Miracle Mom: Tansey Coetzee’s battle with endometriosis
Posted on 25 June 2019
Tansey Sodeinde is a seasoned model, dancer and beauty pageant titleholder
The former Miss South Africa has also placed in the top-five at Miss World and within the Top-15 at Miss Universe. But her crowning achievement, she says, has been winning the battle to become a mom.
“I have had extremely painful periods for as long as I can remember,” she says. “Cramping, vomiting, migraines, muscle tension, excessive bleeding – it is debilitating. As a young professional dancer, I once passed out from the pain in my ballet exam and had to get back up and continue dancing. At high school, I would be in the sick room at least once a month. I had to rewrite one of my matric exam papers because the pain didn’t allow me to complete it.”
Even at that young age, Tansey felt something was wrong. “When I was a teenager, we were told I was anaemic. We just assumed that was why I suffered so much every month.”
It was only when she and her husband, Kolapo, tried and failed to have a baby that they realised something more serious was wrong. After 15 years of living with chronic pain, Tansey was diagnosed with stage four endometriosis by her gynaecologist, Dr Andre van der Westhuizen at Mediclinic Morningside.
Endometriosis: what is it?
Endometriosis is a disease of menstruation that affects an estimated 200 million women worldwide, according to research collected by the Endometriosis Foundation of America. Because of the nature of the symptoms, however, many women go undiagnosed for years.
“The uterus has three layers, which together form the uterine wall,” explains Dr Van Der Westhuizen. “The innermost layer is known as the endometrium. Usually, this is the tissue that is shed in the course of a normal period. And for most women, this is the only area in the body where this tissue occurs.”
Endometriosis is a condition in which this endometrial tissue grows anywhere outside of the uterus, often in the pelvis, the ovaries and the fallopian tubes. When it occurs outside of the uterus, these pockets of tissue are known as implants. Just like in the endometrium, this displaced endometrial tissue continues to develop as it should, thickening, breaking down and bleeding with each menstrual cycle – but outside the uterus, this shed tissue has nowhere to go.
Trapped in place, it can lead to chronic inflammation, scarring and cysts known as endometriomas. In severe cases, endometriosis can cause abnormal bands of fibrous tissue, known as adhesions, that can cause pelvic tissues and organs to stick to each other.
While doctors are undecided on how and why this abnormal growth develops, one thing that unites all endometriosis sufferers is dysmenorrhea. “That’s a nice name for severe soreness, before and during menstruation,” says Dr Van Der Westhuizen. “People with endometriosis do not experience typical or expected period-related discomfort – this is unusual, chronic and severe.”
Another common symptom of endometriosis: impaired fertility. Adhesions can block the fallopian tubes or uterus, making it difficult for the sperm to meet the egg, and endometrial tissue on the ovaries can inhibit ovulation, preventing the release of an egg. Inflammation caused by displaced, discarded tissue can also lead to the production of chemicals known as cytokines, which inhibit sperm and egg cells, making fertilisation more difficult. Estimates from the US suggest that up to half of women with the condition will have difficulty becoming pregnant.
Tansey and Kolapo tried for almost two years and when they were unsuccessful they approached Dr Van Der Westhuizen for advice. A laparoscopy confirmed the severity of her case.
Stage four endometriosis usually refers to the presence of multiple, deeply embedded pockets of endometrial tissue implants, large endometriomas on at least one ovary and many dense adhesions throughout the pelvic region.
Tansey’s late diagnosis is not uncommon, says Dr Van Der Westhuizen. “For doctors, chronic pelvic pain, severe dysmenorrhea and impaired fertility are all red lights pointing to endometriosis. But if you’ve had painful periods your whole life, it can be difficult to know it is unusual or that it warrants looking at.”
Her diagnosis was an emotional moment, Tansey says. “I cried at first. It was a relief to know that there are treatments available, but at the same time I have seen a few of my friends go through this and all the pain their bodies endured scared me. I have always been afraid of needles and operations so realising I had to go through all that frightened me. But I would have done anything to be a mom and that is what got me through it.”
Falling pregnant: what are your options?
Patients have multiple medical and surgical management options, says Dr Van Der Westhuizen, and a recommended course of action will be determined by the severity of the case. “Endometriosis can be effectively managed through various means,” he says, “but there is no blanket, one-size-fits-all approach. We are guided by our patient’s needs.”
Over-the-counter pain relief medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and ibuprofen, may be prescribed to help some sufferers to deal with severe menstrual cramps. Others may require surgical intervention.
For years, it was fairly common practice for doctors to recommend their patients have a hysterectomy to remove the uterus and ovaries entirely. Today, experts prefer to focus on surgically removing endometrial tissue.
After her diagnosis, Tansey decided to undergo a second surgery.
Conservative laparoscopic surgery is a minimally invasive procedure in which a surgeon will make small incisions in the abdomen and use them to insert two instruments: one to view the area, and another to remove problematic scarring, cysts and adhesions.
But for a woman with endometriosis who wants to start a family, removing endometrial tissue is just the beginning. “Immediately after surgery we opted for artificial insemination,” says Tansey, “but it didn’t work. I think I was just emotionally, physically and mentally drained after the diagnosis, two surgeries, and a failed first attempt. We waited a few weeks and tried artificial insemination again but this time I didn’t complete the treatment because I just knew it wasn’t going to work.”
That was when she discovered Vitalab. Vitalab is a comprehensive solutions-based clinic situated a short distance from Mediclinic Morningside that provides a range of fertility treatments. Tansey met Dr Chris Venter, a gynaecologist and obstetrician with a special interest in the effect of endometriosis on pregnancy, who recommended she begin the process of in vitro fertilisation (IVF).
IVF is a multi-stage process that can take weeks to complete, and there is no guarantee of success.
First, a patient is injected with synthetic hormones to stimulate the
ovaries to produce multiple eggs. You may require further medication to help those eggs mature, prevent premature ovulation, and heal and prepare the lining of the uterus for implantation.
“The first step was really to ensure we had a healthy environment for the baby,” Tansey explains. “Dr Venter described my womb as sick, due to the effects of the endometriosis. The initial treatments took a toll on my body and mind: my tummy was blue and swollen from all the injections.”
Mature eggs are then retrieved by transvaginal ultrasound aspiration, which involves inserting a thin needle into the ovarian follicles. These eggs are then placed in a nutritive liquid and incubated. Eggs that appear healthy and likely to succeed will be mixed with your partner’s sperm sample in an attempt to create embryos. A workable embryo will then be transferred into the uterus, via a catheter through the cervix.
It is estimated that the live-birth IVF success rate for women under the age of 35 who start an IVF cycle is just 40%, but Tansey hit the jackpot with her first try. “We know we are extremely blessed to have the treatment work the first time,” she says. “It felt so good to be pregnant at last.”
Overcoming endometriosis: lessons learned
Tansey describes her delivery as beautiful: “22 March 2018 was the best day of my life. I couldn’t sleep, the excitement was too much. I was up at 3:30am to be at the hospital at
5am, ready for my delivery by Caesarean section. We got to the hospital on a cold autumn morning and were surprised to find my pastors from Ridgecrest Family Church waiting for me. I felt good but I was a little nervous about the delivery, mostly because the process was still new to me.”
The delivery was managed by Dr Reinette Rossouw and Dr René Janse Van Rensburg at Mediclinic Sandton. While Tansey says she knew she was in good hands, there was one final hurdle to overcome: scarring and other uterine damage made the act of getting the baby out rather tricky.
Once little Peyton was in her mother’s arms, however, all of that was forgotten. “That was the longest hour of my life, but when it was over and I was with her, I couldn’t stop smiling. I will always have a special place in my heart for the doctors and nurses whom I met on my journey to motherhood. I am so grateful for their knowledge, care and support.”
It is crucial that women are encouraged to understand their menstrual cycles as early as possible, says Dr Van Der Westhuizen. “The difference between normal, period-related discomfort and dysmenorrhea is degrees of pain. How do you describe your own pain?”
He says some of his patients describe pain that makes it impossible to get up out of bed in the morning. “Objectively I can tell you that is unusual and warrants an urgent check-up. But for them, this is something they’ve experienced for years, and it has become normal. We have to give young girls the language they need to say, this is not normal.”
If you have continuous lower abdominal pain or severe periods, Dr Van Der Westhuizen suggests seeing a gynaecologist. “A proper diagnosis is key. Listening to a person’s medical history, in my opinion, may not give the full picture of the scale or extent of the issue. A laparoscopy allows us to define the condition, measure how far it has developed, and treat it if necessary.”
There is hope on the horizon: a new drug known as elagolix, designed specifically for the treatment of endometriosis pain, has recently been approved for commercial use by the US Food and Drug Administration.
Today, Tansey is focused on the future of her new family. “I lived in silence for so long. Now I get to not only share my story but also bring hope to other women in similar positions. Peyton is here, she’s healthy. She’s happy. I will never take for granted what a privilege it is to be a mom.”
Who is at risk of endometriosis?
The condition is more common
in women who:
▶ Have periods longer than 7 days
▶ Have cycles shorter than 28 days
▶ Started their period before
▶ Have a mother or sister who has endometriosis
8 common symptoms of endometriosis
▶ Severe cramps
▶ Long periods
▶ Heavy menstrual flow
▶ Bowel and urinary disorders
▶ Nausea and/or vomiting
▶ Pain during sexual activities
▶ Chronic fatigue
Do you have endometriosis?
Track your symptoms to help your doctor diagnose your condition:
▶ When the pain occurs
▶ How severe it is
▶ How long it lasts
▶ A change or worsening of pain
▶ Pain that limits your activities
▶ Pain during sex, bowel movements, or urination