By Elizabeth Sitotombe

IN many African societies, menstruation is a taboo subject, often hidden in silence and shame. This cultural silence extends to conditions like jeko (endometriosis), win which symptoms such as severe menstrual pain, heavy bleeding and infertility are dismissed as ‘normal’ or attributed to spiritual causes. Women suffering from endometriosis are frequently told to ‘endure the pain’ or ‘pray for healing’, leaving them without proper medical care. Jeko remains widely misunderstood and under-diagnosed in Africa, posing significant challenges to addressing it.

According to the Zimbabwe Society of Obstetricians and Gynaecologists (ZiSOG) jeko is a condition where endometrium tissue from the lining of the uterus forms and grows outside the uterus, often in the pelvic area, causing pain, inflammation and potentially affecting fertility. Unfortunately, there is not much locally published data regarding jeko according to the association. Jeko is a condition which affects 10 percent of women and girls of reproductive age, translating to one in 10 girls and women living with the condition according to the World Health Organisation (WHO). Approximately 176 million girls and women of reproductive age worldwide have endometriosis. On average, it takes seven to 10 years for a woman to receive a diagnosis of endometriosis, even in high-income countries. In low-income countries, the delay can even be longer due to limited access to healthcare and lack of awareness.

Many may never even know of their condition. But up to 50 percent of women with endometriosis experience infertility, making it one of the leading causes of female infertility worldwide. And yet, it is pretty much a common condition that many simply try to deal with. Dr Chenesai Chiriseri, a general practitioner, explains: “In many communities, women are taught from a young age not to talk about their periods. “When they experience pain, they are told its part of being a woman. This cultural mindset makes it difficult for women to seek help, and even when they do, healthcare providers may not take their symptoms seriously.”

found in the intestines. “In my village, people believed my pain was a curse,” says Shuvai, a 33-year-old endometriosis patient from Masvingo. “I consulted traditional healers, mapostori and spent years taking herbal remedies before I finally saw a doctor when l moved to the UK. By then, the disease had already affected my ability to have children.” “Growing up, I was told that pain during my period was normal,” shared 28-year-old, Makanaka, another endometriosis patient. “It wasn’t until I collapsed at work and was rushed to hospital that I learned about endometriosis. We need to break the silence and start talking openly about these issues.” For women like Makanaka and Shuvai, the journey is deeply personal.

“I don’t want other women to go through what I went through,” said Makanaka. “By speaking out and sharing our stories, we can create a future where no woman has to suffer in silence.” With endometriosis, endometrial glands or tissues are deposited outside the uterus. They can be found anywhere around the abdomen. They can be in the ovaries, around the tubes or even be According to a specialist obstetrician and gynaecologist, Dr Tawanda Matsa: “Each time a woman goes on her menses, those areas will also produce blood, causing severe pain during periods. “The condition can either be mild, moderate or severe.

In severe form, one has continuous pain.” One can also develop cysts, also called chocolate cysts, in the ovaries. Another presentation of endometriosis is sub-fertility, with 30-50 percent of the women being sub-fertile or infertile. Most people with endometriosis struggle to conceive because of the endometrial tissues which can be found around the ovaries, disturbing ovulation and blocking the tubes “In terms of how common this condition is, we come across it many times,” says Dr Matsa.

“In women with sub-fertility, the prevalence is above 50 percent.” “Many women come to us after years of pain, having been told that their symptoms are just ‘normal period pains’. This delay in diagnosis can lead to severe complications, including infertility and mental health challenges. “Generally, the diagnosis is made by either harvesting endometrial tissues, or through a diagnostic laparoscopy. “This is a minor operation where surgeons look at the uterus, the ovaries, tubes, intestines and everywhere in the pelvis. “They can find either chocolate cysts or brownish deposits around the pelvic structures.” There is no direct treatment for the condition, but interventions to help ease the pain, as well as help improve fertility. Usually, the first treatments for endometriosis, after pain relievers, are hormone injections which temporarily shut down the body’s production of estrogen.

This is the hormone that causes endometriosis tissue to grow and cause pain. Another one of the treatments involves burning the endometrial tissue during the laparoscopy or keyhole surgery. A laparoscopy is a surgical procedure that allows a surgeon to access the inside of the abdomen and pelvis without having to make large incisions on the skin. The advantages of this procedure are that the diagnosis can be confirmed and treatment carried out simultaneously. No-one knows exactly what causes jeko but there are a few theories as to what may cause it, such as genetics. However, it seems to affect some families more often than others, making a genetic link very likely. Poverty also exacerbates the challenges of living with jeko.

Women in low-income households often prioritise their families’ needs over their own health, delaying or foregoing medical care. Hellen (40) suspects her daughter might have jeko: “She has not yet been diagnosed, but I suspect my 14-year-old daughter may have this endometriosis according to an article l read in your publication. “My daughter does not go to school during her menses. She always feels nauseous and vomits sometimes. She will be in so much pain, sweating profusely sometimes. “Each time we go to the local clinic, we are given pain medication, paracetamol, which does not seem to help much. We have since been referred to a larger hospital. But l know it will require tests and the like.

We cannot afford that at the moment. We have many mouths to feed on a very low income in our home.” However, in Zimbabwe, the fight against jeko is gaining momentum as local advocacy groups, healthcare professionals and affected women work tirelessly to raise awareness, improve diagnosis, as well as provide support to those living with the condition. Despite the challenges of limited resources and cultural stigma, the movement is making strides in breaking the silence surrounding this misunderstood disease. One such group is the Endometriosis Association of Zimbabwe (EAZ), which helps women with this condition.

According to its chairperson, Vimbai Mudanwa, the association seeks to raise awareness of the disease, provide affordable treatments as well as psychological support to the affected. “Endometriosis is often referred to as a ‘silent disease’ because its symptoms, such as severe pelvic pain, heavy menstrual bleeding and infertility, are frequently dismissed or misdiagnosed,” says Mudanwa. “In Zimbabwe, where cultural taboos around menstruation and women’s health persist, many women suffer in silence “The main aim is to reduce the extent of suffering among girls and women living with the condition as there is no cure yet and the available treatments can prove to be expensive for many. Endometriosis is not just a medical issue; it’s a social issue.

Many women feel isolated and misunderstood. Through our association, we want to create a community where women can find solidarity and strength. We also want to push for policy changes that prioritise women’s health.” The association also provides a platform for women to share their stories, access information and advocate for better healthcare services. March was Endometriosis Awareness Month, a global initiative to raise awareness and understanding of endometriosis. This year it ran under the theme: ‘Let’s Talk Endo’. As part of the initiative to raise awareness, taking this test might be an eye-opener for those who do not understand the condition. Consider these five questions to find out if you have symptoms that could be related to endometriosis.

Do you experience frequent pain in your lower back or pelvic area before or during your period that interferes with your everyday activities?

Do you often have pain when you go to the toilet before or during your period? l Do you experience pain during sex?

Are your periods very heavy, or do you experience bleeding between your periods?

Do you experience significant fatigue that affects your ability to take part in your usual day-to-day activities?

Note: This is not a validated test for jeko and answers should not be taken as a diagnosis. If you answered ‘Yes’ to one or more of these questions, your symptoms may be related to jeko. Discuss your symptoms with your GP and ask for further investigation and possible treatment. If you answered ‘No’ to all of these questions but still have other symptoms or concerns, it is still important to talk to your doctor or a trusted health professional about them.