months. They are also used to make fibroids smaller before a
planned surgery.

Uterine Artery Embolization [UAE]
This procedure is used for women who do not desire to get pregnant. UAE
involves inserting some gel into the uterine artery through a catheter to
block the uterine artery blood flow to the uterus. The fibroids will shrink over
months following the procedure.

3. Surgery

Myomectomy
This involves the removal of fibroids in women who still desire to
have babies in the future. Fibroids could be removed through:

Laparoscopic myomectomy
Laparoscopy is the preferred method for fibroid removal. It is done by
inserting a camera through a pinhole and the instruments for surgery are
inserted through small holes in the abdomen. The fibroids are removed
by morcellation [a procedure which cuts it into smaller pieces so it can
be pulled out of the small incisions]

Hysteroscopic myomectomy
For submucous fibroids, removal can be carried out successfully through
the vaginal route without making any incisions on the abdomen.

Laparotomy or abdominal myomectomy
This is the traditional method of removing fibroids. It is used for large
fibroids or multiple fibroids when laparoscopic removal is not feasible.

The normal ovarian function is to produce hormones [estrogen,
progesterone, and androgens] and release eggs [ovulation] from the
follicles every month. Ovulation occurs in response to stimulation by the
hypothalamus and pituitary glands.

TYPES OF OVARIAN FAILURE

1. PRIMARY OVARIAN INSUFFICIENCY
This occurs when the ovary fails to function normally in response to
appropriate gonadotropin stimulation provided by the higher centers
[hypothalamus and pituitary]. Hence, there is a primary problem with
the ovaries.
Causes include:

idiopathic causes [ cause not known]
Genetic disorders such as Fragile X syndrome and Turner syndrome.
A low number of follicles.
Autoimmune diseases, including thyroiditis and Addison disease.
Chemotherapy or radiation therapy to treat cancers.
Metabolic disorders.
Toxins, such as cigarette smoke, chemicals, and pesticides.

2. SECONDARY OVARIAN INSUFFICIENCY
This occurs when the hypothalamus and pituitary fail to provide
appropriate gonadotropin stimulation. Hence, the problem is with the
higher centers
Causes include:

Weight loss from eating disorders, chronic disease, and extreme
exercise
Drugs used in cancer treatment [The three most commonly used
drugs, cyclophosphamide, cisplatin and doxorubicin]

Tumors in the Pituitary glands which secrete hormones

Pituitary necrosis where all the pituitary hormones are extremely low
(Sheehan syndrome)

Hypothalamic tumor which causes a dysfunction of the organ
The risk of POF is higher in persons with a family history of the same and
surgeries involving the ovary.

SYMPTOMS
A lady with ovarian insufficiency may have no initial symptoms at the initial
stage.
The earliest symptom noticeable is short or irregular menses. This could
occur following the use of oral contraceptive pills. Other symptoms are
similar to those of menopause and include:
Night sweats
Hot flushes
Poor memory
Vaginal dryness
Mood swings
Inability getting pregnant

PREVENTION
If the cause of the ovarian failure is known the client can be counseled to
avoid factors that could trigger the condition such as weight gain, reducing
exercises and avoiding medications which could lead to it.

LONG TERM CHALLENGES
It is important to make an early diagnosis of premature ovarian failure to
avoid severe health challenges in this group of women. Apart from
Infertility, a client with POF present with:

Increased risk of bone fracture.
This is caused by low estrogen levels, thereby leading to weak bones
which can fracture easily.

Increased risk of heart disease
Estrogen protects the heart from heart diseases. Early loss of
estrogen predisposes women to heart problems

DIAGNOSIS
Diagnosing POF usually begins with a history of the above symptoms:
menstrual irregularity, chronic illness, drug use, exercise, poor eating
habits or disorders.

1. Laboratory tests
Hormonal assay to assess the level of serum Follicle-Stimulating
Hormone [FSH], Luteinizing Hormone [LH] and Estradiol on day 3 of
menses.
Level of Anti-Mullerian Hormone [AMH] which checks for the level of
remaining follicles. These levels are low.

2. An ultrasound scan of the ovary may reveal small, shrunken ovaries.

3. MRI of the brain [hypothalamus and pituitary] may be useful where a
tumor of the pituitary gland is suspected.

TREATMENT
There is usually no treatment available to restore ovarian function when
the challenge is a primary ovarian failure with the challenge at the level of
the ovaries.
For secondary ovarian failure, it may be possible to reverse the challenge
depending on the cause of the problem.

1. Lifestyle changes

Women are counseled to perform weight-bearing exercises and take
calcium supplements because of the risk of bone fractures.
For those interested in having children, options such as the use of donor
eggs, and adoption should be discussed with them. However, about 5 % of
these women may get pregnant spontaneously.

2. Medical Treatment

Women benefit from estrogen therapy to help protect the heart from
diseases and the bones from fractures.
Progesterone medications can be given also to help the client menstruate
each month, thus preventing endometrial hyperplasia and reducing the risk
of endometrial cancers.

Ovulation induction is relatively cheap, and not time-consuming as you do not
have to make frequent visits to the clinic, not invasive and it’s the first
treatment for suitably selected women.
The procedure involves using drugs to increase the number of
eggs released at the time of ovulation from the ovaries and hence
improve the chances of pregnancy occurring.

These drugs act by causing an increased release of hormones such as
follicle-stimulating hormone (FSH) and luteinizing hormone (LH) which
stimulates the growth and maturation of multiple ovarian follicles. While
taking the medications, one or two ultrasound scans will be carried out
to check for the development of the follicles. When the follicles are large
enough, another drug called HCG is given to cause the final maturation
of the eggs and the couple is counselled to have intercourse 36-40
hours later, which will coincide with the time of ovulation.

WOMEN WHO BENEFIT FROM OVULATION INDUCTION

Ovulation induction is recommended for women less than 35 years with:
Polycystic ovarian syndrome (PCOS)
Anovulatory cycles [not ovulating]
Hormonal imbalance
Unexplained infertility where the cause is not known
Irregular menstrual pattern

It can be combined with any of the procedures such as IUI, IVF and
ICSI.
Up to 75 % of women with irregular menstrual flow will ovulate with
about 50% pregnancy rates within 6 months.

MEDICATIONS FOR OVULATION INDUCTION

Several medications can be used to stimulate the ovaries to develop
multiple follicles. They include:

1. CLOMIPHENE CITRATE [CLOMID]

This is the most commonly used among women. It is an anti-estrogen
medication that acts by increasing the levels of FSH and stimulating the
development of follicles.
It is taken by mouth usually for five days starting from day 3 – 5 of the
menses. The dosage is 50 -100 mg daily. It is preferably taken at night
to reduce its unwanted effects.
Common unwanted effects include- headaches, hot flushes, visual
changes, ovulation pains, and mood changes.

2. LETROZOLE [FEMARA]

This is an aromatase inhibitor that helps to suppress estrogen
production leading to an increase in FSH. FSH increase stimulates the
ovaries to produce multiple follicles thus increasing the chances of
pregnancy.
It is taken by mouth usually for five days starting from day 3 – 5 of the
menses. The dosage is 2.5 -5 mg daily. It is preferably taken at night to
reduce its unwanted effects.
Common unwanted effects include- headaches, hot flushes, muscle
aches, diarrhea, dizziness, ovulation pains, and mood changes.

3. GONADOTROPINS

These are Injectable drugs that cause the ovaries to produce multiple
follicles and eggs. They are usually given daily from the 2nd or 3rd day of
commencement of menses and are stopped when the eggs are large
enough for ovulation to occur. They are administered subcutaneously,
under the skin.
Several types of gonadotropins are available and include:

FSH only [Gonal F and Bravelle]

Human Menopausal Gonadotropin, a combination of FSH and LH
[Menopur]

Common unwanted effects include- weight gain, leg swelling, nausea
and vomiting, and severe lower abdominal pains.

4. HUMAN CHORIONIC GONADOTROPINS [PREGNYL]

These are Injectable drugs that cause the ovaries to release the eggs
and cause ovulation to occur. They are similar in action to LH. They are
given when the size of the follicles containing the eggs is large enough
for ovulation to occur. After administration of HCG, ovulation occurs in
36 – 40 hours.
Common unwanted effects include-, headaches, irritability, leg swelling,
depression, pain at the injection site, and restlessness.

SIGNS OF A SUCCESSFUL IVF TRANSFER

Most women look out for any symptoms that may indicate a successful
embryo transfer. They include:

No symptoms 

About 2 out of 10 women may not experience any symptoms of pregnancy
during the 2 weeks wait after the embryo transfer. The absence of
symptoms does not mean you are not pregnant. The only sure sign of a
pregnancy is a positive pregnancy test.

Vaginal bleeding or spotting

Scanty vaginal bleeding may be a sign of implantation of the embryo.
However, spotting is also common due to progesterone administration
during the 2 weeks after the embryo transfer.

Sore breasts

This is also a pregnancy symptom but could also be a side effect of the
hormone progesterone administered to support the pregnancy.

Abdominal Cramp

This is a feared symptom among women because it could be a sign that
menses is near. It may also be a sign that an embryo transfer was
successful. Abdominal cramping can also occur during the intake of
progesterone.

Nausea

Nausea could occur when taking oral progesterone. It is not usually an
early sign of pregnancy. However, some women who get pregnant report
this feeling before the pregnancy test.

Tiredness or fatigue

Tiredness is not a specific symptom as it could be caused by the rising
progesterone levels following progesterone administration. It is also a
pregnancy symptom.

Increased frequency of urination

Increased urination is one of the early signs of pregnancy. It could also be
a sign of increased levels of progesterone.
However, if the urination is painful, with associated fever and vomiting, it
could be a sign of a urinary tract infection.

Abdominal Bloating

This is another non-specific symptom as the progesterone administered
could be responsible. Pregnancy also causes bloating.

Missed period

A missed period can be a sign of pregnancy, especially in women with
regular menses.

WHEN TO TAKE THE PREGNANCY TEST

The blood pregnancy test is carried out 2 weeks after the implantation. A
blood test is done. It is the only guaranteed way to determine if you’re
pregnant.
While we understand the challenges faced by women while waiting for their
tests, we counsel our clients to remain calm while awaiting the test results.

While it’s a time of celebration, and rejoicing it’s important to know your
treatment isn’t over yet. Your medical personnel will advise you to keep
using your progesterone vaginal suppository. Some clinics counsel their
pregnant client to use it till the 12th week. Daily folic acid which was
commenced 12 weeks before the IVF will continue.

In some clinics, your doctor will check your HCG values to ensure it is
rising. You will be counseled to continue eating healthy meals, avoid
cigarette smoke and alcohol consumption; and engage in daily exercises to
ensure you’re fit.

An Ultrasound scan will be carried out at about the 3rd or 4th week after the
embryo transfer. The scan checks for the number of fetuses and also
identifies the presence of a heartbeat (s). Several scans may be done to
check the well-being of the fetuses.

Your blood pressure will usually be checked each time you visit the clinic.
Because a proportionate number of women who have IVF are in their 30s
and 40s, they are usually prone to hypertension and some chronic medical
diseases. Prevention of these conditions, early detection, and treatment
help the mother and baby stay safe.

When the pregnancy is 10 weeks, your doctor may counsel you on the
need for Non-Invasive Prenatal Testing [NIPT]. This test is carried out with
a maternal blood sample to detect the presence of chromosomal
anomalies.

Between 8 – 12 weeks of pregnancy, you will be counseled to see an
obstetrician to manage the pregnancy henceforth. Your obstetrician will
organize an antenatal package best suited for you. Antenatal care is a form
of organized care provided to pregnant women that allows caregivers to
diagnose, treat, and prevent health challenges and promote healthy living
that promotes the well-being of mother and baby.

In cases of multiple pregnancies, your doctor may counsel you to have a
cervical cerclage to assist in keeping the cervix closed.

RISKS OF IVF PREGNANCY

An IVF pregnancy carries a higher risk of several conditions. These
include:

Congenital defects in the fetus
Gestational diabetes
Intrauterine growth restriction (IUGR)
Pregnancy-related hypertension
Preterm labour
Caesarean delivery

If you develop any challenges in pregnancy, your obstetric team should be
notified so they can manage it actively.
In the absence of any medical challenge, the pregnancy is expected to
continue till the delivery of the baby.

UNDERSTANDING OVARIAN AGING
Before delving into ovarian rejuvenation, its essential to understand
ovarian aging. A woman is born with a finite number of eggs, which
gradually diminishes as she ages. Additionally, the quality of the remaining eggs can deteriorate, making it increasingly challenging to conceive
naturally as she gets older. These biological factors contribute to the age-
related decline in female fertility.

THE PROMISE OF OVARIAN REJUVENATION
Ovarian rejuvenation refers to medical procedures or treatments designed
to revitalize the ovaries, potentially improving egg quality and ovarian
function. While its not a guaranteed solution, it offers a glimmer of hope to
women who face infertility due to advanced maternal age or premature
ovarian insufficiency (POI).

OVARIAN REJUVENATION TECHNIQUES
Researchers are exploring several ovarian rejuvenation techniques
and fertility specialists. These include:

1. Ovarian Tissue Cryopreservation and Transplantation: This approach
involves removing a small piece of ovarian tissue, freezing it, and later
transplanting it back into the woman’s body when she's ready to conceive.
This technique has shown promise in restoring fertility in cancer survivors
who faced premature menopause due to chemotherapy or radiation
therapy.

2. Platelet-Rich Plasma (PRP) Therapy: PRP is a concentration of platelets
obtained from the patients own blood. It contains growth factors that may
stimulate tissue repair and regeneration. In ovarian rejuvenation, PRP is
injected into the ovaries with the goal of enhancing ovarian function.

3. Stem Cell Therapy: Stem cells have the remarkable ability to transform
into various cell types in the body, potentially including egg cells. Some
researchers are investigating the use of stem cell therapy to rejuvenate the
ovaries and improve egg quality.

4. Ovarian Rejuvenation Medications: Some medications, such as
dehydroepiandrosterone (DHEA) and gonadotropin-releasing hormone
agonists (GnRH agonists) have been explored for their potential to
enhance ovarian function and egg quality in certain cases.

CHALLENGES AND CONTROVERSIES
Despite the promising potential of ovarian rejuvenation, its crucial to
acknowledge the challenges and controversies associated with these
techniques:

1. Lack of Long-Term Data: Ovarian rejuvenation is a relatively new field,
and long-term data on the safety and efficacy of these procedures are
limited. The potential risks and side effects are not fully understood.

2. Ethical and Legal Issues: The use of certain stem cell therapies and
experimental techniques raises ethical and legal questions. Regulations
surrounding these procedures vary widely by country.

3. Variability in Results: Ovarian rejuvenation outcomes can vary from one
individual to another. While some women may experience improved
ovarian function and conceive after these treatments, others may not see
significant benefits.

4. Cost and Accessibility: Ovarian rejuvenation procedures can be
expensive and are not always covered by insurance. This can limit access
to these treatments for many women.

5. Alternative Fertility Treatments: Established fertility treatments, such as
in vitro fertilization (IVF) and egg donation, have a track record of success
and are widely available. Ovarian rejuvenation may be considered when
these options are not suitable or have been exhausted.

CONCLUSION: A PROMISING BUT EVOLVING FIELD
Ovarian rejuvenation represents a compelling frontier in fertility science.
While it offers hope to women facing fertility challenges due to age-related
or premature ovarian insufficiency, it is essential to approach these
techniques with caution and realism. Robust research, long-term studies,
and ethical considerations are critical as this field continues to evolve.

Ultimately, the decision to pursue ovarian rejuvenation should be made in
consultation with experienced fertility specialists who can provide personalized guidance based on a woman’s unique medical history and
circumstances. While ovarian rejuvenation holds the potential to extend the
reproductive lifespan and fulfill the dreams of parenthood, it is still a field in
its infancy, and its true potential and limitations are yet to be fully
understood.

PCOS is a hormonal condition in women who present with irregular menstrual cycle, excessive male pattern of hair and enlarged ovaries.

It affects about 10 % of women in their reproductive age group. These women usually have other conditions such as diabetes mellitus.

SYMPTOMS

Most women with PCOS notice symptoms during their first menstrual cycle. Symptoms include the following:

1. Abnormal menses

Some women menstruate at intervals of 35 days to 6 months or more. In some cases, there are no menses for up to 6 months. This usually occurs as a result of chronic anovulation [lack of ovulation in the woman].

2. Excessive androgen production

Androgens are essentially male hormones and they manifest as excessive male pattern of hair distribution around the chin, chest, nipples, and abdomen. Some also have voice change and hair loss.

3. Overweight

Most women with PCOS are obese and about 10% of them are diabetic

4. Polycystic ovaries

The lady has an increase in ovarian volume, with small immature follicles that usually fail to ovulate.

CAUSES

The cause of PCOS is unknown. Some of the reasons why a lady may develop PCOS include:

• Insulin resistance

Insulin is produced by the body to allow the body cells to utilize glucose. If the body becomes resistant to it, the blood glucose will increase and the pancreas will produce more insulin hoping to utilize the increased load of glucose. An increase in insulin production increases androgen production, which may prevent ovulation.

• Excessive androgen production

Women with PCOS have an increased level of luteinizing hormone (LH) which stimulates the ovarian theca cells to increase the production of androgens. These androgens cannot be converted to estrogen leading to decreased estrogen levels and lack of ovulation.

PREVENTION

PCOS cannot be prevented. However, its effect can be reduced by doing the following:

• Living an active life

This helps reduce blood sugar levels and the risk of diabetes. It also helps maintain a healthy weight thus reducing insulin levels and restoring ovulation.

• Healthy eating habit

Eating food low in carbohydrates can help reduce insulin levels.

COMPLICATIONS

PCOS could lead to the following:

• Infertility

This occurs as a result of chronic anovulation.

• Type 2 Diabetes Mellitus

This occurs as a result of insulin resistance.

• Endometrial cancer

This occurs as a result of chronic anovulation and several months of a woman not menstruating. Lack of menstruation increases the risk of endometrial hyperplasia and cancer.

DIAGNOSIS

Two of the three parameters are necessary to diagnose PCOS. They include:

• Abnormal menses
• Hyperandrogenism [evidenced by androgen excess e.g. testosterone]
• Polycystic ovaries [Ultrasound scan diagnosis]

Laboratory examination done may include:

• Testosterone is usually elevated.
• DHEA-S is usually normal or high.
• Blood glucose might be elevated.

A transvaginal scan may be useful in picking up the polycystic ovaries describes as 12 or more follicles in at least 1 ovary measuring 2-9 mm in diameter or a total ovarian volume of >10 cm³.

TREATMENT

When a doctor makes a diagnosis of PCOS, the client will be counselled on lifestyle modifications and the need for medical or surgical intervention.

Lifestyle modification

This involves reducing carbohydrate intake and exercising regularly to reduce weight. Thirty [30] minutes of walk daily is recommended. Losing 5 – 10 % of body weight could help restore ovulation.

Medical Treatment

• Regulation of menses

This can be achieved with the use of oral contraceptive pills containing estrogen and progesterone. Hence, women menstruate monthly reducing their risk of endometrial cancers. The use of progestin medications such as minipills or Mirena has a similar effect in regulating the menses.

• Regulation of ovulation

For women who wish to get pregnant several drugs are used to help induce ovulation. These drugs are first-line treatment for women who wish to get pregnant. They include:

1. Metformin [Glucophage]. Originally used to treat diabetes, it is known to lower insulin levels and reduce androgen production. About 50% of women will ovulate while using it.
2. Clomid [Clomiphene citrate]. It is an antiestrogen that blocks the effect of estrogen in the ovaries and increases follicle-stimulating hormone which helps with ovulation.
3. They are injectable medications that stimulate the ovaries to produce eggs.

• Reduction of excessive hair

Excessive hair can be removed using shaving creams or laser treatment.

Medications that can reduce excessive hair growth include oral contraceptive pills [reduces androgens secretion], spironolactone [an androgen]. There are several other medications for sale that are effective.

Surgery

This may become necessary in some cases where medications are not able to restore ovulation.

Laparoscopic ovarian drilling is the treatment of choice as it is minimally invasive and reduces the risk of adhesions among other benefits.

WHEN TO SEE A DOCTOR

You are advised to see your doctor if you experience the following.

1. If you are not able to get pregnant
2. If you have challenges with your menstrual period

If you have a male pattern of hair distribution on your face and body

Endometriosis is a medical disorder in which endometrial tissues which normally is seen in the uterine bed is found outside the uterus. The tissues could be found in the ovary, fallopian tube, pelvis, bladder, abdomen, lungs and several other parts of the body.

Endometriosis is usually accompanied by severe pains because these tissues will bleed and get trapped in the organ around the time of the menstrual cycle.

It is a common disorder in women and the severity of symptoms varies depending on its location. About 1 in every 10 women suffer from endometriosis. In women with fertility challenges, it could be found in as many as 3 out of 10 women. Women with relatives suffering from endometriosis have an increased risk of suffering from the disorder.

It is a cause of great distress to many women as it negatively impacts their quality of life.

SYMPTOMS

A lady with endometriosis may present with no symptoms. A diagnosis may be made intra-operatively during surgery for some other conditions. However, most clients with the condition may complain of the following.

• Painful menses

 Also called dysmenorrhea, most ladies will experience severe pelvic/back cramps several days before and after menses. This is sometimes associated with heavy vaginal bleeding.

• Chronic pelvic pain

This pain could be constant and debilitating. It is usually related to the depth of tissue penetration by endometriosis.

• Painful Intercourse

Common among women with endometriosis, it is usually caused by the presence of nodules in the uterosacral ligament [one of the supporting structures of the uterus].

• Difficulty getting pregnant

Endometriosis could lead to infertility by causing damage to the ovaries and fallopian tubes.

CAUSES

The exact cause of endometriosis is unknown. Possible reasons for the condition include:

• Retrograde menstruation

Menstrual blood is thought to flow backwards through the fallopian tubes and into the pelvic cavity. The endometrial cells contained within the blood stick to the pelvic sidewalls and organs, and begin to grow.

• Lymphatic/vascular spread

Endometrial cells are thought to spread through the lymphatic channels and blood vessels to other parts of the body.

• Coelomic metaplasia

The epithelium lining the abdomen could be transformed into endometrial cells by hormones or immune factors.

• Immunologic disorder

The body immune may find it difficult to identify and destroy endometrial tissue growing outside the uterus.

PREVENTION

The risk of acquiring a PID can be reduced by:

• Being faithful to one faithful partner
• Use a condom if you’re having casual sex
• Delay sexual intercourse until you are older as a lady
• If you have an IUCD inserted, see your doctor regularly
• Get tested if you feel you have a PID
• Have your partner tested if you have been infected with a sexually transmitted disease

COMPLICATION

About half of all women with endometriosis have challenges getting pregnant due to damage to the fallopian tubes, ovarian tissue or the sperm and egg by the disease.

However, in mild cases, women could still get pregnant.

DIAGNOSIS

Diagnosing endometriosis usually begins with a history of the symptoms.

At the health facility, your doctor may perform a general examination and elicit pains in your abdomen. Pelvic examination may reveal a cystic mass or elicits pains when the cervix is touched [cervical motion tenderness].

A transvaginal scan may be useful in picking up endometriomas.

Magnetic Resonance Imaging [MRI] may assist the surgeons in planning for the procedure to remove the implants.

Laparoscopy may also be carried out to have a good view of the pelvic organs and to visualize the endometrial deposits. It is the gold standard in the diagnosis of endometriosis and the disease could be treated at the same time.

TREATMENT

Treatment for endometriosis commences with counselling. The approach your doctor chooses depends on the severity of the disease.

Medical Treatment

This involves the use of several medications including:

1. Pain relief to help reduce pains during menses. Medications include NSAIDs such as Ibuprofen, mefenamic acid, etc.
2. Hormonal treatment use may help eliminate menses and reduces pains by blocking the production of ovarian hormones. Medications used include oral contraceptive pills, progesterone such as Mirena, Gonadotropin-Releasing Hormone Agonists, and other medications.

Surgical Treatment

This could be conservative or radical.

Conservative management involves ablation to remove the endometriotic deposits. This is usually done through laparoscopy.

Radical management involves the removal of the uterus and ovaries. This may not be the best modality of treatment especially for clients who are desirous of children. Also, removal of the ovaries induces menopause with its attendant problems.

WHEN TO SEE A DOCTOR

You are advised to see your doctor if you experience the symptoms listed above.

Early diagnosis usually helps with better management of the disease.

Ladies with the disease are counselled to start having children early because the disease is progressive.

Corpus luteum rupture [CLR] is a condition that happens monthly in women. The corpus luteum is formed by the ovarian follicle following the release/rupture of the monthly eggs in the process of ovulation. The site of a rupture usually has a small amount of bleeding, which resolves spontaneously. In a few cases, bleeding from the ovary can be severe becoming a surgical emergency.

Most clients with corpus luteum rupture do not present with any symptoms, while a few with massive internal bleeding may require laparoscopy to secure the bleeding point.

SYMPTOMS

A lady with ruptured corpus luteum usually presents with severe sudden onset of lower abdominal pains about 14 days after her menses [time of ovulation].  Other complaints include:

• Bleeding from the vagina
• Weakness, or fainting attacks
• Nausea and vomiting

CAUSES

The cause of worsening bleeding following corpus luteum rupture is not known. While the corpus luteum ruptures every month in most women it usually presents no significant symptoms.

However, women on drugs that thin out their blood such as aspirin or who suffer trauma to the abdomen are at an increased risk of this condition.

PREVENTION

The cause of the increased bleeding in corpus luteum rupture is not known; hence it is difficult to offer methods of prevention.

COMPLICATIONS

If undetected on time, the client could suffer from circulatory collapse as a result of excessive internal bleeding, leading to hemorrhagic shock and death.

DIAGNOSIS

Diagnosing increased bleeding from CLR usually begins with a history of the above symptoms: sudden onset abdominal pains, vaginal bleeding, dizziness, and fainting attacks.

Clinical examination by the doctor may reveal a painful abdomen on touch, and a mass below the umbilicus. The pulse rate is usually very high and the blood pressure is low.

Laboratory test done may include:

• Packed Cell Volume/Hematocrit to check for blood levels that will be reduced.
• Pregnancy test to exclude an ectopic pregnancy.

An ultrasound scan of the pelvis will usually reveal a mass and the extent of internal bleeding.

TREATMENT

Medical treatment

This involves the use of pain-relieving drugs to reduce pains. Most patients on medical treatment will be on admission and regular checkup to ensure symptoms do not worsen.

Surgical treatment

If the client is clinically unstable or an ultrasound scan reveals a large volume of internal bleeding, the patient will need to have a laparoscopy or laparotomy to secure the bleeding point.

WHEN TO SEE A DOCTOR

You are advised to see your doctor if you experience the following.

1. If you have sudden onset abdominal pains
2. If you feel dizzy or have fainting attacks