Experts Explain Endometriosis and Encourage Women with This Condition to Reach Out for Help

WORDS LIM TECK CHOON

5 FACTS ABOUT ENDOMETRIOSIS

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  1. It is a condition that sees tissue similar to that of the uterine lining growing outside the uterus, such as at the ovaries, fallopian tubes, and the tissue lining the pelvis.
  2. It can also be found in other areas of the body, but this is very rare.
  3. Endometriosis can cause debilitating pain, severe bloating, and fatigue, especially during one’s period.
  4. It can affect one’s ability to have children, as 30% to 50% of women with infertility also have endometriosis.
  5. Approximately 350,000 women in Malaysia may be silently suffering from this condition.
WOMEN SHOULD REACH OUT FOR MEDICAL ATTENTION IF THEY BELIEVE THAT THEY HAVE ENDOMETRIOSIS
FEATURED EXPERT
SURITA MORGAN
Founder and President
Endometriosis Association of Malaysia (MYEndosis)
Website

Surita Morgan tells us: “Malaysians are generally not aware of what endometriosis really is and why some women have this condition. One of the biggest reasons is because it is often considered as a taboo subject. People are simply uncomfortable speaking about menstrual health openly. But it doesn’t have to—rather, it shouldn’t—be that way.”

She adds: “We need to change the narrative around menstrual health and endometriosis. We need better research, better resources, and better recognition of this condition. By doing so, we can begin to pave the way for a future where endometriosis is not a burden anymore carried in silence, but a challenge met with understanding and solidarity.”

UNDERSTANDING ENDOMETRIOSIS
FEATURED EXPERT
DR LIZA LING PING
Consultant Obstetrician, Gynaecologist, and Fertility Specialist
TMC Fertility

Dr Liza Ling Ping shares that endometriosis reveals itself in stages.

The First Stage or Minimal Endometriosis

At this stage, there are scattered patches of endometriosis tissue, often without symptoms or with mild pelvic discomfort.

The Second Stage or Mild Endometriosis

The number of tissue patches increases, potentially affecting fertility and causing discomfort during menstruation and intercourse.

The Third Stage or Moderate Endometriosis

There is further spread of endometriosis tissue, along with scar tissue and adhesions that can lead to chronic pelvic pain and digestive issues.

The Fourth Stage or Severe Endometriosis

This stage is characterized by extensive endometriosis tissue patches, large cysts, and significant scarring. There is intense pain as well as potentially impacting bowel and urinary functions.

CAN ENDOMETRIOSIS BE TREATED?

Dr Liza reveals that there is a range of treatments available such as laparoscopic surgery to specialized fertility treatments, all aimed at managing symptoms and preventing escalation.

Early diagnosis and intervention can open the door to effective treatment options that not only alleviate symptoms, but also improve quality of life, and even protect fertility.

Hence, she advises women that are affected by this condition to seek formal help and professional medical attention.

What Kind of Sleeping Position Is Best for a Pregnant Mom and Safest for Her Baby? Let’s Find Out!

WORDS LIM TECK CHOON

When it comes to pregnancy, the mom will have to generate enough energy for her well-being and for the growth and development of her baby. This includes eating for two (or more if she is carrying more than one baby!) as well as getting enough sleep to meet the physical demands of pregnancy.

Of course, the mom may have to adopt a different sleeping position during the pregnancy. This brings us to the question of which sleeping position is best when it comes to keeping the baby safe while allowing mom to get the most out of her sleep.

THE ACCEPTED CONVENTIONAL WISDOM OUT THERE

It is generally assumed that sleeping on the left side is better for a pregnant woman, as it’s more comfortable and helps to maintain proper blood flow between the mom and the baby she is carrying. This better blood flow also decreases the chances of swelling around the mom’s ankles and in her legs.

Sleeping on the right side is said to put pressure on the mom’s liver, so many advise a pregnant woman to sleep on her right side only for short naps.

How true are all these assumptions, though?

THE UK NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE) REVIEWED AVAILABLE EVIDENCE

They stated that the purpose of their review was to determine whether there is any link between the mom’s sleeping position and the incidence of either stillbirth or the baby being born smaller in size than typical normal, healthy babies of the same age (small for gestational age or SGA).

In their findings, published in 2021, they stated that:

There is high quality evidence linking supine going-to-sleep position—that is, the mom sleeps lying on her back—and stillbirth.

NICE noted that the overall incidence of stillbirth is generally low (1 in every 244 births in the UK based on 2018 statistics), but they feel that there is enough evidence for doctors to advise pregnant moms to avoid sleeping in this position.

HOW ABOUT SLEEPING ON THE LEFT SIDE THAT IS GENERALLY SAID TO BE GOOD FOR MOM & BABY? ANY EVIDENCE FOR THAT?

Well, NICE noted that the evidence for this, as well as for sleeping on the right side, ranged from low quality to very low quality. They concluded, therefore, that more research would be needed to look into this matter.

One thing is for sure, though—they noted that sleeping on mom’s back is definitely something to be avoided!

THE TAKE HOME MESSAGE

Pregnancy may also give rise to other sleeping issues, such as problems falling asleep, and special care is often needed for pregnant women that also have obstructive sleep apneoa (OSA) and other health conditions that could affect her sleep or her breathing while she is asleep.

Hence, it’s always sensible for a couple expecting a baby to discuss mom’s sleep matters further with their obstetrician and gynaecologist. They should do this as early as possible—don’t wait for the sleeping issues to arise first!

Reference: National Guideline Alliance (UK). (2021). Maternal sleep position during pregnancy: Antenatal care. National Institute for Health and Care Excellence (NICE). https://www.ncbi.nlm.nih.gov/books/NBK573947/

A Quick Primer for Understanding Ovarian Cysts & Uterine Fibroids

WORDS LIM TECK CHOON

FEATURED EXPERTS
DR WONG YEN SHI
Consultant Obstetrician & Gynaecologist
Sunway Medical Centre Velocity
DR FARAH LEONG RAHMAN
Consultant Obstetrician & Gynaecologist and Fertility Specialist
Sunway Medical Centre Velocity
DR WONG YEN SHI ON UTERINE FIBROIDS
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AT A GLANCE
  • They are non-cancerous growths that form in the muscular layers of the uterus.
  • One can have a single fibroid or multiple fibroids.
  • Often found in women in their reproductive years—that is, the period of time when they are capable of conceiving.
  • We still don’t know what causes fibroids to develop in a woman. Dr Wong states that hormones and growth factors could be possible causes.
YOU MAY HAVE UTERINE FIBROID(S) IF YOU HAVE…
  • Irregular or painful period
  • Heavy bleeding during your period
  • Frequent urination or constipation
  • Abdominal distension or bloating
  • Back pain
  • Unexplained weight gain
  • Painful sexual intercourse

TREATMENT

  • Fibroids can be removed via surgery. Depending on the location and size of the fibroid(s) present in the uterus, this can be open surgery or laparoscopic surgery, the latter involving the use of a laparoscope to make fewer and smaller cuts in the body. Women that no longer want to have children can also opt to have their womb surgically removed.
  • Newer treatments such as uterine artery embolization (blocking the blood vessels that nourish the fibroid, thus causing it to shrink) and high intensity focused ultrasound (HIFU) surgery can be considered, but note that not every medical facility in Malaysia offer these treatments.
  • Medicines to relieve symptoms such as heavy menstrual bleeding and painful period
DR WONG YEN SHI & DR FARAH LEONG RAHMAN ON OVARIAN CYSTS
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AT A GLANCE
  • These are sacs that contain mostly fluid, sometimes with tissues or blood, which form within the ovaries or on its surface.
  • They are mostly benign, but can be cancerous on rare occasions–especially among women between 60 and 65.
  • Ultrasound and CA125 tumour marker test are used to tell whether an ovarian cyst is benign or cancerous.
  • Conditions such as pregnancy, pelvic infections, and endometriosis can increase the likelihood of developing ovarian cysts. A woman with a history of ovarian cysts is more likely to develop ovarian cysts in the future.
  • Yes, it’s possible to have both fibroids and ovarian cysts at the same time.
YOU MAY HAVE OVARIAN CYST(S) IF YOU HAVE…
  • Irregular or painful period
  • Frequent urination or constipation
  • Abdominal distension or bloating
  • Back pain
  • Unexplained weight change
  • Unexplained loss of appetite
  • Quick sense of fullness while eating
  • Painful sexual intercourse

TREATMENT

  • Smaller cysts usually don’t require treatment. Instead, the doctor will monitor the cyst for signs of growth and other changes. 
  • Larger cysts can be removed via open or laparoscopic surgery.
CAN UTERINE FIBROIDS & OVARIAN CYSTS AFFECT ONE’S CHANCES OF HAVING A BABY? DR FARAH EXPLAINS 
  • Most women with fibroids and cysts have no problems getting pregnant.
  • However, depending on the size and location, uterine fibroids may affect one’s fertility. For example, fibroids that form in the womb lining may block the fallopian tubes, keeping the egg from being fertilized by a sperm cell, or make the womb environment less conducive for a fertilized egg to attach to the womb for further development.
  • Fibroid developing during pregnancy may increase the risk of early delivery. “In some cases, it can cause severe pain when fibroids outgrow their blood supply. If the fibroid is large, it can cause the baby to be positioned wrongly, such as the baby’s head not turning down even at term,” explains Dr Farah.
  • Ovarian cysts forming during pregnancy is usually not a cause of concern, except when the cyst grows so big that it ruptures open.

DR FARAH’S ADVICE

  • Go for regular gynaecology check-up to detect the growths of uterine fibroids and ovarian cysts as well as to ensure that the rest of the reproductive system is in good condition and working order.
  • When you’re about to embark on your pregnancy journey, seek advice from your doctor if you have a history of uterine fibroids and/or ovarian cysts.
  • We still don’t have any evidence-based method to prevent the formation of uterine cysts or ovarian fibroids. However, practicing good health and maintaining a well-balanced diet will be good for your overall well-being and improve your chances of a safe and successful pregnancy.

Small for Gestational Age: When Baby Is Born Smaller Than Normal

WORDS PROFESSOR DR MUHAMMAD YAZID JALALUDIN

FEATURED EXPERT
PROFESSOR DR MUHAMMAD YAZID JALALUDIN
Senior Consultant Paediatrician and Paediatric Endocrinologist
UM Specialist Centre

Most babies seem small when they first come into the world, but for some, they truly are smaller when compared to their fellow babies-in-arms.

This condition is known medically as small for gestational age (SGA for short).

Gestational age, by the way, is the length of time a baby spends growing in their mother’s womb.

Small for gestational age babies that weigh below 2,500 g at birth are additionally considered to have low birth weight.

SMALL FOR GESTATIONAL AGE CAN BE MEASURED AND DETECTED AFTER A BABY IS BORN

After a mother has given birth in a hospital or clinic, nurses will clean the newborn and giving them a quick check for any abnormalities. The nurses will also measure the length and head circumference of the baby as well as weigh.

These measurements inform healthcare professionals whether or not a baby is small for their gestational age.

POSSIBLE CAUSES OF SMALL FOR GESTATIONAL AGE

Pregnant women should go for their antenatal check-ups to monitor for and manage any problems that might result in a small for gestational age baby
The mother’s health during pregnancy
  • Presence of infections or medical conditions such as heart disease, uncontrolled diabetes, thyroid disease, or high blood pressure
  • Drinking alcohol or smoking
  • Poor nutrition during pregnancy
The mother’s age

The risk of having a small for gestational age baby is significantly higher for women aged 30 and above that have never given birth before, as well as all women aged 40 and above, compared to women in their 20s.

The mother’s height

Women that are short are at risk because their smaller wombs and shorter birth canals influence the growth of their foetus.

Family history

Interestingly, research has shown that the risk of having a small for gestational age baby can be influenced as far back as two generations.

If the pregnant woman and/or her own mother were small for gestational age babies, the foetus has a higher chance of being born small for gestational age.

Issues with the placenta during pregnancy
  • Placental insufficiency, which happens when the blood vessels in the uterus that are supposed to transform into the blood vessels of the placenta do not change as they should, can lead to placental infarction
  • Placental infarction sees the disruption of the blood supply to the placenta, resulting in the death of placental cells, placental abruption (the placenta partially or completely separates from the uterus before childbirth), and structural abnormalities of the placenta
  • All these conditions cause the foetus to receive insufficient nutrients and oxygen from their mother, thus affecting their growth
Chromosomal or genetic abnormalities

These abnormalities include those that give rise to Down syndrome and congenital abnormalities such as structural defects of the heart, kidneys, lungs, or intestines.

Other possible causes

Catching an infection while in the womb or being part of a multiple pregnancy (twins, triplets, etc) can also negatively affect a foetus’s growth.
SMALL FOR GESTATIONAL AGE COMPLICATIONS AFTER DELIVERY
  • As they have only small amounts of fat or energy stored away, they may have a low body temperature at birth. This can result in hypothermia, where the body loses heat faster than it can produce it. If this condition is prolonged, the baby can die as their heart and brain cannot function well at these sub-optimal temperatures.
  • The lack of fat and glycogen stored in a small for gestational age baby’s liver can cause hypoglycaemia, where they have low blood sugar levels that are unable to match their body’s needs. This can cause the baby to have seizures and/or brain damage. If the hypoglycaemia is prolonged, the baby may die or develop long-term neurodevelopmental deficits, including cerebral palsy.
  • As they are deprived of sufficient nutrients in the womb, small for gestational age babies become ‘programmed’ to hoard whatever nutrients and calories they receive. This means that after birth, they can very easily put on weight if their caloric intake is not carefully monitored. Thus, these babies are prone to obesity and its associated conditions (diabetes, high blood pressure, high cholesterol, osteoarthritis, heart disease, etc). This “programming” lasts throughout their lifetime.
  • Their growth rate can influence when they achieve puberty. Small for gestational age babies that catch up in their growth very quickly might experience early puberty. On the other hand, if they are slow in growing, their puberty might be delayed.
  • Persistent short stature.
SMALL FOR GESTATIONAL AGE, FORTUNATELY, CAN BE MANAGED

Generally speaking, small for gestational age babies should be able to catch up in their growth within the first six months to two years of their life with good nutrition.

In fact, 85% of these babies achieve normal height and weight for their age and gender by two years of age.

Some children require a longer time and there is still some leeway until the age of five to allow them to catch up in growth to their peers.

However, by five years of age, 8-10% of small for gestational age babies would still be smaller than normal, and this is the time that parents and doctors need to start discussing treatments for the child.

Growth hormone therapy
  • The main treatment for small for gestational age babies that do not manage to catch up in growth by the time they are four to five years old
  • Will enable them to achieve their optimal final height as adults, through improving muscle and bone growth
  • Helps increase the breakdown of fats, to address the tendency of small for gestational age babies to accumulate fat and become obese
Good nutrition
  • Nutrition plays a critical role in the first two years of life in promoting a child’s growth
  • Their diet must be carefully monitored as they are prone to becoming overweight; on the other hand, when they are not fed enough, they might become stunted
  • Parents need to do a careful balancing act when it comes to feeding their small for gestational age baby
Regular physical activity
  • As the child grows, parents also need to encourage and allow their child to be active
  • Doing so will prevent excessive weight gain and help stimulate the natural production of serotonin and growth hormone to help the child grow
  • Such physical activity must be vigorous enough that the child’s heartbeat increases and they sweat.
Proper sleep
  • It is critical that children are asleep at the latest by 9 pm, as the peak time for the body to produce its natural growth hormones is between 10 pm to 12 am.
  • Sleeping later, as many Malaysian children tend to do, will cause them to miss this critical period of growth hormone secretion.

A Free App for Women, Especially Marginalized Women

WORDS LIM TECK CHOON

The University of Nottingham Malaysia (UNM) and Hanai Jiwa Ibu Sdn Bhd have developed an app, called Jiwa Ibu, to provide localised and tailored information on mental, women’s, maternal, and children’s health.

This app, developed in collaboration of the two entities with St George’s University of London, Universiti Malaya and Universiti Malaysia Sabah, serves to reduce the great disparity in access to healthcare between those residing in urban and rural communities. This is because rural communities have limited access to quality medical centres and professionals, and residents of those communities have to travel further in search of quality healthcare.

AN APP FOR MARGINALISED WOMEN

“For years, we’ve wanted to shift our focus to the rural and marginalised communities of Malaysia. Since the idea began, our team of eight dedicated women have run focus groups involving doctors, nurses, midwives, community nurses and everyday women, to better learn what the ideal women and maternal healthcare pathway should look like,” explains Hanai Jiwa Ibu Founder and CEO, Shamala Hinrichsen. “We don’t expect to solve the world’s problems, of course, but one tiny step forward is better than no steps at all.”

UNM and Hanai Jiwa Ibu recently inked a Memorandum of Understanding (MoU) to allow for the copyrighting and trademarking of the app, ahead of plans to work alongside Selangkah, Selangor’s healthcare app, to embed part of Jiwa Ibu into the system.

“The Jiwa Ibu app is expected to benefit 15 million women across Malaysia. During its initial alpha-test, the app was downloaded by 3,000 women, with 75% returning to the app within the span of one month from downloading,” shares Associate Professor Dr Joanne Lim Bee Yin of the UNM School of Media Languages and Cultures. “Based on the surveys and interviews that we carried out, 95% of respondents also shared that they wanted the app.

MANY FUNCTIONS FOR EMPOWERMENT & HEALTH SELF-MANAGEMENT

Jiwa Ibu will include a directory for doctors and healthcare centres within the vicinity of the user and other important resources, such as those for violence against women cases.

Users can also store and track their own health records and seek medical assistance through the app.

In an effort to be more accessible, the app will be made available in Bahasa Melayu, English, and other native languages.

Click here to download the app (link opens in a new tab) in the Google Playstore. The app is free.