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The Health | january, 2019
Fertility journey
Treatment for
severe period pain
and infertility
Severe pain during
your period and
infertility can
be caused by
endometriosis, and
there are treatments
which can help
By Dr Agilan Arjunan
T
here are some things in
life that men will never
understand, it’s a fact.
And before you say the
pain of giving birth, you
should also think about
the pain some women go
through every month.
Period pain is no laughing matter.
Some women’s pain are so excruciating
that they simply can’t function normally
and go about their daily routine. If you
are the one to experience severe period
pain, it could be a condition called
endometriosis.
The condition can also be extra
debilitating for some, as it can affect a
woman’s fertility.
We talked to Dr Agilan Arjunan,
Obstetrician and Gynaecologist from
KL Fertility Centre, specifically about
the condition, and how women can find
treatment for it.
What is endometriosis?
“Endometriosis is a condition where the
tissues that lines the womb, also known
Twin gifts
for Jenny
Jenny (not her real name) married her husband
in 2008, and was busy with each other’s career to
even think about having children. Both didn’t felt
the need so soon despite tender nudges from family
and friends.
Things changed when she and hubby had some
time off from work. “We both decided to that it
was time to start a family,” Jenny says. However,
the delay took a toll, and their chances were quite
slim. The couple also found out that she had mild
Polycystic Ovary Syndrome (PCOS) during their
visit at a fertility center.
“It didn’t take long to make up our minds, and
we signed up for IVF treatment,” she adds. Jenny
lamented the challenges she went through with
IVF, particularly in her fear of needles. Yet, the
husband’s will made it easy for both of them to go
through it.
After treatment, the couple were blessed by
the news that were to expect children, with key
word being plural. “What was more amazing than
knowing we were expecting was knowing that it
was twins!”
Jenny’s pregnancy later on was also met with
few challenges, as the nature of her job had her
to travel locally and abroad a lot. She was able to
persuade her boss to not be travelling during the
later months of her pregnancy, and it had helped
plenty. Jenny gave birth to her twins in January
31 2013. It was the most wonderful thing to have
happened to her.
“My advice to couples who are trying to start
a family is, if you think you’ve been trying for
several years, do consult the doctors at a fertility
center immediately.” Yoke highly recommends to
go for treatment if you are not having luck with
pregnancy.
Fertility centers are always an amenity available
to the public, be it in public or private centers. Do
everything you can to achieve your dream.
Source: Catching my Baby Dust, First Edition 2016
(Available in MPH and Borders bookstores)
And so far, the condition is not cur-
able, and women will have it until they
are no longer menstruating.
The symptoms
as uterus lining, is present outside of
the uterus as well. The uterus lining
sheds as period blood every month
when a woman doesn’t get pregnant,
yet because the tissues are also present
outside of the uterus, it will also bleed
as it breaks down. The bleeding causes
inflammation of the uterus which then
leads to scaring as well as ovarian cysts,”
Dr Agilan explains.
What is causing it?
According to Dr Agilan, there has not
been any conclusive answer to the
question.
“So far what we think is happening
is, the menstrual blood somehow flow
backwards, it retrogrades. The blood
then goes through the fallopian tubes
and those uterus lining tissues gets
implanted outside of the uterus.”
The exact reason why the blood
flows backwards is the question to be
answered. Theories claims that it has to
do with genetics, yet which exact gene in
the woman’s body to cause the condition
is still unknown.
Severe period pain is the most common
of symptoms for endometriosis. Yet
many women with the condition are
lucky not to have much pain during
their periods. However, the second most
common symptom of endometriosis
affects women more, as it can cause
them to produce lesser quantity and
quality of eggs to get pregnant.
“Some of the women who come
into the clinic looking to get help with
pregnancy, is found to actually have the
condition, despite having mild or no
period pain,” Dr Agilan tells.
Other symptoms may include
unusual pain during sex, as well as severe
back pain, pain during urination, and
pain during bowel movement. “For these
type of pains, it may be caused by the
uterus lining getting implanted some-
where else other than the outside of the
uterus, perhaps on the bladder or the
bowel.”
Uncommon infertility
Severe period pain is indeed debilitating,
yet the inability to conceive a child can
be harrowing, and can be a bigger moti-
vation for women to seek treatment.
Dr Agilan explains; “Endometriosis
can result in infertility in three ways. The
first, is because of the ovarian cysts that
grows after inflammation. Cysts causes
lesser eggs production.”
“The second is the scarring. Scarring
is also a result of inflammation, and it
Polycystic
ovary syndrome
Where one symptom does not fit all
By Dr Paul Tay Yee Siang The illustration shows a polycystic ovary
(right) compared to a normal ovary on the left.
olycystic ovary syndrome (PCOS)
is a difficult condition to diagnose
as it has a group of clinical features.
KL Fertility & Gynaecology Centre
Consultant Obstetrician and Gynaeco-
logist Dr Paul Tay Yee Siang disclosed
that different people present with
different features.
“There is no one feature to determine that you’ve
got PCOS. With PCOS, there are multiple features.
Clinical features like lots of hair on the body can
vary according to each race. So, there are different
definitions on hirsutism. Obese, is yet another
feature – but again obesity can be alone or can be
combined with other things as well. The end of
ovulation means you would have irregular periods.
Infertility is yet another feature of PCOS.” There are endocrine features as well. High
androgen means there are high male hormones,
high LH – scrutinising hormones which is used to
be the classical features of PCOS, and also insulin
resistance which was discovered 10 – 15 years ago
by the endocrinologist. It has become an important
part of PCOS. This are the basic of the pathophysiol-
ogy of PCOS.
“Then there are ultrasound features. When we
do an ultrasound on these women, their ovaries are
enlarged – they have a thicken stroma. Stroma is the
middle part of the ovaries here are thickened and
white and they have an increased number of follicles
in the ovary – some classical features where the
follicles are all scattered on periphery of the ovary.”
Because of these multiple features, making a
diagnosis is actually quite difficult.
P
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