Menstrual pain could be endometriosis; affects 1 in 10 females in child-bearing years in S'pore

MP Carrie Tan suffered menstrual cramps that were so intense, she made a trip to the emergency department. PHOTO: COURTESY OF CARRIE TAN

SINGAPORE - For around a decade during her teenage years, Member of Parliament Carrie Tan suffered severe menstrual cramps every month, where the pain was so intense that she had to lie down to wait for it to subside.

The agony was so bad that when she was in her late 20s, there were two consecutive months she blacked out when her period came. On the second occasion, she broke out in cold sweat, blacked out, woke up feeling afraid and made a trip to the emergency department of a hospital.

"I was put on drips, given painkillers and again sent home. No one told me why I was having so much pain," the 39-year-old MP for Nee Soon GRC said in a virtual media briefing on Wednesday (March 2), a day before the start of Endometriosis Awareness Week.

She later discovered that she suffered from endometriosis, a chronic condition where tissues resembling the lining of the womb grow in other organs such as the ovaries, bowels and even the lungs and nose.

This may result in pain in various parts of the body, including while urinating and during sex, and increased menstrual discomfort.

Ms Tan's condition is common here, where about one in 10 females in child-bearing years suffer from it. Endometriosis is a disorder that is dependent on the female hormone estrogen, hence, the condition tends to regress after menopause. Estrogen levels decline during menopause.

Dr Ma Li, a consultant in the department of obstetrics and gynaecology at the National University Hospital (NUH), said: “Endometriosis is a systematic disease  that can affect the whole body and other organs including uterus, ovaries, vagina and rectum. Early treatment will help these women with their overall and reproductive health.”

Some 30 per cent to 50 per cent of women with endometriosis encounter challenges conceiving, said Dr Celene Hui, a consultant in the minimally invasive surgery unit, division of obstetrics and gynaecology at KK Women's and Children's Hospital.

Endometriosis can result in inflammation and scarring, damaged fallopian tubes, impaired embryo implantation, poorer egg quality and decreased egg supply or ovarian reserve, she added.

These painful periods can also result in emotional distress, affecting work and quality of life.

"Most of the time, women of the reproductive age group attend our clinics because they are trying to start a family. The child-bearing potential declines significantly with increasing age. I urge women with symptoms of endometriosis to come forward earlier, so that their pain can be better managed and their fertility may be preserved and protected," Dr Hui said.

There is currently no non-invasive, reliable method for diagnosing endometriosis, so the condition's true prevalence is unknown. Although surgery still remains the gold standard for definitive diagnosis, there is a shift towards diagnosing endometriosis based on symptoms and investigations, allowing doctors to start treatment earlier rather than later. 

Dr Hui added that there is a 6.7 year delay between symptom onset and diagnosis, as the lack of awareness of this condition, stigma around menstruation and lack of specific symptoms increase the difficulty of diagnosis.

This condition is more common among Asians compared with Caucasians, and more prevalent among women with a lower body mass index. Those with a short menstrual cycle length or experience obstruction of menstrual flow are also likely to experience higher risk.

To help women diagnose this condition, an online questionnaire that is available in four languages can be done.

"The higher the score, the more they should see a doctor to seek advice. We are still in a society where everybody thinks it is normal to have some menstrual pain. But when the pain becomes so severe that it's affecting your job, your quality of life, it can't be normal any more," Dr Anthony Siow, medical director at ASC Clinic for Women in Gleneagles Medical Centre, said.

A group shot of the virtual media briefing on March 2, 2022, a day before the start of Endometriosis Awareness Week. PHOTO: BAYER

Based on the endometriosis questionnaire carried out from March 2021 to February 2022 involving 2,522 women in Singapore, it was found that 55 per cent suffer from symptoms that may suggest possible endometriosis or other gynaecological conditions that warrant a visit to a gynaecologist.

The questionnaire – created by doctors from NUH, Singapore General Hospital and KKH – also found that more than half of the participants are on regular medicines or supplements to control their pain.

The public can take the endometriosis symptom questionaire at this website.

Medical therapy can provide effective pain relief in 60 per cent of women here. This can be in the form of hormonal therapy with the progestin-only pills or the combined hormonal contraceptive pill, the hormonal intrauterine device or medications to induce a menopausal state.

Surgery can also be performed through keyhole incisions.

For Ms Tan, she changed her diet, consuming more “warming foods” such as ginger tea a few days before her period and cutting cold drinks out as much as possible. 

She still suffers from period pain, but it does not happen every month and is manageable now.

On how to raise awareness and reduce the stigma around periods, she stressed that it is important to encourage conversations.

There are ground-up initiatives, such as a campaign called E for Endometriosis that is actively going around spreading awareness of the condition, Ms Tan said. 

The campaign was started by Ms Namira Mohamad, who began experiencing painful menstrual cramps right from her first period at age 11. She is a stage four endometriosis patient.

“If we can make conversations around periods and menstrual pains more commonplace and easier to talk about, then it is easier for women to share their pain and experience... then those who have more awareness can share the knowledge and encourage others to step forward to see their GPs,” Ms Tan added.

On advocacy to employers, efforts such as opening up conversations at the workplace, holding health talks and educating human resource departments about this condition will be useful.

"So that women don't feel shy to talk about it and to seek help," Ms Tan said.

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