Not everyone has an average period

We're taking a look at endometriosis and polycystic ovarian syndrome.....
06 October 2020

Interview with 

Caroline Overton, Royal Society of Obstetricians and Gynaecologists

WOMEN-IN-PAIN

a woman sitting at table, in pain

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Not everyone has the average period described in the quick fire science earlier. In this section, we hear a tough personal account of endometriosis, and discuss the science of endometriosis and polycystic ovarian syndrome with gynaecologist Caroline Overton...

Sophia - Before experiencing endometriosis, I didn't know that such pain was possible every month. I would find myself on the floor fluttering in and out of consciousness as an invisible hand seemingly worked to slice my lower abdomen apart with a series of blunt knives. I was so scared. The first doctor I saw told me some people just have painful periods. Fortunately, I didn't listen.

Eva - Endometriosis affects about 10% of people with ovaries worldwide, where cells like those that line the womb, the endometrium, grow where they shouldn't - like on the ovaries or fallopian tubes. These misplaced cells respond to the same cyclical hormonal cues as the endometrial cells in the womb, so with each menstrual cycle, they grow, and then shed. Only because they are outside the womb, they can't leave the body through the vagina and instead can cause irritation and pain. And this in turn can lead to the growth of scar tissue and adhesions between organs.

Sophia - I'm now post-op and things are much better, but there is no cure, only management. And I worry everyday that a resurgence of that immobilising pain, those days of lonely desperation and fear, await me just around the corner.

Katie - That was Sophia there sharing her experience. And you also heard from Eva Higginbotham. Caroline, is it common with endometriosis to experience that level of pain?

Caroline - Well, thank you for sharing Sophia's experiences. I'm very glad that she didn't take the doctor's advice that it was normal. Very much wasn't, and that sort of severe pain where she is in agony is not normal and is classic of endometriosis.

Katie - In Sophia's case, she had surgery, which helped what are the treatment options short and long term with this condition?

Caroline - So the main aim of treatment now would be about picking it up as early as possible so that hopefully you can avoid the long term complications such as adhesions and infertility. So the current guidelines are to actually make the diagnosis based on the symptoms. So somebody like Sophia coming along and saying, I'm doubled up with my period. That should flag up that she might have endometriosis. There are painkillers, there are treatments like the hormonal pill. Basically, you want to make the periods either disappear completely or shorter and much lighter in order to control the endometriosis and the symptoms.

Katie - Are there fertility implications here?

Caroline - There are fertility implications. Endometriosis starts as little pimples in the pelvis, which are slightly sticky as they grow and develop. And those can cause the organs to stick together, which we call adhesions, and the adhesions then can get in the way of the egg escaping from the ovary and/or getting down the fallopian tube, causing infertility in the longer term. What we don't know is why some women get severe adhesions and in other women, it seems to have a much more benign course where it doesn't progress so much.

Katie - What are the theories?

Caroline - There may be a sort of family link there, so an inherited problem - you are more likely to have endometriosis if a family member of yours has got endometriosis and it's more likely to be severe. We think it may be linked with the amount of period, think of that period slightly overwhelming the body's immune system and stirring up the blood cells from inside the pelvis. The other one is that there is an immune modification, that you've got a slightly altered immune response where in some ways those immune cells are not clearing up as well.

Katie - Endometriosis can result in having to manage severely painful periods as we've heard. And managing irregular ones throws a different challenge and one potential reason for this could be a condition called Pcos or PCOS. Time for another quick fire science from Eva.

Eva - Polycystic ovarian syndrome, sometimes called Pcos or PCOS, is a common syndrome whose cause isn't well understood. It's often characterised by its symptoms, which can include the growth of more follicles or egg sacs than is normal on the ovaries. These sacs aren't always able to release the egg inside, which can cause problems with ovulation periods and fertility. People with PCOS can have irregular or no periods at all as a result. And also often have higher than normal testosterone levels, which can lead to symptoms like weight gain, acne, and hair growth on the body in a more typically quote unquote male pattern sometimes with hair growth on the face, chest and back.

Adam - So we've talked about the fertility outlook for people with endometriosis, but what about the fertility outlook for someone diagnosed with this, with PCOS?

Caroline - Somebody diagnosed with PCOS is likely to have irregular periods with long gaps between them. Although some people with PCOS can have regular periods. If you're having long gaps between your periods, you're not ovulating as regularly and there might be a delay in getting pregnant. It's normal to have a period every 25 to 35 days. So if you're getting longer than that, that might be a problem, and you might have Pcos.

Adam - Now the condition is also associated with high insulin levels. So why is that? And what does it mean for someone's health throughout life?

Caroline - Those high insulin levels are part of the changes in the body causing the hormone changes that lead to the effects that we heard about in the snippet there. You get increased production and activity of hormones like testosterone. That high insulin level leads to insulin resistance. So your cells if you like are numbed to the effect of the insulin, and there's a diabetic tendency there.

Adam - How can you manage a condition like this, or what's the best way to go about it?

Caroline - It would be about making a diagnosis. It would be if you are overweight, trying to lose weight, eating a healthy, balanced diet. And if your periods are still very irregular, drugs such as Metformin, which increase insulin sensitivity, and possibly if you're wanting to get pregnant fertility drugs such as clomiphene.

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