Endometriosis
“Endometriosis
has a surgical
diagnosis. We
need to see
endometrionic
spots on the
uterus, which
we cannot
do without
surgery. By the
time we get
to diagnose
it with
ultrasound, it
tends to be at a
late stage”
taboos surrounding periods and menstrual health
are widespread, sometimes promoted by religious
teachings.
According to one interpretation of Islam, the
dominant religion in the Southeast Asian nation,
women are considered unclean and not allowed to
pray during their periods. Hindus, who account for six
percent of Malaysia’s population, hold similar beliefs
and exclude women from worship. And cultural taboos
often prevent menstruation being discussed by the
quarter of Malaysians who are ethnic Chinese.
This lack of openness about periods and
awareness of endometriosis is partly behind a system
that Surita says discriminates against patients and
requires them to “fight to be given a voice.”
“Nobody wants to talk about periods openly.
There’s this taboo where women don’t talk about it
openly even between themselves. That’s why there’s
this delay before women are diagnosed.
“We’re being discriminated against by doctors, as
In Malaysia, cultural and religious taboos make it hard for some women to discuss
menstrual issues with their doctors
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MARCH 2020
well. Many times they speak to us, especially to those
who have not yet been diagnosed, but they think we’re
exaggerating our pain. The pain issue is taken lightly,”
she added.
Her organisation believes a Malaysian woman
will usually have to wait 7-8 years before she gets an
endometriosis diagnosis.
According to Dr Leong Wai Yew, a consultant
obstetrician and gynaecologist at Alpha IVF and
Women’s Specialists in Kuala Lumpur, the longer the
wait, the more problematic the condition is to treat.
He stresses, though, that it’s rather hard to detect the
condition during its early stages.
“Endometriosis has a surgical diagnosis. We need
to see endometrionic spots on the uterus, which we
cannot do without surgery. By the time we get to
diagnose it with ultrasound, it tends to be at a late
stage,” he told Global Health Asia-Pacific.
According to the American Society of Reproductive
Medicine, there are four stages of endometriosis. The
first three stages can only be picked up through a
laparoscopy, a form of keyhole surgery that captures
images of a patient’s pelvis from within her abdominal
cavity.
Endometriosis shows up through the scope as
brown spots that look like powder burns, usually
over the pelvic organs. There may also be signs of
inflammation caused by chronic endometriosis, with
scarring on parts of the bowel, intestines, and pelvis,
as well as some adhesions.
Ultrasound will pick up fourth-stage endometriosis
by identifying endometrial cysts, which appear on
pelvic organs and elsewhere, said Dr Leong. This is
when most cases are diagnosed by doctors.
“I would say there’s a reasonable delay in terms of
diagnosis in Malaysia because of the stigma of seeing
a doctor for menstrual disorders. But once they see a
physician, I don’t think the way the doctors approach
it is any different from in other parts of the world.
“A lot of Malaysian girls are taught that periods
are a bad thing, a dirty thing. So by the time a patient
comes forward to have her symptoms examined, it’s
invariably quite late,” he explained.
Because a laparoscopy is a surgical diagnosis, not
all doctors want to jump straight into surgery, leading
them to delay their diagnosis. Instead, they might give
the patient a course of painkillers and send her away.
“So by the time, a couple of years down the line,
when she comes back to her doctor because of
worsening pain, it could have reached stage four,” he
said.
At this point, some damage will probably have
been done, especially in terms of the patient’s
ability to conceive. Given that fertility is Dr Leong’s
specialisation, endometriosis is constantly on his
radar as a possible cause of sub-fertility, and he’ll
usually test for the condition straight away if the
patient reports painful periods. By contrast, a GP
would not be expected to have such a deep suspicion.
“If we wait, more damage could be done and some
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