Norjana Bte Juma’at, 46, administrative assistant, single mother of four children ranging from 10 to 23 years old tells For Life about how she overcame endometriosis and heavy menstrual bleeding (HMB) with obstetrician gynaecologist Dr Heng Tun Lan from SOG Women’s Clinic

Q: Describe your periods before you were diagnosed and treated for endometriosis and heavy menstrual bleeding. When did you feel something was amiss and what did you do about it?

My periods during my teens were regular and not heavy. I had cramps but they were not particularly intense or painful. It was only after I married and delivered my third child that the trouble started.

When I was pregnant with my first and second child, regular scans with my gynaecologist did not show up any endometriosis. As I was pregnant, we were more concerned about the health and safety of the babies and that I carried them to full term.

In 2005, I had an appendectomy. It was then that I was diagnosed with endometriosis; the histology report showed that my appendix was filled with endometrial cells. A year later I got pregnant again but miscarried four months into pregnancy due to pelvic infection disease (PID). Although I was heartbroken, I did not dwell on it for too long as I had to be strong for my other children.

It was only after giving birth to my fourth child in 2007 that I began to experience heavy menstrual bleeding (HMB) which was caused by endometriosis. My period could be prolonged for one month or more, and often I would experience intense cramps that felt more like contractions, as if I was pregnant. I was often fatigued and experienced migraines frequently. I was also anaemic and was put on iron tablets.

Q: You mentioned that “the trouble started” after you delivered your third child. Can you describe the changes that you started to observe? What caused you to get an appendectomy?

My menstruation became irregular and the flow became heavier than before I delivered my third child. The cramps got more intense and were usually accompanied by headaches.

So one day I had a fever and was also experiencing pain that was unlike menstrual pain so I went to see a general practitioner (GP) who suspected that my appendix was inflamed. That very day I was referred to a general surgeon who admitted me for appendectomy. Upon receiving my histology report, I was then referred to a gynaecologist for the treatment of endometriosis

Q: During your fourth pregnancy, were you ever worried that your endometriosis would cause any difficulties or complications?

I went to see my gynaecologist, Dr Heng Tung Lan, and told her about my concerns but she assured me that all would be well as long as I had positive thoughts and took care of my pregnancy just how I took care of the others. In fact, Dr Heng was surprised that I was even able to get pregnant as well as carry my fourth child to full term considering that I had endometriosis. Additionally, although I had been taking iron tablets to manage my anaemia through all pregnancies, my red blood cell count was unusually low during my fourth pregnancy, and I was given iron injections during my third trimester to counter that.

Q: What made you want to seek treatment or see a doctor about your condition?

It was very difficult to function with HMB especially with the prolonged bleeding, intense cramps and migraines.

Q: Who did you turn to for support?

When I told my sister and my mother about my condition, they were shocked but comforted me that all would be well. I was very fortunate to have the support of my family and my colleagues when I struggled with my condition. My mother and siblings helped manage and care for my youngest child while my first and second children took care of their younger siblings and with the housework whenever they can.

Q: What treatments have you undergone? Were you afraid of receiving treatment?

I was put on oral contraceptive pills to regulate my periods and had a few cycles of oestrogen injections but they did not help with HMB. After taking contraceptive pills for six months, I was diagnosed with hypertension which I had to manage with daily medication.

The heavy menstrual bleeding worsened after delivering my fourth child in 2007 with the bleeding and spotting prolonging over a month and intense cramps which seemed to worsen every month. I managed the pain with taking painkillers. A year later, Dr Heng asked me if I would like to have an intrauterine system/ device (IUS) inserted to manage my heavy menstrual bleeding and I agreed as the other options did not seem to work.

Q: Did you have to undergo any surgical procedures to manage your conditions?

I did not undergo any surgery to correct my endometriosis or heavy menstrual bleeding. The only surgery I have undergone was dilation and curettage (D&C) which was to remove the tissue in the uterus after the miscarriage to remove pieces of placenta and prevent infection or heavy bleeding. I underwent another D&C when a new IUS was inserted after removal of the previous IUS.

Q: What sort of change did you observe as a result of your treatment? Have any of them been successful in reducing the pain and improving your quality of life?

I have had two IUS insertions since 2008 (an IUS needs replacing every five years) and they have improved my quality of life by a great deal. My periods are not as heavy as before and I am no longer experiencing cramps. I am no longer on contraceptive pills and no longer need oestrogen injections. I am able to concentrate better at work and  day to day activities since I am no longer suffering from migraines and have not been taking painkillers since I am no longer experiencing pain.

Dr Heng has advised me to exercise to manage my hypertension. Being a single mother, it has been very difficult for me to find the time and energy to exercise and the prolonged bleeding and cramping have made movement impossible leave alone exercise. However after having the IUS inserted, I have begun walking in the neighbourhood.

Q: What is your advice for family members of women who have the condition?

If you have prolonged and heavy menstrual bleeding, it is important to get yourself diagnosed by a gynaecologist. Endometriosis and heavy menstrual bleeding can be treated and there is no reason for any woman to suffer in silence.

Q: What have you learnt from the things you’ve experienced as a result of your health condition? What is your advice for women who might have your condition?

You must seek help and get diagnosed and treated correctly and never assume or take things for granted that what you are going through is just a temporary condition. I’m happy I got it treated and need not face the same problem every time I menstruate. My illness has made me a stronger person and a happier mother who sees things in a more positive light.