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As a condition that can be excruciatingly painful, and lead to further complications including infertility if left untreated, we asked - why does endometriosis take so long to diagnose, and remain undiagnosed, in so many women?

1. A menstrual disorder that affects approximately 200 million women around the world, endometriosis impacts one in every ten women globally. The prevalence of endometriosis is highest in Asia, and in Singapore, diagnoses are on the rise.

2. There is a delay of 4 to 11 years from the onset of the first symptoms to a definitive surgical diagnosis, yet, this invisible condition has a profound impact on a womans’ life.

3. The lack of conversation and stigma still attached to talking about a womans’ period and menstrual health -  may lead young girls and women to assume that intense pain is part of the norm - just regular menstrual cramps.

4. Even when women decide to take symptoms seriously, reaching out often leads to a lack of validation and acknowledgment. Instead of investigating the pain, family, friends and even doctors may assume a low threshold for regular menstrual cramps. That painkillers and menstrual aids can help manage the pain.

5. But Endometriosis is more than just a ‘bad period’. The condition occurs when tissue usually found inside the uterus grows outside of it - on the ovaries, bowel or lining of the pelvis.

The hormonal changes that occur during the monthly menstrual cycle still impact the rogue endometrial tissue, making it inflamed and painful. There are no ‘set’ symptoms of endometriosis - some women experience a constellation of severe symptoms, and a few experience mild symptoms.

6. Depending on the individual, severe pain can be felt in the abdomen, pelvic area, lower back, radiate outwards into the legs, shoulders, chest and neck and also during sex. Endometriosis related pain can occur before and during a womans’ period or it can come and go.

Period pain that lasts for more than two or three days, or leaves you unable to leave the house for activities, is not normal, and should be investigated by a doctor.

7. It can be challenging for women to push for a medical diagnosis, and to insist to the doctor that they are experiencing more than just menstrual cramps. Pain is a common concern, and since it is subjective, diagnosis is not as straightforward as a simple blood test.

A medical procedure called a laparoscopy is the only way to confirm whether you have endometriosis.

8. Most diagnoses of endometriosis occur incidentally when a surgeon operates in the pelvic or abdominal area for a different reason and finds endometrial tissue in places where it shouldn't be.

The condition is also often unveiled during infertility workups - infertility is a common symptom of endometriosis.  

The yellow ribbon stands for Endometriosis Awareness!

9. March is Endometriosis awareness month, and we need more women to educate themselves about, and talk about endometriosis. Endo warriors, it may be daunting to convey to others what you are going through.

When you reach out, you will realise that you are surrounded by other women who live with menstrual conditions, and find ways to thrive...

10. Celebrities have endometriosis too, and many share their struggles, successes and journey online.

Singaporean actor Cynthia Koh was diagnosed in 2012 after experiencing intermenstrual bleeding.

Halsey gave a powerful speech about the challenges she faced with Endometriosis and her journey to becoming a mum, including multiple surgeries and a miscarriage.

It took 23 years for author and tv host Padma Lakshmi to receive a medical diagnosis, and she has since been advocating for others with the condition, and sharing her diet for Endometriosis.

Kayla Itsines, an online fitness phenomenon with over 12M followers, recently had her second surgery for endometriosis. She shares how her experience with Endometriosis has shaped her relationship with her body.

These inspiring ladies encourage women to always move forward, in favour of their health.

11. Surgery is the definitive treatment for endometriosis, however, there are several ways to manage its symptoms.

Scarlet offers a unique, natural approach by addressing the root cause, hormonal imbalance, over time.

Wild Yam has anti-inflammatory and antispasmodic properties that can alleviate pain. Chasteberry can help support optimal hormonal balance in the long term.

Apart from these two active ingredients, the Scarlet blend is complemented with magnesium, calcium, and vitamin B complex, evidence backed supplements to help maintain menstrual health.

REFERENCES

1) Eisenberg, VH, Weil, C, Chodick, G, Shalev, V. Epidemiology of endometriosis: a large population-based database study from a healthcare provider with 2 million members. BJOG 2018; 125: 55– 62.


2) Facts about endometriosis « Endometriosis.org


3) Rogers PA, D'Hooghe TM, Fazleabas A, Gargett CE, Giudice LC, Montgomery GW, Rombauts L, Salamonsen LA, Zondervan KT. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci. 2009 Apr;16(4):335-46. doi: 10.1177/1933719108330568. Epub 2009 Feb 5. PMID: 19196878; PMCID: PMC3682634.


4) Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, Singh SS, Taylor HS. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019 Apr;220(4):354.e1-354.e12. doi: 10.1016/j.ajog.2018.12.039. Epub 2019 Jan 6. PMID: 30625295.


5) It was not ‘all in her head’. She wants women to know menstrual pains are not always ‘normal’ - TODAY (todayonline.com)


6) Bourdel, N., Alves, J., Pickering, G., Ramilo, I., Roman, H., & Canis, M. (2015). Systematic review of endometriosis pain assessment: how to choose a scale?. Human reproduction update, 21(1), 136-152.