BEYOND THE PAIN: Understanding Endometriosis | Medical Facts & Expert Insight

There's a pain that millions of women have been taught to endure in silence. >> First of all, [snorts] I think I just need to state the actual data. >> Yeah. >> Cuz it's really disturbing honestly. >> Mhm. >> 10% of all women eventually will suffer from endometriosis. >> That is approximately according to the World Health Organization 190 million women. >> That's a huge number. >> For years severe period pain has been dismissed as normal. Women have been told to simply take a painkiller and carry on. While for some, the real cause of the pain remains undiagnosed for years. Endometriosis is a chronic condition that can have a profound impact on women's health, fertility, work, and quality of life. Yet, awareness remains low. Diagnosis can take years, and access to specialized care remains a challenge for many women. As conversations around endometriosis grow louder in Kenya, we ask a crucial question. Are we doing enough to recognize, diagnose, and support women living with this condition? Today, we are having that conversation with a specialist to understand what every woman needs to know about endometriosis and what needs to change. Right with me here in studio is a very beautiful woman who's been courageous enough to put herself out there. She's a doctor. And our today's topic is actually something that's been very vocal in our space right now. So allow me to introduce her. She introduces herself and tell us who she is and what she does. Karibana. >> Thank you so much for having me. Uh good morning. My name is Linda Bambda. Um I work as a medical doctor. um currently just finished my previous job at a level six facility that is the mo teaching and referral hospital in Aloret. Have relocated to Nairobi now and no one has taken me yet. Um but I am a medical doctor. I'm also a certified and a licensed financial advisor with IC Lion. I tend to try to um empower mostly women and um and young children on matters health and finance because I realized both of them go hand in hand. [laughter] Um I'm also a health advocate. I try to do series and teach people on different health topics. Yes. Especially um in matters public health and preventative medicine. >> Thank you so much. It's so nice to have you here. And to kick us off, we today we're talking about endometriosis and it's something that so many people are actually talking about it right now. Uh to begin, what is endometriosis and why is it important for people to actually know it better and understand it? >> Okay. Um the classical definition of endometriosis is the presence of uterine like glands outside of the uterus. So you have uterine cells, stroma glands that are usually present inside the uterus. You find them outside the uterus. >> Personally, I'm not the best um for I'm not very fond of that definition. I like the John's Hopkins definition of um endometriosis that it's a chronic inflammatory disorder that is hormonal um hormonal dependent. I feel like that encompasses the fact that women do suffer >> and it's a chronic disease that happens to be lifelong. >> Okay. >> Um yeah. So um in the definition of endometriosis we say that it is the presence of you know um uterine like cells and glands and tissues outside of the uterus. So it can go to either um the ovaries which is the most common place. These cells and glands can also go to um the fallopian tubes. They can go to the pelvis around uh the bladder and just within the pelvis in general there's um ligaments within it. There's a broad ligament and also rarely it can also go to um your intestines. It can also go to um your umbilicus and in case you've had surgery before if you have a laparoscopic scar or you've had a um a cicerian section that scar it can also be there and also very more rarely also it can be in the lungs in the chest. >> Um and according to very recent studies that studied a thousand um women who have suffered from endometriosis, it's shown that it can even go to the brain and the nervous system. Yes. Yeah. So that's how I can define endometriosis. But the most important bit is that these cells are not just going there, but they're also responsive to hormones, specifically the hormone estrogen. Okay? >> So when they go there um the same way women go through this menstrual cycle in a month, these cells will go through that cycle where they'll um thicken, they will shed, and then eventually they will bleed. >> In the uterus, there's an outlet for that bleeding. But in those areas there's no end inflammation, you end up having pain. You end up having discomfort and this tends to happen in a um um a constant chronic state over decades of um in a woman's life. >> Yeah. >> Uh I mean just for better understanding uh severe period pains have often been dismissed as you know >> something just very normal. How is an individual able to differentiate the discomfort between period pains and that of endometriosis? >> Okay. Um that's true. Unfortunately, in our current society, period pain has been normalized very >> and it shouldn't honestly >> um having a cramp or two um a few days to your periods is normal even during the periods and discomfort. It can be very normal. However, there are characteristics that might start tipping you to think I could be having endometriosis. >> Okay, >> the first one is that that pain can be um endometriosis pain is very severe, way more severe than the uh the period pain. Um someone would ask what is the scale for you to say like this is very severe and this one isn't. The normal period pain should not be very severe to the point where you're unable to go on with your daily activities like going to school or going to work really right. But endometriosis pain the one that is very debilitating. You cannot work. You have to lie in bed for the whole day. >> That should start tipping you to think that um it could be more than just the normal period pain. That's number one. >> Number two, endometriosis pain. You see in um normal period pain it tends to be the same intensity every month in like every cycle. But with endometriosis that intensity of the pain tends to increase with every cycle. >> Okay. >> And then um that pain also can then um mutate and become just chronic pain either when you're having your periods or even when you're not having your periods. >> And then um you can also have pain that comes days before your period and even after your periods. uh ceases, you still have more pain even after and you're like I think I've completed my periods. It's a week or two after my periods but you're still having the same exact type of pain. >> Mhm. >> And endometriosis type of pain especially if it has also um kind of spread to your pelvic region. Okay. >> You can have a urinary um pain like pain when your passing urine that is only mostly associated with your periods. usually don't have any um pain when you're passing urine, but anytime you're having your periods, you have urinary pain. So, it's cyclic urinary pain. You can also have cyclic um pain with your bowel movements. You want to go past two, but when um when it's your periods, you have pain. And then another good um distinction factor that you should also notice that the normal period pain normally in many instances it responds to over-the-counter pain medication. Okay? like for example with rest with using a hot water bottle um with a painkiller like panadol but endometriosis pain tend to not necessarily always respond to um those uh measures to to try to alleviate the pain. So those are some of the things that can tip you to differentiate um the endometriosis type of pain and the normal discomfort and pain that can be associated with your periods. Yeah. >> Okay. Allow me to ask this Dr. I mean what are some of the symptoms that many women have overlooked or mistook for other conditions >> other um instead of endometriosis? >> Yes, instead of endometriosis. >> Yeah, I think I've answered some of them. Um the characteristics of the pain um cyclic urinary pain which and um which people tend to think that >> I could be having a UTI urinary tract infection but in actual sense it's associated with the endometriosis. Um and then and then and then you can also have other symptoms that are associated with endometriosis that number one um this woman is of um of reproductive age. The peak um presentation of women with endometriosis is between the age of 25 to 35. So you these women also tend to have what we call um bloating and um some have discomfort um constipation that alternates with diarrhea. So they're like ah this is usually normal when I'm having my periods. You see the way we say that it's normal to have diarrhea or sometimes constipation during your periods. It might not necessarily be that can be a sign that um the uh this pain and the symptoms that you're having are associated um with endometriosis. Other signs and symptoms include infertility. >> Okay. >> Um data shows that 30 to 50% of women with endometriosis >> present with infertility. Mhm. >> Um and you'll find that up for this uh for this group of women, some of them will only come with infertility, they've actually never had any symptom at all. They just came for a routine checkup or >> um you know with a presentation of infertility and then you know a diagnosis of endometriosis is now um made or done. Yeah. >> Okay. Amazing. Um why let me ask why does it take long for women to actually be diagnosed on the same breath what are some of the challenges that the healthcare providers face to be able to diagnose someone with endometriosis >> endometriosis okay first of all I think I just need to state the actual data >> cuz it's really disturbing honestly >> 10% of all women eventually will suffer from endometriosis that is approximately according to the world health organization 190 million women. >> Wow. >> That's a huge number. >> Very >> right. So one in every 10 women >> eventually will suffer from endometriosis. >> Right? So this is something that we can no longer keep on ignoring. >> That's number one. >> Number two, WH has shown that the time it takes from the onset of symptoms for an actual diagnosis to be made is between 4 to 12 years. people go for a decade plus with no diagnosis, >> right? Number one is because well according to our culture even I myself I um my parents were both health professionals but I used to have you know um period pains and I'd tell them and they tell me it's normal just take your medication and then I I take medication it's not improving they're like ah it's normal it's it's part of life so we have normalized period pain >> the moment your period pain affects your quality of life you can no longer um continue if you're an adolescent go to school. Um if you cannot go with your daily activities that pain should be assessed. That's number one. Number two, endometriosis in itself >> can be very complicated in terms of its presentation. The presentation can mimic other diseases including as I've mentioned urinary tract infection, inflammatory bowel disease and arometriosis in itself also has also been associated with other risk factors and it can present um itself with other diseases at the same time. So it has been shown to be linked to other autoimmune um diseases including thyroid issues. Right? Uh but the things that can tip you also is if you have a family history of endometriosis there's a 7 to 10 chance more than the average person um for you to have endometriosis. So if you have a a firstderee relative a first degree is like a sister brother or a mother or a father um and and you experience any of these symptoms then you should be able to um um to get checked for endometriosis. The other challenge as to why the diagnosis is not made early um um is is is the fact that >> many clinicians don't have a high clinical acumen for endometriosis. The same way the normal monanchi has been um taught that period pain is normal the same way even these doctors grew up in the same you know um >> environment as us the same society as us. So many of us and I can say this although I was taught by a very good doctor who's um the chairman of the Kenya and gynecological society um in the rift valley region he I actually I remember I presented that class in sixth day of medical school of endometriosis um he really made sure that we were taught but you'll find that in many other instances endometriosis might not been given that enough attention so we need um the education system uh the healthcare system to teach and train our clinicians better to have it as a diagnosis as a possible diagnosis when when you're trying to diagnose a patient. >> And the other um which can be a disadvantage and um a challenge that we face is that you can actually go to hospital. >> Mhm. a a clinician does a a physical examination on you, does imaging on you, including ultrasound, including MRI, and not pick up any endometrial um tissue that is outside the the uterus and make a an assumption that you don't have endometriosis. Yet, in actual sense, the latest guidelines by the World Health Organization continue to prove that all of that might be true, yet you might still have endometriosis. >> Yes. >> Oh, amazing. uh here in Kenya in our own country how accessible how accessible is proper diagnose and uh you know specialized care for women living with endometriosis >> okay um believe it or not we're doing really really well okay >> in terms of the presence of expertise we really have many um expert uh doctors who can very quickly um and very accurately pick up endometriosis they have a very high clinical acumen the problem is access and the referral system that we have. >> Okay, >> a woman in Nairobi, we are in Nairobi right now, might have access >> to a specialist, you know, um these specialized services including MRI and a specialized ultrasound that is done by um a specialist substitution and gynecology to pick up endometriosis. But we forget that 80% of the Kenyan population still lives in the rural areas. >> Yeah, for sure. >> Right. So many of those women who live in all these rural areas might not necessarily get the same quality of care that a woman for example in urban areas might experience. So before they get to these specialized areas where they can get um have access to a specialist, they usually go to different levels of healthcare. I'm sure you've heard of hospitals having a level one, level two, level three, level four. So they go to the primary healthcare facility. They're probably sent home. Ah, it's okay. It's period pain. And then eventually it's um it becomes debilitating. They can't do anything else. Um their quality of life is really severely affected and that's when they eventually referred to a level six facility where they can meet a specialist and get healthcare. So the issue is not necessarily that we don't have the expertise. We really do. The issue is at the grassroot level. Do we have clinicians who are trained enough to pick up endometriosis who to have a high clinical acument to think that h this could be endometriosis. So there's a gap there. >> Yeah. >> Uh I've come to learn that actually endometriosis has stages. Maybe you could take us through that. >> Uh okay. So the stage one to stage four I personally don't like and I've seen even other experts do not like to classify endometriosis like that because if you have stage 4 endometriosis that doesn't necessarily mean um that your prognosis that is your outcome will be worse as compared to someone who has stage one endometriosis. It's just about the extent to which this um uterine like cells and glands are found outside of the uterus. For example, in in stage one, you might find that it's only confined to the pelvis. >> And there isn't much that inflammation, scarring, and pain. And then that in stage four, there's a lot of adhesions, there's a lot of scarring, there's a lot of uh pain that and discomfort that this person goes through. It doesn't directly correlate to the to the long-term outcome >> or recovery of the patient. You can still have stage 4 endometriosis and get the necessary help and have a good quality of life. >> Amazing. So, it's something that is curable with a proper treatment. >> I can say it's something that is treatable. I don't think I can say it's something that's curable because the moment you're diagnosed with endometriosis, it's a lifelong disease. >> Yes. because we are yet to know the exact reason why we find this endomet why it happens. There are several theories that have been stipulated but there are still theories not necessarily like actual causes that have been confirmed yeah and established. >> Okay. I don't to believe that treatment is actually expensive and it would require maybe long-term management. What happens to someone who is unable to access, you know, a specialist for care? >> Okay. Okay. >> Well, that's unfortunate. >> Yeah, >> it is. It is. Especially when there's adhesions and scarring and they need surgery and they cannot afford it. >> Um, so it goes it um it it now um brings in the aspect of the systems that we have as a country in terms of helping women. Um, does SHA pay for surgeries um for women who have endometriosis needing surgery? On paper, yes. But then you'll find that if it's in a level one, level two facility, it might not pay for it. It might only pay for it. It might only consider to pay for it if it's if that patient is a level five, level six facility or in a high-end private hospital. The good thing about endometriosis is that depending on um your your your situation, we don't generalize patients. We do personalized care, right? Each patient will present differently. So if a woman comes today and they're presenting with endometriosis and for example they don't have a desire for fertility, >> I'm able to put them on combined oral contraceptives and other medication that we say that gonadotropin hormone releasing agonist or antagonist. You don't have to know those nittygritties, right? um but I'm actually able to put them on medical um uh management to also alleviate on the symptoms. Now there are other cases where even that is not enough. >> Okay. >> Now they need surgery. Right. Um and in such cases that is where um specialized treatment is needed and before you even need to get that surgery remember to see a specialist you need to pay for that uh consultation fee. you need imaging to be done and for a very long period of time even the current guidelines still st uh stipulate that clinical diagnosis is not enough to diagnose um uh endoviosis. What I mean by that is that you coming to me as a medical doctor and me assessing you and doing a physical exam on you is not enough for a diagnosis to be made. It has been like that for a very long time. The guidelines have always said that I have to do either laparoscopic or an open surgery and note ah there's that endometal tissue there and then I have to take a biopsy it's taken to the lab and then it's it's studied and it's confirmed that it's actually endometrial like tissue that is outside the uterus but with the newer guidelines and with this trend of delayed um diagnosis 4 to 12 years which is honestly unacceptable it is now acceptable more and more to start um a woman on treatment even before that um uh the surgery and and and the biopsy sample is taken as you're waiting for those results, right? Um and even with that, studies continue to prove that medical treatment and surgical treatment still kind of have the same outcomes at the end of the day. Uh but surgical treatment has a little bit of a higher um um that is the surgical removal of the endomet. There are some surgeons who prefer to remove them and there are some surgeons who prefer to bang them or ablation. I'm not the fan of the ablation type but you know different surgeons different um surgical techniques. Uh yes but unfortunately um you might find that a woman who is from a rural um community and they're unable to afford it. They might find it hardest compared to someone who can afford it. However, many of times in Kenya, we tend to think that you can only get good quality care in private hospitals. I want you to remember that many of times when you're going for the specialist in a private hospital, it's kind of almost the same specialist that you'll find in a public hospital. You can also try to take advantage of the public referral systems and just seek healthare and you might actually get help. I again I mentioned that I was trained and I practice at my teaching and referral hospital. They have worldclass laparoscopic surgeries now they do every single day. I've seen them doing for women with endometriosis and I've seen SHA paying for it. So it's also something to consider. >> So Sha is working. >> I cannot say for it entirely. >> I can say that I have >> for this particular topic that we are talking about >> um Sha pays for it. You know, at the end of the day, um I can't say a radical statement like that cuz I have been in a situation where a woman came to me. Um I was at the emergency department and they had a retained placenta that and she she was at a very high risk of of postpartum hemorrhage. She didn't have any money to herself and Sh did not pay for it. >> So it's I don't want to use an umbrella term and say that sh is working. I'm saying that I have seen cases where women need surgery for endometriosis and sh has paid for it. >> Interesting. >> How can uh endometriosis affect a woman's fertility? And I mean at what point should a woman who's struggling to actually conceive be checked for the condition be assessed rather? >> Okay. Okay. So in that case we have to define infertility. Um, infertility is the failure to conceive um, for a minimum period of 12 months if you're less than the age of 35 and a minimum period of 6 months uh, if you're above the age of 35. This is the new guidelines that uh, that just came out and when you're trying it has to be unprotected intercourse and it has to be that you're not on any form of contraception. Right? So, you've tried for 12 months and it's not working. That's when you can start thinking of h there could be either a primary infertility or an acquired or a form of secondary infertility. Right? As I had mentioned 30 to 50% of women who have endometriosis tend to present with infertility and some of them infertility could even like be the first um symptom for them to present. >> Okay. >> Okay. So how endometriosis causes infertility um is that we said that there's a presence of endometrial like tissue outside of the uterus. Remember um the fallopian tubes are not part of the uterus. This the ovary. So when it goes to the ovary it causes what we commonly call a chocolate cyst >> or or an or an endometrioma. The reason why it's called a chocolate cyst is that it actually looks like chocolate. >> Really? >> Yes. on laparoscopic surgery you check that ovary it does look like a chocolate so it's called a chocolate cyst it's brown uh so what happens is that this endometrial like like tissue remember because it's it's it behaves exactly like the endometrial tissue and the your endometrial tissue usually goes through that cyclical changes uh with every cycle where it thickens at some point um the layer the lining of your uterus is thin and then it becomes thick and then eventually it sheds off >> uh through bleeding So when it goes to the ovary as an example um on how it forms the chocolate cyst it goes there it goes through those exact same changes and that brown appearance is that bleeding remember the ovaries are the ones that are responsible for manufacturing and releasing the egg or the over. So um the so it can directly affect the ovaries in um their function to manufacture and also release the eggs. But the most common um associated form of infertility is we see um due to anatomical distortion where you find that for example um uh we said that this um these cells or the uterine the uterine like cells that are found outside the uterus if for example they're found in the fallopian tubes these cells are um responsive to hormones and specifically the hormone estrogen. So eventually due to that bleeding for example in the fallopian tube eventually there'll be inflammation that is secondary um inflammation is likewa right you see when you get stung by a bee and if I get stung by a bee here my skin will become very tender it becomes red swells exactly like that so it causes inflammation there and then eventually with healing with scarring and with scarring um sometimes if these parts are together like this they they attach um to each other so you find that this anatomical call distortion such that even the fall can fallopian tubes can get stuck to each other. So there's no room even if the egg is released and the sperm um um has been also released there's no room for um this to meet for the egg and the sperm to meet. So it can be due to those anatomical distortion. Yes. and and and and the long-term effects of the presence of endometrial like tissue outside the uterus including the inflammation the scarring we call them adhesions also um in the medical term >> so I think you had asked me how endometriosis can be responsible for infertility and when to assess for it >> generally if you experience all the symptoms that I have told you and you have a family history of endometriosis many a times a firstderee relative I think you don't need to wait for um the traditional one year for you to say that ah I need to go get assessed for infertility. I think you can get assessed immediately. However, it's very important to note that not all women with endometriosis will experience infertility. >> Okay. >> Yes. You um there are people who have endometriosis and they still go ahead and have children. As a matter of fact, um, pregnancy and multiparity, multipariety is having many children has been shown to cushion or or reduce the severity of the symptoms of endometriosis. It doesn't cure, but it reduces the uh the symptoms of um endometriosis. And another thing that uh it can affect um the the fertility of a woman is that it has also been shown that uh endometriosis is associated with uh pain during and after sex. So the woman now starts associating sexual intercourse and intimacy um with pain. So they end up not engaging in it as much. So you need sex to get pregnant, right? >> Yeah. >> Okay. Maybe for better understanding, allow me to ask this. >> Beyond the physical pain, what other impact does endometriosis have on a woman's life in terms of, you know, relationships, well-being, work, and quality of life? >> Okay. Um first of all many of times we have noted that the pain especially the the chronic pelvic pain that is associated with endometriosis it's severe pain. >> Yeah. >> And it can be debilitating to the extent where you're no longer able to go ahead with your normal daily activities including work. If you're an adolescent including school so you end up missing out on school. You end up missing out on work. it affects um your economic capacity to you know work and bring in an income at home. So it it doesn't just affect you, it also affects the economy. That's number one. >> Yeah. >> Um number two, just imagine um the mental impact it has um for a woman who is married and in a marriage and she's unable to have intercourse with her husband just because she experiences pain every single time. Right? And remember, some of these symptoms might mimic that UTI. The WHO has uh clearly brought out that some women might not report the pain during um urination or or or the pain during intercourse because of stigma. >> So, it ends up affecting their mental health. >> Yeah. >> Right. Cuz uh they're just keeping it all in. And eventually when they even communicate um and remember for example in the case of Kenya 80% of the um of the Kenyan population is based in the rural areas they go to a primary healthcare facility and they're told that's normal just take this um over the counter medication and and you should be fine and even if it doesn't end up being fine they're just told it's normal >> it's normal right so you can imagine the mental um impact that it can have on a woman um and then the also associated it with other um issues including chronic fatigue and then the fact that endometriosis um sometimes can present uh with other diseases at the same time or it can mimic other diseases. So you have a really poor quality of life. Imagine every time you want to go play, you're feeling pain. Everyone um every time you want to pass tool, you're feeling pain. Um you're chronically tired. Um you're not even motivated to do things. And then it's on top of that, it is associated with other chronic illnesses like autoimmune diseases. So it can be very debilitating on a woman. Um yes. So yeah, >> those are some of the mental health impact and just the emotional impact it can have um on a woman. And I think many times since um the what's the word um since it's more common in women between the age of 25 to 35 we forget that even adolescence can experience endometriosis. >> Um yes so this impacts by the time it's being diagnosed at 10 or 15 years later this person has really really been affected for a very long time. >> Yeah. >> Okay. Uh you've mentioned that sometimes you know when a woman goes to the hospital they told I mean it's just normal pain. >> Yeah. >> You know to Leah to what advice would you tell that lady who's repeatedly gone to a facility and is like I have pain and he she's sorry she's being told that this is normal pain. What would you advise that lady? >> Okay. Um if you're in a position to seek medical attention at a higher facility and in Kenya we have um different facilities. you have a level one, level two, level three, level four. If you're going to any of these primary health care facilities and that's what you're told, I think it's time for you to seek >> expert medical attention from a qualified gynecologist or obstitrician and gynecologist. Um, or if you if you have access to someone who has actually subsp specialized in endometriosis, then you can directly go to them, right? Um, but that is not something that you should be ashamed of. It's not something to be ashamed of. >> In fact, it should encourage you more and you should be more proud of yourself that you're willing to look and seek for answers for some of the things that you are experiencing. Experiencing severe pain um period pain or severe chronic pelvic pain is not normal. And sometimes some of this chronic pelvic pain can also present as chronic uh lower back pain. And we we tend to normalize that. It's not normal. I know it can be it can be laced with stigma especially in you know our day dayto-day society but seek for help uh from a qualified gynecologist and you should uh be met by compassion. They should be able to listen to you and they should be able to do the necessary test and physical examination um to and and help you to get the help that you need. >> Yeah. >> Okay. Interesting. Uh let me ask Dr. what needs to be done in the Kenya. Yeah. To improve in the Kenyan healthare system. >> Okay. Exactly. Yeah. I know that. Um the best way that I can answer that is that we are not lacking expertise. As a matter of fact, we have very many doctors who are experts at endometriosis and even diagnosing it and picking it up. >> The issue is the um access. >> So it goes it boils down to a system issue number one. um SHA should be able to pay for surgeries and medication for women who um who have endometriosis the same way they pay for other diseases and conditions. That's number one. Number two, we need to train more clinicians, including um just medical doctors who have not even specialized in, for example, obsetics and gynecology, general physicians to be able to diagnose and pick up and have endometriosis as one of um the differential diagnosis when they're treating these patients. And remember also that you can have endometriosis at the same time while you have things like inflammatory bowel disease or an autoimmune disease and all that. So having that other diagnosis does not necessarily negate this other one. So we should train we should have better systems in healthcare to continue training um our people and and our health care professionals and not just doctors but also nurses, clinical officers, physotherapists um on endometriosis. We should also have more campaigns to create more awareness to the general public on endometriosis so that we reduce on the stigma and also debunk all these myths that have been deeply rooted in us for many many years that having severe period pain um is is normal and also to help the women who are experiencing these symptoms and are afraid or coming forward for the fear of being judged. for example, that they're experiencing pain um during urination and they're thinking it's a UTI and they're thinking that it's an infection or something like that and it might not necessarily be that. Um so that so that sensitization can help to um reduce the stigma around um endometriosis. And then the other thing is that um our system should also um catch up with the re most recent international guidelines where we don't necessarily need to have a tissue biopsy or a surgery has to be done for you to start a patient on medication. Even if you don't have the confirmatory results the WHO has given the go ahead please try to make your patient comfortable like try to improve their quality of life. start them on a painkiller. Even if it's just a nerdal inflammatory drug like like like um panadol, start them, you know, um alleviate the pain. Start them on either hormonal suppressants like for example gonadotropin releasing hormone um agonist or antagonist. Like just start them on on medication that can improve their quality of life as we try to continue to make you know a more um decisive uh diagnosis. But it goes beyond the individual. It also goes all the way to the systems. Um. Yes. >> Okay. Allow me to ask this. Do you believe the Kenyan government is fully supporting people living with endometriosis? >> Yes. I not sure if I can say it is fully supporting people living with endometriosis. uh but when you look at for example in every county as we speak right now in Kenya there's an obstetrician and gynecologist which is an improvement uh in every county now they're trying to set up you know an MRI ultrasound that um these are things that never used to be there in every county before but now every almost every county has a CT scan machine has an MRI machine that can help to pick up um onomiosis so that's such an um an improvement And um we also have all these you know public health measures and campaigns out there that are going on uh on and sensitization campaigns on endometriosis. So I think it's improving. We still have a long way to go especially in terms of training people who are at the grassroot levels to help them to help these women identify that it could be endometriosis and refer them adequately and accordingly and in good time. uh once that referral system has um once that gap in the referral system has been um closed then I think to be good to go really really done well. Yeah. >> Amazing. Which brings me to my last question. I can now at least say finally. Okay. Finally. >> What message do you have for every Kenyan lady about endometriosis? What would you love her to know about all this? My message to every Kenyan woman whether you have been diagnosed with endometriosis or not is that number one having severe debilitating period pain is not normal and the word severe can be very relative. The moment the period pains that you're experiencing is affecting your quality of life in in a way that it's affecting you in terms of your productivity. you're unable to go ahead with your daily activities. That is something that um should be um evaluated almost immediately. You should not be ashamed. Um you should not be fearful. Kindly come and seek medical attention. You you should be able to get help. Doctors are better informed now. Um they're more listening and compassionate. um in medical school now it has been included in the curriculum for doctors to have um a communication skills assessment all the way from first year all the way to sixth year. So every single year we're taught to you know listen better. Uh so do not um hide with your symptoms. Kindly come out seek for help and you should be able to get the help. Um, if you're a woman who's already living with endometriosis, I keep on getting questions that since I have endometriosis, am I infatile automatically? Yes, the studies show that 30 to 50% of women with endometriosis can have infertility. But we've also seen that even these women once they this endometrial lesions are removed, they're actually able to regain fertility and have children. and uh the more they get pregnant and have more children, the more even um the severity of the symptoms improves. So in that case, it's never like a death sentence that you could never have children again. And having endometriosis does not necessarily translate to infertility. So there's still help out there. Um and if you also uh fear that if you cuz usually the medication that we put on these women who are who have endometriosis is the uh medication that is that suppresses hormones and it's literally like a form of contraceptive because we actually give them combined oral contraceptive and sometimes progesterine only contraceptives that suppresses pregnancy. If you do des um desire um pregnancy, we can still stay away from the home um this medication and we go for surgery directly. We remove this endometal tissue. We try to see if um if sorry um and correct the anatomical distation and then we see if we can get um expectant management and nowadays there are more options. there's interuterine um implantation, there's IVF, you know, there's more option in terms of getting pregnant. So, it's not a death sentence anymore. >> Um be encouraged. If you're going through the pain, be encouraged. >> Um yes. >> Oh, thank you so much, Takari. I mean, this has been such an interactive session. I've been able to learn personally. I've been able to learn so much and I'm so glad that people will now be able to get perhaps a better understanding and you know so that we can talk about it. Yeah. And I'm really grateful for you creating time to come here to our studios. It's so nice and so you're such a beautiful soul and it's really nice. Thank you. >> [bell]