Endometriosis Q&A

Ask the Consultant

Endometriosis is a condition where cells of the uterine lining are found outside the womb. We asked three of our leading women's health consultants about this common condition.

Mrs Kavita Goswami
Symptoms can vary, as can the severity of the symptoms.

Typically a patient suffering from endometriosis will experience some or all of the following:

  • Pelvic pain, which can sometimes be confused with colorectal and bladder problems
  • Pain during intercourse
  • Painful periods
  • Heavy irregular periods
  • Infertility

The intensity and the frequency of the symptoms can be variable.

Mr Alvan Priddy
Painful periods, heavy and irregular periods, pelvic pain (usually cyclical), pain on intercourse, difficulty in conceiving, low back pain, cyclical pain on opening bowels, cyclical pain/bleeding on passing urine, rarely cyclical coughing of blood, scar pain/bleeding. Also fatigue.

Mr Andrew Baxter
Painful periods, pain with intercourse, pain with a full bladder/bowel, infertility, fatigue.

Mrs Kavita Goswami
Typically sufferers will be women in the reproductive age group, particularly older women who have not had children and even more likely in women with genetic predisposition i.e. family history.

Mr Alvan Priddy
Endometriosis is one of the commonest gynaecological conditions.

The peak incidence is in women 30-45 years old.

However it can occur at any age including in teenagers. It is uncommon after the menopause.

Mr Andrew Baxter
This condition can affect any age group from teenage years onwards.

Mrs Kavita Goswami
No one knows the exact causes of the condition but there are a few theories:

  1. Retrograde menstruation/implantation
    This is when the lining of the womb flows back through the fallopian tubes and into the abdomen and grows within the pelvis.
  2. Coelomic metaplasia
    This theory believes that the cells within the menstrual flow have the ability to change and transform into endometrial cells.
  3. Immunological factors
    This is where the immune system is unable to stop the build-up of endometriosis.
  4. Spread of cells
    Endometrial cells could get into the bloodstream or lymphatic system and build up on organs and cause painful symptoms.

Mr Alvan Priddy
The exact cause is not known.

The cause is likely to be due to an interplay between several factors.

These include retrograde menstruation (where some cells from the womb lining spill backwards along the fallopian tubes at the time of menstruation), genetic (as it is more common in families), lymphatic or circulatory spread (to distant sites such as the lung, kidney), auto-immune factors (where the immune system is not able to fight off endometriosis), metaplasia (where in the womb one type of cell changes to a different kind of cell and then some adult cells retain the ability to transform into endometriotic cells).

Mr Andrew Baxter
We still do not know.

It is likely to be due to a combination of genetic and environmental factors.

Mrs Kavita Goswami
Usually a clinical diagnosis would be made by either a GP or a gynaecologist and you would then be referred on for further treatment.

An ultrasound scan of the pelvis is also used to support the diagnosis.

To confirm the diagnosis the gold standard of treatment is a laparoscopy.

This is usually a day case procedure when the patient has a general anaesthetic and through a small insertion in the abdomen a small camera is passed so the consultant can view the endometrial tissue, allowing for small samples to be taken if required.

Mr Alvan Priddy
The only definite way to diagnose endometriosis is by a laparoscopy.

This is an operation in which a telescope is inserted into the pelvis via a small cut near the navel and the surgeon uses a camera to look for endometriosis.

If an ovarian cyst (endometrioma) is present it can be detected by ultrasound or MRI scan.

A blood test (CA125) can be raised in endometriosis, but this is not specific to this condition alone and therefore is not very useful.

Mr Andrew Baxter
A patient's history, along with an examination is often highly diagnostic.

An ultrasound scan can see associated ovarian cysts, but the only absolute diagnostic test is a laparoscopy (keyhole procedure) with biopsy of any suspected lesions.

Mrs Kavita Goswami
Non-surgical treatments can be split into two categories:

  1. Non-Hormonal
    This is where the symptoms of the condition are treated through the use of painkillers such as ibuprofen.

    This helps with the inflammation caused by the condition and helps ease the pain and discomfort.
  2. Hormonal
    Certain hormonal treatments can be used to lower the amount of oestrogen the body produces which causes the endometrial tissue to grow.

    This will then help ease the symptoms.

    Typical treatments include the combined pill, mini-pill, mirena coil and GnRH analogues.

    The latter causes a temporary medical menopause.

Mr Alvan Priddy
There are several medical treatments available for endometriosis.

These include painkillers e.g. for painful periods, such as paracetamol, ibuprofen, diclofenac and codeine.

Also hormone treatment e.g. progestogens (tablet or injection) which reduce the oestrogen effect on the endometriosis deposits which cause them to shrink and resolve, the oral contraceptive pill given continuously for at least 6 months, the Mirena coil which contains the progestogen levonorgestrel and makes the lining of the uterus thinner greatly reducing and even abolishing periods for up to 5 years.

GnRH analogues which block the pituitary gland from releasing gonadotrophins and reduces the oestrogen made in the ovary so that periods stop for 6 months.

Other hormonal drugs such as the synthetic androgens danazol, gestrinone can be used to treat endometriosis but are rarely given due to their side effects.

Mr Andrew Baxter
Pain killers may be sufficient.

If not, there are a variety of hormonal treatments which tend to be all equally effective.

All of these can have side-effects which can in fact determine the most suitable treatment for a woman.

Mrs Kavita Goswami
Dependent on the severity of the symptoms the surgery can be minimally invasive which may be day case surgery to invasive surgery which involves a hospital stay of 2 to 3 nights.

Minimally invasive surgery focuses on laparoscopic techniques which remove endometriotic lesions, cysts and adhesions.

If the symptoms are more severe, removal of the respective fallopian tube or ovary may be considered.

If the patient has already had children then the invasive end of the surgical options is a hysterectomy, where the womb and ovaries are removed.

Mr Alvan Priddy
A laparoscopy is done under general anaesthetic to diagnose and treat endometriosis.

Endometriosis deposits can be excised or ablated (with diathermy or laser), ovarian cysts can be removed, and adhesions (scar tissue) released to improve both pain and fertility.

Some patients with very severe endometriosis will need a laparotomy (a larger incision on the abdomen) and surgery performed jointly by the gynaecologist and a bowel surgeon or bladder surgeon (urologist).

In some patients who have severe recurrent endometriosis and their family is complete, will need a hysterectomy.

The surgery for endometriosis can be technically difficult and should be done by an experienced gynaecologist to give the best results and outcome.

Mr Andrew Baxter
Surgery is laparoscopic, where a small camera is inserted into the abdomen through the tummy button under general anaesthetic.

2-3 smaller incisions are made in the lower abdomen.

Endometriotic deposits are either cut away of ablated.

In more advanced cases, surgery on the ovaries, bowel and /or bladder may be necessary.

Mrs Kavita Goswami
The time to full recovery has an individual variation and is also dependent on the type of surgery performed.

For minimally invasive procedures, patients should expect to recover and be able to return to work and normal activities within two weeks.

For more invasive surgery the recovery is longer and could take up to six to seven weeks.

Mr Alvan Priddy
After a general anaesthetic a patient can feel groggy and nauseous.

A tube is inserted into the throat to help breathing during the laparoscopy so afterwards the throat may feel sore.

Gas (carbon dioxide) is used to distend the abdomen at laparoscopy and although removed at the end of the operation, excess gas can cause some discomfort.

There may be some vaginal bleeding. Most people feel some discomfort following the laparoscopy. All these symptoms are treated with medication. For the first couple of days patients need to rest and allow their body to recover from the procedure. Gently moving around will help excess gas to leave the body.

It is normal to feel weak and tired and it can take up to 14 days to recover from significant laparoscopic surgery.

Due to the stiches, patients should be careful bending, stretching and washing. Normally the stiches will dissolve and will be hidden under the skin (subcutaneous).

It is not unusual to feel emotional ups and downs following surgery.

This will pass over time and it is important for a patient to give themselves time to recover physically and emotionally.

An experienced nurse and doctor will be sensitive to all these issues and help ensure their patient makes a good recovery.

Mr Andrew Baxter
Surgery is generally a day-case procedure.

Some women experience shoulder pain due to the gas used at the laparoscopy; this disappears in 24-36hrs.Women should expect a return to full activities in 10-14 days.

Mrs Kavita Goswami
The condition can be managed but not cured.

Non-surgical and minimally invasive surgery will help with the management of the symptoms.

But even following surgery where the endometrial tissue is removed there is a possibility of recurrence over time.

Unfortunately the most invasive option is the more likely to give a lasting effect, which is the hysterectomy with the removal of the fallopian tubes and ovaries.

Mr Alvan Priddy
There is no permanent cure for endometriosis.

However it can be treated with good relief of symptoms and improvement of fertility.

Endometriosis can recur in about 50% of cases.

Mr Andrew Baxter
Endometriosis has a recurrence risk of 20-50% over the years so often continued hormone suppression and/or repeat surgery can be required.

Mrs Kavita Goswami
When looking for a Gynaecological Consultant to treat endometriosis a patient should look for someone who has experience and understands the condition.

Endometriosis treatment is not a one-fits-all solution and the consultant should be able to offer a spectrum of treatments tailored to the patients' needs.

The consultant should be able to listen to the patients symptoms and devise an individual treatment plan that suits them.

Mr Alvan Priddy
Patients should look for an experienced gynaecologist who sees patients with endometriosis regularly.

Some of the subtle signs of endometriosis can be missed at Laparoscopy if this is not done carefully and meticulously.

Also the gynaecologist should have the skills to treat endometriosis (and ovarian cysts) using the Laparoscope, giving the advantage of keyhole surgery which is more cosmetic, less painful and allows earlier return to normal activities.

The treatment of each patient needs to be individualised taking into account her age, fertility, severity of symptoms and extent of the disease.

It is important that the gynaecologist takes all these factors into consideration and after discussion with the patient, arranges the appropriate treatment.

Mr Andrew Baxter
A specialist should offer all medical and surgical options to a patient with endometriosis.

A patient with endometriosis undergoing a laparoscopy should ensure that their surgeon can treat all stages of the condition to prevent any unnecessary second procedures.

Mrs Kavita Goswami
I have been a Consultant Obstetrician and Gynaecologist at University Hospitals Coventry and Warwickshire for 14 years.

I have vast experience in dealing with a diversity of gynaecological conditions and am able to offer most gynaecology operations.

I helped set up the Pelvic Floor Clinic at the hospital to treat women with urinary incontinence and pelvic floor issues.

In addition I specialise in menstrual disorders, outpatient procedures and undertake my own gynaecology scans.

Other than clinical work I am keenly involved in teaching and lead the postgraduate Obs & Gynae teaching in the department.

Mr Alvan Priddy
Obtaining Honours in obstetrics and gynaecology at medical school.

Being awarded the Young MRCOG award for my research.

My MD thesis and becoming a Fellow of the Royal College of Obstetricians and Gynaecologists.

Having many publications, papers and presentations in the UK and abroad.

Teaching students and trainees, especially in laparoscopic surgery.

Becoming a senior consultant and having the respect of my colleagues.

Giving excellent care to my patients and seeing them get better after treatment.

Mr Andrew Baxter
Since becoming a Consultant in 2002 I have helped develop the laparoscopic surgery services in Sheffield.

As Lead for the planned Sheffield Endometriosis Centre I am responsible for the management of women with the most severe forms of this debilitating condition.

Seeing the improvement in quality of life in women after such surgery is one of the most rewarding aspects of my job.

  • Man Men's Health Discover engaging articles dedicated to male health. This includes advice, trends and interviews with our top male health Consultants.
  • Woman Women's Health Stay on top of your health with our tips, advice and Q&A’s with leading women’s health Consultants.
  • Runners Health and Wellbeing Get inspired for a healthier you. Find the latest in healthy living and fitness tips, as well as our medical and treatment updates.
  • Man Men's Health Discover engaging articles dedicated to male health. This includes advice, trends and interviews with our top male health Consultants.
  • Woman Women's Health Stay on top of your health with our tips, advice and Q&A’s with leading women’s health Consultants.
  • Runner Health and Wellbeing Get inspired for a healthier you. Find the latest in healthy living and fitness tips, as well as our medical and treatment updates.