By June Cheong

She began experiencing fainting spells and gastric pains during her menstrual periods when she was 18.

It was not until Ms Azeeza Jalaludeen turned 22 and visited a gynaecologist after her marriage that she found out what was wrong with her.

She said: "The doctor said I had cysts which were clumped together and had formed around my womb and ovaries."

Ms Azeeza, 35, was diagnosed with endometriosis, a disease characterised by the presence of womb lining tissue outside the womb.

There is no known cause or cure for the condition although medical and surgical treatment can relieve pain, control symptoms or destroy the endometrial growths.

She underwent a five-hour laparoscopic surgery to remove the cysts. After the operation, she was placed on hormone treatment for the next six months.

She said: "It was very painful. I had hot flushes and I put on weight like crazy."

Ms Azeeza's doctor also suggested that she give birth or consider a hysterectomy. She plumped for the former as she wanted to start a family and gave birth to three children in quick succession. They are now eight, 10 and 11.

Giving birth bestowed Ms Azeeza with a new lease of life and she no longer experiences severe pain during her periods.

When her youngest child, Abdul Mun'im, turned six, however, she suffered a relapse. She suffered debilitating cramps for two weeks and walked around doubled over. She also threw up constantly and suffered from gastric pains and diarrhoea.

She said: "The worst thing about the condition was not being able to do everyday things with my family or spend quality time with them."

Her husband, Mr Ramesh Nambiar, 44, said: "Sometimes, she'd hold back and not tell me about her pain but I could see it in her face.When the pain was extreme, she went into this cocoon and completely shut down. If she's not well, I'm not well because we're in this together."

Fed up with the insidious ways in which the disease was taking over her life, Ms Azeeza decided to learn more about it in order to find out how to beat it.

She attended a doctors' and patients' forum on endometriosis last year and was inspired to set up a support group, Seas, for fellow endometriosis patients (www.shineworldwide.com/seas.html).

She said: "Women need to be educated. My intention was to inform people and raise awareness. It's not about just surviving the pain but conquering it in your mind and body."

Mr Nambiar added: "Women with endometriosis hardly get any support. Husbands may just take their symptoms as menstrual pain and walk away."

Despite her relapse, Ms Azeeza decided to eschew Western medicine and sought traditional and alternative therapies like emotional freedom techniques, which is a psychotherapeutic tool based on notions that emotions are linked to the body's energy fields.

She explained her decision: "I know what's happening inside me now and I've already been told I have endometriosis and it will come back. I don't want my womb removed because there's the feminine aspect to it and I'm a vain pot."

Ms Azeeza also changed her diet, cutting down on soy-based and dairy products and avoiding meat, even going on detox diets thrice a year.

She said: "I feel like a newborn baby each time after I cleanse my system."

Her strategy has paid off so far. She no longer sees blood clots in her menstrual discharge or suffers from gastric pain.

She said: "It's not a life-threatening condition so most people don?t discuss it. But the pain is real and pain management is important."

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Warning signs and treatment

Endometriosis is a disease which affects roughly 5 per cent of all women of reproductive age.

It is characterised by the presence of womb lining tissue outside the womb cavity and usually occurs in the pelvic and abdominal region.

Women in their late 20s and 30s are most likely to suffer from the disease. Common symptoms include pelvic pain, pain with menstruation or painful sex.

Dr Tan Thiam Chye, obstetrician and gynaecologist at KK Women's and Children's Hospital, said: "The magnitude of the symptoms may not correlate with the extent of the disease. For example, a patient with severe disease seen during surgery may have very little pain."

However, the risk of infertility does increase as the disease becomes more severe. The exact cause of endometriosis is unknown but there are two main schools of thought.

One hypothesis is that endometriosis patients may have problems with their hormonal or immune systems which allow implants of menstrual discharge to grow in a woman's abdominal area. Another presumes that the disease is hereditary.

Dr Tan Yew Ghee, consultant obstetrician and gynaecologist at Raffles Hospital, said that it most certainly is dependent on the female hormone oestrogen.

For moderate to severe cases of endometriosis, surgical treatment and the removal of cysts using keyhole or laparoscopic surgery is needed. This is followed by drug treatment which lowers oestrogen levels. The complete treatment process may take between six and 10 months.

Women who do not wish to get pregnant can consider a hysterectomy.

Patients with mild endometriosis and who are planning to start a family are encouraged to become pregnant as it seems to be a natural cure, said to Dr Tan.

This article was first published in Mind Your Body, The Straits Times on June 25, 2008.