Ten years ago, Kris, 40, started experiencing pains she could only describe as “debilitating.” They were so severe that an attack brought her to a physical standstill. Her legs stopped working, her body felt like it was frozen, and she stayed that way for hours, wherever the pain brought her—on the couch, the bed, or worse, the floor. At the start, Kris couldn’t pinpoint where the pain was coming from nor predict when it would come. But the more she experienced them, the more she realized a pattern—the symptoms came like clockwork, right at the same time as her period.
Difficult periods had always been the norm for Kris as soon as she started menstruating. “I always knew mine was more painful and heavier than others. But I just thought, ‘Oh, luck of the draw.’ Some girls have it easy and some don’t,” she says. But when she entered her 30s, the elevated, erratic pains were beginning to get in the way of her life.
Not everyone with endometriosis experiences symptoms, and the ones who do can feel an abnormal pelvic pain that can be mistakenly associated with a digestive problem.
One attack in particular was so bad, that her husband had to carry her to the emergency room, where she found it challenging to get more clarity about her symptoms. “They said, ‘Oh, maybe it’s just really painful premenstrual syndrome (PMS). You probably just have low pain tolerance,” she recounts. “As someone who’s had bad periods and has had to manage it all their life—you don’t want to hear that.” She was given an IV for the pain and sent home with a stomach-related diagnosis. “For two years, I had to live like that,” Kris says, remembering how all the emergency room visits became routine. “The pain was a part of my life. I was just hoping it would go away.”
It wasn’t until a trip abroad that Kris’ mom suggested a checkup with a relative who was also an OB-GYN. She had a transvaginal ultrasound and for the very first time, Kris was given a name for her pain. “I think you have endometriosis,” the doctor said.
A Tough Pill to Swallow
Endometriosis happens when your reproductive system grows tissue where it shouldn’t. It’s described by the Mayo Clinic as an “often-painful condition in which tissue that is similar to the inner lining of the uterus grows outside the uterus.” It’s also more common than we think. In the Philippine General Hospital’s Department of Obstetrics and Gynecology’s annual census, endometriosis consistently comprises 15 to 20 percent of yearly consults.
Still, historically, it’s difficult to diagnose, because not everyone with endometriosis experiences symptoms, and the ones who do feel an abnormal pelvic pain that can be mistakenly associated with a digestive problem. “For many women, the journey to endometriosis diagnosis is long and fraught with barriers and misdiagnoses,” says a 2019 article published in the American Journal of Obstetrics and Gynecology. Making matters more complex, the condition has no exact cause.
After Kris was diagnosed with endometriosis, her next step was managing the symptoms that came with it, especially the pain. Her doctor suggested taking oral contraceptive pills, and “it changed my life,” Kris says. “Finally, I was pain-free. I was so, so happy.”
Approximately 4.5 million Filipinas live with PCOS. More often than not, the women diagnosed with the condition are advised to just take the pill or to lose weight.
Jam, 33, also remembers a time when pain would take control of her days. When she was still in university, she traded hours that should have been spent in class in exchange for time curled up on the couch, riding out the inevitable pain that came with her period. But with so many of her peers experiencing varying degrees of period-related pain, it never occurred to her to get herself checked. “I just thought it was a part of it,” she says.
When she was in her mid-20s, she visited an OB-GYN. “The doctor told me that I had something called PCOS [Polycystic Ovary Syndrome],” Jam says. “She didn’t really elaborate on it. She just told me that the immediate solution would be to take birth control pills to help manage it. Since there were no other resources, I took her advice at face value.”
According to a 2020 study on PCOS in the Philippines funded by the UK Research and Innovation, “PCOS results from a hormonal imbalance that can lead to infertility, disordered menstrual cycle, masculinization, and weight gain.” The same study shares that approximately 4.5 million Filipinas live with PCOS. More often than not, the women diagnosed with the condition are advised just to take the pill or lose weight.
Taking the pill does not cure endometriosis. It just masks the pain. But the tissue is still growing inside the woman’s body and it has to be taken out.
But with more access to information, there’s an ongoing shift among Filipinas wanting to gain more understanding about their own reproductive health issues. “I think the noticeable shift began in 2020 during the pandemic,” says Audee Sunga-Berces, RND, a registered dietitian and nutrition coach who developed a PCOS Reversal Program that’s helped over 500 women as of writing. “The rise of TikTok led women to start sharing their own experiences with PCOS.”
PCOS as a condition isn’t new, “but it was largely misunderstood because of the lack of information online and because it wasn’t being talked about enough,” says Sunga-Berces. “It was just known as a condition that can be managed with weight loss and birth control pills, and women settled with this [information] even though they had plenty of unanswered questions.”
Jam was on the pill for close to two years, but her experience with it led her to a desire to try something else. “The biggest impact of taking the pill was on my mood,” she says. “It would give me a lot of anxiety. It was messing up with my mood, and how I interacted with people as well. It got to a point where I needed a different solution because it just wasn’t sustainable.”
On the pill for a year, Kris was able to get her life back again. But a serendipitous encounter with a friend brought her to an endometriosis specialist based in Brazil. “The doctor basically gave me a come-to-Jesus moment. He said, ‘Taking the pill does not cure endometriosis. It just masks the pain. But it [the tissue] is still growing inside of you, and we have to take it out.’”
Getting to the Root of It All
Menstrual irregularities are among the top concerns Filipinas have regarding their reproductive health, says Kristine Ann O. Canseco, MD, a fellow with the Philippine Obstetrics and Gynecologic Society. Other key issues include access and knowledge about contraception, and vaginal infections including sexually transmitted infections.
The uptick in period-related issues—from endometriosis to PCOS to dysmenorrhea—is three-fold. First, there’s more information available now compared to a decade or so ago, meaning patients are able to identify that they need help and doctors are able to diagnose them. Second, genetics play a part. Says Canseco, “Women with first-degree relatives diagnosed with PCOS and endometriosis are highly likely to have the disorder, too.”
Finally, our lifestyles and the elements we are being exposed to are increasing our risk. “This includes changes in lifestyle and diet, weight gain, and increasing exposure to hormone or endocrine disruptors present in our everyday food intake, cosmetics, cleaning products, and other environmental toxins,” says Canseco.
It’s easy to get overwhelmed about what or what not to do when it comes to managing or treating menstrual irregularities and pain. Experts agree that there isn’t just one way to go about it, but the road to getting better begins with empowering yourself with information and knowing that there’s nothing normal about your pain. “Majority of my patients now have looked up their symptoms online prior to their first clinic consult,” says Canseco. “Patients experiencing signs and symptoms that 10 years ago were thought of as ‘normal,’ like painful menstruation or irregular menstrual cycles, are seeking help.”
“My approach to PCOS and women’s nutrition… is not just about getting the weight down. It’s also addressing the symptoms that are making your daily life difficult, and repairing the compromised relationship you have with your body and food from years and years of fad dieting.”Audee Sunga-Berces, RND
The next step is finding support and fueling the process with a lot of patience. “The path toward health transformation can be a long one, but getting help from the right set of medical professionals will make it a lot easier than dealing with it alone,” says Sunga-Berces. “Having the right approach and mindset is crucial before starting the journey.”
Locked down during the pandemic, Jam saw an opportunity to “reset” her body without distractions. She came across a book—WomanCode by Alisa Vitti—that encouraged her to approach PCOS management and treatment more holistically. She ate more home-cooked food and didn’t let herself get bogged down by the list of things she shouldn’t be eating. “I wouldn’t say that I eliminated processed food completely, but it helped knowing where my food came from and how it was prepared,” she says. “It was a really good experience because now I don’t think of [having to eat] healthy food as a chore.” She also made it a point to be in bed between 9 to 10 p.m., getting better sleep. When Jam had a check-up in 2021, she found out she no longer had PCOS.
Then the world began adjusting to post-pandemic life, which meant having to spend more time outside of the house again, so Jam decided to go for another check-up. “I was kind of scared before having my tests done in 2023, but I’m still PCOS-free,” she says. “That proved to me that I just needed to make certain adjustments and commit to them. It’s different for every person, but I think the fact that I was able to integrate the changes into my life made it a lot easier for it to be sustainable and more long-term.”
This long-term outlook is also echoed by Sunga-Berces. “My approach to PCOS and women’s nutrition… is not just about getting the weight down,” she says. “It’s also addressing the symptoms that are making your daily life difficult, and repairing the compromised relationship you have with your body and food from years and years of fad dieting.”
In 2017, Kris was able to undergo surgery to remove the tissue caused by the endometriosis. “And then the pain just never came back,” she says. “I was like, ‘Holy shit. I’m finally in control of my life.’” She has been endo-free since. In 2020, she shared her journey for the first time in public through Instagram and was surprised by how many women (and men who had a woman in their life going through something similar) reached out. “The journey can be so isolating,” she says. “You feel alone because you have no idea what’s going on. But knowing what I had, even before the surgery, I already felt a lot better. It validated me that the pain is real. I’m not making it up, I’m not exaggerating, and I’m not just finding excuses. And if there were more awareness about these conditions, people would be helping each other out.”
