Endometriosis affects women of all ages. Sadly, it is often underdiagnosed and undertreated, while sometimes it is also misdiagnosed and therefore mistreated.
Endometriosis occurs when the cells which contribute to the lining of the womb (the endometrium), are found in abnormal places outside the womb. These abnormal places are called the endometriosis sites, and they commonly occur between the womb and the bowel, near the bladder or near the ovaries. (They can be found at more distant sites as well, but this is much more unusual.)
Endometriosis can cause pain in the pelvis, sometimes quite severe, and this can become worse during menstrual periods. One of the main complications associated with endometriosis is difficulty getting pregnant.
We do not yet fully understand what causes endometriosis, although there are a range of factors that we think are involved. There is currently no cure for endometriosis, but there are treatments available that can help relieve your symptoms. These include giving hormones to counteract the growth of the endometriosis cells, or surgery to cut or laser away the areas of endometriosis.
The only way to accurately diagnosed endometriosis is by performing an operation called a diagnostic laparoscopy: keyhole surgery. It is carried out under general anesthetic, and a small fibre-optic cable is placed through the wall of the tummy near the belly button to allow us to inspect the inside of the abdomen and pelvis. This is done as a day case procedure, meaning you will be able to go home the same day.
Sometimes when we are investigating whether you have endometriosis, depending on the surgical risk, we would actually recommend being treated medically as first line management, to see if people improve without needing surgery. If their signs and symptoms improve with hormones and or medication, there is then no need to put them through the risks of surgery. This approach will need a minimum of three months to see if the symptoms begin to improve. I would then see you at a follow up of six months to assess things and to determine if this approach is relieving your symptoms sufficiently. Medication options include painkillers, hormone medicines and contraceptives, and these options will be discussed thoroughly with you in advance to ensure you have all the information you need to make an informed decision about your treatment.
Should there be no improvement using medication, we would then move on to the next stage of management, which would be surgery. I find that it is always helpful to have alternative plans in case the first approach doesn’t work or isn’t as effective as you’d like. This can be so helpful to people, knowing that if one thing doesn’t work, there are alternative options available to them.
Surgery aims to remove as much of the endometriosis as possible while leaving the uterus and ovaries intact and minimizing injury to surrounding organs. This surgery can often help to relieve the pain associated with endometriosis, although you should be aware that both the endometriosis and its symptoms may return in the future. Surgery may involve offering you removal of your ovaries or your womb or maybe both, but this is individualized and is dependent on your family status and age.
Recovery depends on the severity and the location of the endometriosis. Most people usually need two weeks off work as a minimum, and I would expect them to have fully recovered by 4-6 weeks. However, if there was extensive endometriosis or there were endometriotic cysts, the surgery would have been more challenging and taken longer. This longer surgery is reflected in a longer healing process, which can be 6-8 weeks.
Endometriosis is a long-term condition and can be challenging and frustrating to live with. From abdominal and pelvic pain, especially during menstrual periods, through to fertility problems, it can have a real impact on quality of life.
If you are struggling with endometriosis, it is really important that you are under the supervision of a clinician who has an interest in endometriosis and chronic pelvic pain. They will be able to ensure your treatment is tailored to your specific needs. When I see you at Circle, I would want to investigate a whole array of symptoms, ranging from your menstrual cycle through to what pain you experience during your menstrual cycle and whether you have pain relating to other structures, which may be in the pelvis such as the bladder or the bowel.
I am very much an advocate of patient-centered care and believe that patients should be involved from the start of the process through to the finish of treatment. Rather than carrying out ‘tick box’ exercises to fit standard treatment pathways, I believe that treatment should be focused around what suits you best within your lifestyle choices. I am very keen for patients to make decisions about what they need, as long as it's within the realms of clinical safety.
To book a consultation with me, please contact Circle. You will be able to choose a date and time convenient to you, and I will work closely with you to help treat your endometriosis effectively and to get you out of pain.