🩸 Men's Health

Endometriosis in Nigeria

Q: Is severe period pain normal in Nigeria?

No — painful periods that interfere with daily life (require strong medication, cause absence from school or work, or cause vomiting) are not normal and should be investigated. In Nigeria, severe period pain is widely accepted as 'just the way it is' for women — this cultural normalisation delays diagnosis by years and allows ongoing tissue damage and infertility to develop.

Q: Can endometriosis be cured?

There is no complete cure for endometriosis. Both medical treatment (hormones) and surgical treatment suppress or remove disease, but recurrence rates are significant (30–50% within 5 years). The approach is to manage symptoms, preserve fertility where desired, and maintain quality of life long-term. Hysterectomy removes the source of oestrogen and endometrial shedding — it is the most definitive option for those who have completed their family, but is not 100% curative.

Q: Will getting pregnant cure endometriosis?

Pregnancy temporarily suppresses endometriosis (due to high progesterone and absence of periods). However, it is not a cure — the disease typically returns after delivery. Using pregnancy as a treatment for endometriosis is medically inappropriate, especially given the significant emotional and social implications of pregnancy. Treat the disease with appropriate medical or surgical management.

Q: Does diet help endometriosis?

There is growing evidence (though not definitive) that an anti-inflammatory diet may reduce endometriosis symptoms. This includes: increasing omega-3 rich foods (fish, flaxseed), colourful vegetables, and fibre; reducing red meat, processed foods, and trans fats. This is an adjunct to, not a substitute for, medical and surgical treatment.

A painful, underdiagnosed condition affecting millions of Nigerian women

Endometriosis is a chronic inflammatory condition in which tissue similar to the lining of the uterus (endometrium) grows outside the uterus — on the ovaries, fallopian tubes, pelvic peritoneum, bladder, bowel, or elsewhere. This ectopic tissue responds to monthly hormonal cycles, causing inflammation, pain, and scar tissue formation. Endometriosis affects approximately 10% of women of reproductive age — an estimated 2–3 million Nigerian women. The average delay to diagnosis globally is 7–10 years — in Nigeria it is likely longer, as severe period pain is often normalised culturally and medical awareness remains limited. Endometriosis is one of the leading causes of female infertility.

Signs and Symptoms

✓ Dysmenorrhoea (painful periods): pain that starts before the period, worsens during, and may persist after — different from normal period cramps

✓ Chronic pelvic pain: persistent lower abdominal/pelvic pain not just during periods

✓ Dyspareunia (painful intercourse): deep pain during or after sex — a classic symptom of endometriosis

✓ Dyschezia: pain on opening bowels, especially during periods

✓ Dysuria: pain on urination, especially cyclically (worse during periods if bladder involved)

✓ Infertility: endometriosis accounts for 30–50% of female infertility cases

✓ Bloating and bowel symptoms: cyclical — worse during periods

✓ Fatigue: often severe and underappreciated

✓ Endometrioma (chocolate cyst): ovarian cyst filled with old blood, often 5–10cm — detected on ultrasound

Risk Factors

Family history of endometriosis (mother or sister): 6x increased risk
Early menarche (< 12 years) or late menopause
Short cycles (< 27 days) or heavy periods — more retrograde menstruation
Uterine structural abnormalities causing outflow obstruction (mullerian anomalies)
Low BMI
Delayed childbearing
Retrograde menstruation (menstrual blood flowing backwards into the pelvis) is thought to be the primary mechanism — but doesn't explain why only 10% develop endometriosis

When to Seek Help

Painful periods that affect daily functioningPeriod pain that requires strong painkillers, time off school or work, or causes vomiting is NOT normal — seek assessment

Pain during or after sexDyspareunia should never be dismissed — it is a red flag symptom for endometriosis and other pelvic pathology

Unable to conceive after 6–12 months of tryingEndometriosis investigation (pelvic ultrasound, laparoscopy) may identify a treatable cause of infertility

Known endometrioma on ultrasound + trying to conceiveRequires specialist fertility assessment — timing of surgery vs. IVF decision is nuanced

Bowel or urinary symptoms cyclically worseningDeep infiltrating endometriosis involving bowel or bladder — specialist multidisciplinary assessment

Tests & Diagnosis

🧪 Pelvic ultrasound (transvaginal)

Detects ovarian endometriomas (chocolate cysts), adenomyosis (endometriosis of uterine muscle), and sometimes deep infiltrating lesions. Does NOT reliably detect peritoneal endometriosis

🧪 MRI pelvis

Better than ultrasound for deep infiltrating endometriosis — bowel, bladder, uterosacral ligaments. Available at tertiary hospitals

🧪 CA-125

Often raised in endometriosis but not specific or sensitive enough for diagnosis alone. Useful for monitoring treatment response

🧪 Laparoscopy (surgical diagnosis)

The gold standard — endometriosis can only be definitively diagnosed (and treated) by laparoscopy. A 'negative ultrasound' does not exclude endometriosis

🧪 Histopathology

Endometriotic lesions excised at laparoscopy should be sent for pathology — confirms diagnosis and excludes rare malignancy

Treatment Options

Pain management

NSAIDs (ibuprofen, mefenamic acid) started 1–2 days before period — most effective for dysmenorrhoea. Paracetamol as adjunct

Hormonal suppression — the mainstay of medical treatment

Combined oral contraceptive pill (COCP): taken continuously (no pill-free breaks) to suppress periods and endometriosis activity. Progestogen-only: norethisterone, desogestrel, or Mirena IUD — highly effective. GnRH agonists (decapeptyl, zoladex): create temporary menopause — reserved for severe cases with menopausal side effects

Laparoscopic surgery

Excision (preferred) or ablation of endometriotic deposits. Drainage and excision of endometriomas. Adhesiolysis. Improves pain and fertility. Available at specialist gynaecology units

Fertility treatment

IVF is often more effective than surgery alone for endometriosis-related infertility. Decision between surgical treatment and IVF must be individualised

Bowel or bladder endometriosis

Requires multidisciplinary team — gynaecologist, colorectal surgeon, urologist. Surgery is complex and should only be performed at specialist centres

Definitive surgery (hysterectomy + BSO)

For severe, refractory endometriosis in women who have completed their family — after thorough counselling. Not a guaranteed cure as ectopic deposits can persist

Frequently Asked Questions

Is severe period pain normal in Nigeria?

No — painful periods that interfere with daily life (require strong medication, cause absence from school or work, or cause vomiting) are not normal and should be investigated. In Nigeria, severe period pain is widely accepted as 'just the way it is' for women — this cultural normalisation delays diagnosis by years and allows ongoing tissue damage and infertility to develop.

Can endometriosis be cured?