Endometriosis, hysterectomies and your menstrual cycle: What you need to know - The Little Things

March marks International Endometriosis Awareness Month.

March marks International Endometriosis Awareness Month, which is intended to raise awareness and spark conversations about a condition believed to affect up to one in every seven women.

Although most people who menstruate don’t have endometriosis, there is a surprising lack of awareness about the menstrual cycle and its wider ramifications on our health.

A recent New Zealand study showed functional menstrual literacy is as low as 50 per cent, and 38 per cent of those who menstruate don’t know the normal length of a period.

To dig into this knowledge gap, The Little Things, the Herald’s women’s health and wellbeing podcast, this week talks to Auckland-based gynaecologist and obstetrics specialist Dr Amelia Ryan about what people need to know about periods and a healthy uterus and cervix.

Ryan told hosts Francesca Rudkin and Louise Ayrey that there is a process called “retrograde menstruation”, where blood and cells pushed out of the fallopian tubes during a period are reabsorbed into the bloodstream. For those with endometriosis, however, those cells don’t get reabsorbed and instead stick to other surfaces within the pelvis, such as the outside of the uterus or the bowel and bladder.

Dr Amelia Ryan is an Auckland-based gynaecologist and obstetrics specialist. Photo / Supplied

She said this can be debilitating for women. The age at which it starts varies for patients.

“Because it’s associated with the leaking of the cells into the pelvis, typically it happens somewhere in the range of the 20s into the 40s, and we used to think it couldn’t happen in adolescence because girls hadn’t been bleeding for long enough to form these deposits, but we know now that it is possible in adolescence. It can even be seen in children who haven’t started their periods yet.

Ryan said that if a patient presents with the symptoms, she treats them as having endometriosis until proven differently - but the process of getting diagnosed can take a long time.

“The stats are awful. It’s somewhere between 7 and 11 years. And there’s an awful lot of work going on to try and address that.”

While some women may feel dismissed when they are told by their GP to take the pill and see if they get better, Ryan said hormonal treatments like the pill are good for this.

“The progesterone within contraception sort of turns the disease off like a light switch at the wall.”

Surgery can be necessary though. This can include having a hysterectomy - removal of the womb.

Ryan said that in the ‘80s, it was believed about 20 per cent of women had a hysterectomy, but that number fell during the ‘90s when the IUD Mirena was invented.

“Having reflected on that, I saw that there was a real push to use the Mirena over a hysterectomy and so there was probably a group of women over that time that would have done really well with a hysterectomy and instead were encouraged aggressively to proceed with the Mirena.

“Now I think the pendulum is swinging back a little bit more towards understanding that it’s patient-centered decision-making.”

Listen to the full episode of The Little Things for more on if hysterectomies are right for you, and more aspects of the menstrual cycle that women need to know.

The Little Things is available on iHeartRadio, Apple Podcasts, Spotify or wherever you get your podcasts. The series is hosted by broadcaster Francesca Rudkin and health researcher Louise Ayrey. New episodes are available every Saturday.