Jepkogei Kemboi, 24, had her first period at 13. In between her thirteenth and eighteenth year, her periods never showed up. In the five years, her life seemed okay, and she was generally unruffled.
When her menses finally reappeared, her otherwise calm life would be stormy, especially during her periods. “I always had an abnormal menstrual cycle. I thought it was normal until I talked to my friends,” recalls Jepkogei.
With the stigma surrounding menstrual health, it took a lot of courage to open up. Her friends advised her to seek a medical opinion. “I would go for two months without my period,” she says. “In fact, because of painful cramps, I once suspected I had endometriosis.”
Until about a week ago, she did not know that she could be diagnosed with Polycystic Ovarian Syndrome (PCOS), a hormonal disorder caused by excessive androgen hormones (also called the male hormones).
Previous check-ups did not reveal anything suspicious. She always dreaded receiving her periods due to painful cramps. The first time she went to hospital she was told she had dysmenorrhea.
Dysmenorrhea means having painful periods. In fact, the World Health Organization estimates it to be the most important cause for chronic pelvic pain. About 45 to 93 per cent of women in the reproductive age, especially adolescents, experience this monster.
Three years later, the pain persisted. The irregular periods never played by the book. For a girl who never had acne as an adolescent, suddenly, it appeared at 19.
“Before I was diagnosed (with PCOS), I did an ultrasound, which revealed that my left ovary was inflamed with follicles,” she says.
“I am afraid that I may have a problem with conception, which I have talked to the doctor about. She told me when I am ready to have a baby, they will induce ovulation,” says the 24-year-old.
At the hospital, she was advised to always stick to a healthy diet. And that regulating her hormones may help.
Thirty-year-old Karen Maina, who did not wish to be named, was diagnosed with PCOS in 2014. But, before then, she had been to hospital in 2013 and her gynaecologist told her that she had hormonal imbalance. Karen, who had been having irregular periods, was put on pills ( called Yasmin) for about six months. “The pill worked for six months and my menses were regular,” says Karen.
When she stopped taking them, her previous condition came back in full swing. “I would go up to six or seven months without my periods. When they came, they would be really heavy and painful, and lasted for a month or even more,” she adds.
It is in 2014 that after seeking a second opinion from a different doctor that she was told she had PCOS. A year later, it did not go.
She went to another doctor who gave her a different type of medication from Yasmin to help balance her hormones. Again, the condition did not get any better.
In 2016, she sought another option, but this time, she was asked to go for a surgery. “I was told that I had fibroids. But, during the surgery, the doctor did not find any fibroids, so he took the opportunity to puncture my cysts without asking me,” she says.
Since then, she has been on and off the pill and maintaining a healthy diet. Unfortunately, her weight gain has been exponential. She says one pill costs her about Sh1, 200 which is not catered for by her insurance cover. “Immediately a girl starts menstruating, they should see a gynaecologist,” she advises.
Dr Bob Achila, a gynaecologist at Aga Khan University Hospital, says PCOS manifests itself differently in women. Whereas some people could be symptomatic, others who are asymptomatic may be diagnosed when they try conceiving.
He says clinicians ought to use the Rotterdam criteria to diagnose patients, advice that is also endorsed by the Endocrine Society. That criteria advises that two out of the three major symptoms (hyperandrogenism, irregular menses, and polycystic ovaries) should tell if one has PCOS.
“If you have delayed periods say by 35 days, or generally irregular periods, you need to get checked,” says Dr Achila. “Management of PCOS depends on the presentation of the patient, so the doctor has to focus on the complaint of the patient.”
Since there is no cure for PCOS, oral contraceptive pills can help manage the symptoms. “It is not one disease, it is a syndrome,” he says. “Since it is a disease complex, it may be hard to diagnose because it requires a specialised ultrasound to be able to look at the ovarian volume and count the number of cysts. It also requires hormonal tests.”
Hormonal tests cost about Sh6,000, which may be expensive, but the Rotterdam criteria could suffice.
Common symptoms include irregular periods, acne, thinning scalp hair and excess hair growth on the face and body
