Endometriosis Q&A

 

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

Mrs Kavita Goswami
Endometriosis 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

Mr Christopher Mann
Endometriosis can affect women who are in the fertile period from the start of periods to menopause.

Mr Alvan Priddy
The exact cause is not known, however this is likely due to 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).

 

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 Christopher Mann

In terms of medical therapies, the most commonly used are the combined oral contraceptive pill, the progesterone only pill (the mini pill), low dose progesterone, or the coil. It should be noted that none of these therapies actually get rid of the disease. They simply reduce the severity of the symptoms in a proportion of, but not all, patients.

It’s also possible to use extremely powerful drugs that releasing hormone agonists, which induce a medical menopause. However, these are drugs with severe side-effect profiles and as such are only used for a very short time period. In fact, they are only licensed for a six month period. Again these drugs do not get rid of the disease, they simply make the symptoms less severe in a proportion of patients. Within six months of stopping any of the drugs mentioned above, the vast majority of patients will have found that their symptoms have returned.

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

It's not unusual to feel emotional ups and downs following surgery. This will pass over time and it's important for patients 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.

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

Mr Christopher Mann
Ideally patients should look for a consultant who has a particular interest in endometriosis and also has experience of a laparoscopic approach for excising the disease.

It's important that patients also approach consultants who ideally work in a team environment with input from general/bowel surgeons, urology surgeons, as well as pain management specialists and an experienced radiological consultant.

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