How To Build A Singaporean Woman: Believe Her When She's In Pain

“How To Build A Singaporean Woman” is a Her World original docuseries which highlights the social and cultural issues that women in Singapore face, and asks: what does it mean to be a Singaporean woman today? In the second episode, “Believe Her When She’s In Pain”, Dr June Goh-Rin and endometriosis sufferer Bianca share their experiences around the physical, mental and emotional pain that women face during their periods, as well as the stigma and embarrassment women struggle with when it comes to discussing menstrual health openly.

The pain women face

Bianca’s periods became more painful during university. “I’m using a minimum of seven pads a day, on the toilet bowl for one whole hour. Obviously [when you’re going through something like this] you are just in pain the whole time,” she recalls.

How pain affects work life

Bianca recalls a manager putting her on the work roster despite her telling him she was on her period, only to be annoyed when she couldn’t make it – despite the issue stemming from him not taking her seriously. 

Dr June Goh-Rin, an anaesthesiologist who is also the past President of Singapore Council of Women’s Organisations and ASEAN Confederation of Women’s Organisations, concurs: “When you undergo menorrhagia [prolonged or excessive bleeding for seven or more days], there’s blood everywhere – you can’t [get someone to cover you while you’re using the toilet] every 2 hours, because that’s unprofessional.”

Part of the hesitance to speak up stems from a culture of shame. “There are some derogatory terms that really should be done away with,” says Dr Goh-Rin. “For example, ‘She’s always on MC, I don’t know whether her period pains are true’. And of course, ‘Oh, she’s so menopausal’. We should be feeling more empathy towards these women who are undergoing changes which are invisible to the people around them”.

Seeking medical help for pain

Bianca’s experience seeking help for period pains was fraught with challenges. 

Her first OBGYN found polyps, which are a projecting growth of tissue from a body surface, and she had to undergo a dilatation and curettage procedure. She was given birth control, which she took for a few years.

Bianca was told her endometrium (uterus) lining was more than double the thickness of others – which she googled and found could be a sign of endometriosis, a condition where the endometrial cells in the lining of your womb grow outside of where it’s supposed to be.

Bianca was hospitalised for a uterine and kidney infection, when she discovered she had 5-6 cm thick fibroids, non-cancerous growths in the muscle layer of her uterus. Doctors suggested removing the fibroids, as they could be the cause of the UTI and the procedure would prevent recurring kidney infections.

Her second gynaecologist initially dismissed her suspicions it was endometriosis – only to realise it was indeed endometriosis when during the surgery to remove the fibroids, her uterus was found to be stuck to her large intestine. 

Bianca believes she wasn’t taken seriously by gynaecologists about her endometriosis, despite it being a common issue – it affects 1 in 10 women. “One of the hallmarks of it is how people don't find out until 10, 20 years later from the beginning of their periods”, she noted, pointing out how long that time is compared to other health conditions. “That just means they don’t care enough”.

Seeing a knowledgeable specialist makes a difference – that said, there are only two endometriosis specialists in Singapore. Bianca recounts meeting Dr Ma Li, who runs the Endometriosis Clinic in NUH. 

From a physical examination and an ultrasound, Dr Ma Li could diagnose her. That was surprising for Bianca – other doctors had told her endometriosis could only be diagnosed through a laparoscopy, a surgical procedure to examine organs.

Getting rid of endometriosis requires surgical excision. Being referred to a colleague colorectal specialist, Bianca was told there was endometriosis in her rectum. That required the removal of a part of her rectum as well – a procedure that required her to live with a colostomy bag for at least three months. 

Raising awareness amongst medical practitioners

“When I said pushing awareness of all these women’s issues, I don’t just mean to the general public,” Dr Goh-Rin said. “I also mean to perhaps our general practitioners, polyclinics as well, because this is usually the first port of call.”

She highlights one common women’s health issue. “When you put your career first, infertility may become a problem. It comes with a whole gamut of issues, mentally and socially as well.” 

Awareness of women’s health issues

“My attitude back then was, I am suffering through this, I might as well educate everyone else about it too,” Bianca said. “I found out, especially during uni[versity], how sheltered men were. Something as simple as periods, people don’t talk about it enough – period pains, how come men don’t know about it enough?”

She notes how lack of awareness can impact those afflicted with health conditions: “You don’t know how to deal with it because you were never educated about it in the first place”.

Dr Goh-Rin concurs. “Even at my workplace, I don’t think I’ll be able to talk openly about it without my male colleagues cringing with embarrassment.” 

“When there’s more awareness of these changes women’s bodies are going through, then we’re not so likely to be self-conscious and will be more comfortable with ourselves.”

The invisibility of women’s issues

With how many of these women’s health conditions are invisible, awareness and empathy becomes paramount. 

“Menopause is a fairly invisible condition that carries with it a lot of mental, physical and physiological changes”, Dr Goh-Rin gives an example.

“People think of disability only as amputation, or when you’re in a wheelchair, very outward[ly visible] kind of thing,” Bianca adds.

Bianca makes a comparison. “If you were bleeding anywhere else, and you were constantly bleeding from it, you would want to take a break from life. And you should – why would you exempt people who have menstruation from that?”

Transcription and article: Saw Yone Yone