27 September 2017
It’s a painful statistic - one in ten women of reproductive age in the UK suffer from endometriosis. It can affect women from every social group and ethnicity. Those with the condition deal with a monthly cycle of pain, scarring and inflammation. Endometriosis can be a debilitating condition that has a profound effect on the quality of a woman’s life, causing untold misery and pain, over many years.
The presence and amount of endometriosis does not necessarily correlate with symptoms. Endometriosis afflicts women in different ways, with respect to how badly the pelvis is affected, the type and severity of symptoms, and the effect on general health and quality of life, which can make initial diagnosis difficult.
The impact of the condition on a woman’s normal life may mean she has to deal with:
- Chronic pain
- Heavy and painful periods
- Abnormal bleeding
- Painful bowel motions
- Pain when passing urine
- Difficulty in conceiving
- Fatigue/lack of energy/tiredness
- Pain or discomfort during intercourse
- Problems with sex life/relationships
- Employment issues and taking time off from commitments
With the right treatment, many of the above can be addressed, and the symptoms of endometriosis made more manageable.
There is often a delay between symptom onset and surgical diagnosis, and the symptom overlap may lead to the referral to non-gynaecological specialists in the first instance. This is because there is no simple test for endometriosis. The only way to make a definite diagnosis is by performing a small surgical operation known as laparoscopy.
Laparoscopy (a day-case telescope procedure under anaesthetic) is still the gold-standard diagnostic test when looking for evidence of all types and stages of endometriosis.
Treatment must be tailored for each woman individually, taking other factors such as age, response to previous treatment, and the desire for pregnancy into account.
One of the main complications of endometriosis is difficulty getting pregnant or not being able to get pregnant at all. This can have a deep psychological effect on an individual.
Medical treatment options
Initially painkillers, hormonal treatment, or alternative/complementary therapies may be suggested to treat the condition. The main symptom of endometriosis is pelvic pain - there are various pain relief and pain management options available including:
- Heat therapy
- Painkillers, such as Paracetamol and Non-steroidal inflammatory drugs
- Pain modifiers such as Gabapentin and Amytriptyline. These drugs work by tring to alter the way the body percepts pain. Some hospitals have specific pain management clinics where referrals can be made
- Transcutaneous Electrical Nerve Stimulator (TENS) machines
The following hormone treatment options are also available to women with endometriosis:
- Combined oral contraceptive pill
- Mirena coil
- GnRH analogues
Surgical treatment options
Surgical treatment options include both conservative and more radical surgery.
Conservative surgery includes excision or laser ablation done via key-hole surgery.
More complex surgery can be difficult and it is important to speak with an experienced surgeon who has expertise in this area. Radical surgery may include removing the ovaries or undergoing a hysterectomy usually by key-hole surgery.
Surgery to remove endometriosis tissue can help improve your chances of getting pregnant, although there's no guarantee that you will be able to get pregnant after treatment.
Surgical options should be discussed in detail with a Gynaecologist, such as Mr. Alex Swanton.
Endometriosis is not an easy topic for women to discuss with their GP because of society’s reluctance, in general, to discuss what was euphemistically known as “women’s troubles”. If you are suffering stop “just about coping” and discuss the issue with Alex Swanton at Spire Dunedin Hospital.
About the consultant
Mr Alex Swanton
MBBS, MD, FRCOG
Consultant Alex Swanton graduated from University College London and completed his postgraduate training in the Oxford Deanery.
He has over 12 years of IVF experience both in practice and research. His MD thesis studied women with polycystic ovary syndrome (PCOS) undergoing IVF treatment and has received a number of national and international awards.
His research interests include subfertility, PCOS, endometriosis, recurrent miscarriage, and fibroids. He is also an expert in advanced laparoscopic surgery.
Alex Swanton has developed particular expertise, over a number of years, in keyhole surgery for conditions including fibroids, hysterectomy, and endometriosis. He is accredited and fee assured with BUPA, AXA and all other major health insurance companies.
The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.