Some women with endometriosis find it tough to have a baby, so Francesca De Luna’s pregnancy was a welcome surprise…
“My baby boy Kyle Deuel is 17 months old now. He is tall and heavy, likes to dance, play ball and is active and smart.
I wasn’t always sure that I could have children, because I had endometriosis ― a condition where cells from the lining of the womb is found outside the womb where they attach and form cysts.
I first started having painful period cramps back in 2012. It was so painful that I had difficulty moving and I couldn’t even go to work.
My regular GP recommended me to see a specialist, since the period pains had been going on for two to three months.
So, I scheduled an appointment with a gynaecologist. I was shocked to learn that I had endometriosis. I was told that I had to undergo surgery as soon as possible ― I had no idea my condition was so serious!
“I was told that I had to undergo surgery as soon as possible – I had no idea my condition was so serious!”
I decided to look for another gynaecologist for a second opinion. When I saw Dr Kelly Loi, she explained to me that I needed to undergo surgery to prevent the cyst from growing even further and scheduled surgery for me almost immediately.
I was just 27 years old at the time. I didn’t even think about it affecting my fertility. All I was thinking about at the time was to remove the cyst as soon as possible, so that it would not grow anymore.
When I told Dr Loi that I was indeed planning to have a baby in the future, she told me to take care of my health and that she would guide me through the process of conceiving.
I underwent a laparoscopic cystectomy (removing the cyst with a laproscope), hysteroscopy with dilation and curettage (removing the lining of the uterus for tissue analysis) and hydrotubation (where a liquid medicine-filled tube is injected through the cervix into the uterus and fallopian tubes) at one go.
After the surgery, I took Visanne, a medicine that acts as progesterone and helps to reduce the pelvic pain caused by the endometriosis.
I was 29 years old when I got married in 2015. I was told that I should stop the medication when I wanted to have a baby. Since I wanted to have a baby before my 30s, I went off Visanne three months before my wedding.
In March 2015, just two months after my wedding, I found that I was pregnant! I tested myself with five pregnancy test kits as I just could not believe it!
I have no words to describe how happy and excited I was. I remembered talking to my son in my womb every single day while I was pregnant. I always told him that he should keep strong and healthy and I would always guide and care for him.
The first trimester was the toughest time. I actually lost a lot of weight because I was nauseous all the time and was unable to eat and I felt so tired.
“I have no words to describe how happy and excited I was.”
I’m an IT administrator in a shipping company ― my work can be stressful and requires me to lift, assemble and fix computers. Thankfully I was surrounded by colleagues who helped me out when I was pregnant.
I was also fortunate to have my husband’s support through my pregnancy and after delivery as we do not have our parents or relatives here in Singapore.
After conquering the first trimester, the rest of my pregnancy was smooth. I followed my doctor’s advice and went for my monthly check-ups to keep track of my baby’s condition.
Once, when I woke with a fever, I quickly went to the doctor for a check-up. Thankfully, the baby was fine.
I decided to give birth in the Philippines where I was from originally. I went to meet my gynae, who said that my baby was big. She advised me to deliver the baby normally and asked me to take medication to induce the baby.
However, nine hours of trying after she induced me, I was only 2cm dilated, so my gynae advised me to deliver my baby through a C-section. It went well and I delivered a healthy baby boy.
I hope to have another one or two children, hopefully a baby girl next, when Kyle is a little older, perhaps when he’s about 3years old.”
Gynaecologist Dr Kelly Loi from the Health & Fertility Centre for Women gives us the low down on Endometriosis.
What is endometriosis?
Endometriosis is a condition in which cells from the endometrium, or the lining of the womb, are found outside the womb. They could be in the pelvis and around the ovaries and fallopian tubes where they attach and form cysts and lesions.
It can take hold behind or around the womb, in the peritoneum (the tissue that lines the abdominal wall and surrounds most of the organs in the abdomen), or on the bowel and the bladder. It can also develop deep within the muscle wall of the uterus.
How do women contract endometriosis?
Endometriosis is neither a contagious infection, nor a cancer but the exact cause is not certain. The most likely explanation is that during menstruation some of the blood containing cells from the endometrium flows backwards into the pelvic area via the fallopian tubes. Once in the pelvic area, the cells attach themselves to other organs and begin to grow. With each period more cells from the endometrium enter the pelvic area while those already present are stimulated to grow by the hormonal fluctuations of the menstrual cycle.
“Endometriosis can develop on the ovaries as well as in or on the fallopian tubes, and these can block the passage of both sperm and eggs, affecting fertility.”
What factors can increase your chances of getting endometriosis?
Although the cause of endometriosis is not known, it often runs in families. Another factor is when a woman has fewer babies later in life. Two or three generations ago, women gave birth earlier in life and also had more babies which they mainly breastfed. While they were pregnant and breastfeeding, their menstruation cycles was temporarily put on hold and they had no periods. This meant there was less opportunity for a back flow of menstrual blood to cause endometriosis. Today, many women put off babies until their 30s, so they may have 15 or 20 years with an uninterrupted menstrual cycle. This increases their exposure to the risk of a back flow of menstrual blood and of developing endometriosis.
Does endometriosis affect your fertility?
Endometriosis can develop on the ovaries as well as in or on the fallopian tubes, and these can block the passage of both sperm and eggs, affecting fertility. Surgery to diagnose and remove the cysts can improve fertility, but repeated surgery is generally not beneficial, and may cause harm by reducing the ovarian reserve.
How do I know if I have endometriosis?
If you are experiencing painful periods, pelvic pain and or discomfort or pain during sexual intercourse, your doctor may suspect endometriosis. However, although pelvic pain and painful periods are common with endometriosis, they are not always present and don’t necessarily relate to the severity of the condition. It is the location of cysts and lesions rather than their size which causes pain.
If you are experiencing period and or pelvic pain, or having difficulty conceiving, you should consult your gynaecologist. The best way to increase the chances of a successful outcome is an early diagnosis and treatment of endometriosis and other causes of pain and infertility.
Learn about endometriosis treatment procedure…next!
How does the gynae determine if I have endometriosis?
To check for endometriosis, the doctor will usually do a pelvic exam. The doctor will feel the areas in your pelvis for abnormalities, such as cysts on your reproductive organs, or scar tissue behind your uterus. However, it is often not possible to feel small areas of endometriosis unless they've caused a cyst to form. So, the doctor may do an ultrasound scan, either on the abdomen, or through the vagina. Ultrasound scans can identify ovarian cysts and large growths.
To be completely certain, the patient may need to undergo a surgical procedure called a laparoscopy to look for signs of endometriosis inside the abdomen. A laparoscopy requires general anaesthesia, after which a tiny incision is made near the navel and the laparoscope is inserted to look for endometrial tissue outside the uterus. Samples of suspected endometriosis tissue may be taken for a biopsy. A laparoscopy can provide information about the location, extent and size of the endometrial growths to help determine the best treatment options.
“A laparoscopy can provide information about the location, extent and size of the endometrial growths to help determine the best treatment options.”
What treatment options are there?
There are several to consider:
1. Contraceptives Contraceptives can be prescribed for mild to moderate endometriosis. They may reduce or eliminate the pain of endometriosis by helping to control the hormones responsible for the build-up of endometrial tissue each month, thus making periods shorter and lighter.
2. Gonadotropin-releasing hormone (GnRH) agonists This drug stops the production of certain hormones to prevent ovulation, menstruation and the growth of endometriosis. However, this treatment sends the body into a "menopausal" state which causes side effects similar to menopause including hot flashes, tiredness, problems sleeping, headache, depression, joint and muscle stiffness, bone loss and vaginal dryness. As with all hormonal treatments, endometriosis symptoms return when you stop taking GnRH agonists.
3. Visanne An oral progestin medication, this hormone therapy reduces the production of certain hormones associated with menstruation. Most women find that they stop menstruating after taking it for a few months, so it is effective at reducing period and pelvic pain. It can also cause cysts and lesions to shrink. Normal fertility returns within a month or two after you stop taking Visanne
4. Surgery For women who hope to get pregnant, removing as much endometriosis as possible while preserving the uterus and ovaries may be required to increase their chances of success. If the endometriosis is causing severe pain, surgery may also help to relieve it; however, the endometriosis and the pain may well return unless a hormone treatment like Visanne is used to control it. Surgery can be done laparoscopically or the traditional abdominal way.
5. Total hysterectomy and bilateral salphingo-oophorectomy (THBSO) This procedure removes the uterus and cervix as well as both ovaries. A hysterectomy alone is not effective as the oestrogen produced by the ovaries could stimulate any remaining endometriosis and cause pain to persist. As one can’t get pregnant after a hysterectomy, it is typically considered a last resort for women in their reproductive years.
Photos: Francesca De Luna & iStock
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