Mrs Z has experienced severe menstrual pain since her teenage years, often causing her to miss school and later, work on the family farm. Over the years, the pain has worsened, extending beyond her menstrual cycle to almost daily discomfort, particularly in her lower abdomen and back. She frequently experiences fatigue and struggles with painful intercourse, which has strained her marriage.

Mrs Z visited the local clinic several times, but her symptoms were initially attributed to general menstrual cramps. Given the limited resources and knowledge of endometriosis in the region, it took years for her to receive a proper diagnosis. It wasn't until she travelled to a larger town, where a visiting gynaecologist held a clinic, that endometriosis was suspected. 

The gynaecologist conducted a pelvic exam and, suspecting endometriosis, referred Mrs Z to a hospital in the nearest city.

An abdominal ultrasound scan was done. While imaging confirmed the presence of cysts, definitive diagnosis required laparoscopic surgery, which was not available locally. The doctor explained that the condition likely involved her ovaries and pelvic lining, contributing to her chronic pain and fertility issues.

The gynaecologist prescribed pain management and hormonal therapy in form of hormonal IUD and progesterone pills to make her amenorrhoea and reduce symptoms. Even though there is limited access to endoscopy, diagnosis was based on the clinical history and ultrasound examination. Mrs Z was also advised on lifestyle modifications, including dietary changes to help manage inflammation.

While Mrs Z 's symptoms improved somewhat with medication. She continues to manage her symptoms as best as she can, balancing her treatment with the demands of her daily life. Her case highlights the challenges faced , where late diagnosis and limited access to specialised care in remote areas are common barriers to effective treatment.