Endometriosis

Endometriosis is one of the commonest causes of pelvic pain in young women.  Endometrium is the lining of the womb that is shed during a period. In endometriosis this tissue is found outside the uterus, mainly in the pelvis, where it grows under the influence of the hormone oestrogen. The exact cause for this abnormal deposition of endometrium is not known. It is now believed that there may be multiple causes rather than a single cause. During the time of a period, these tissues also bleed leading to inflammatory changes around them. This causes pain and adjacent tissues to stick to each other.

• Painful periods
• Deep pain on intercourse
• Cyclical or perimenstrual symptoms, such as bladder urgency/frequency, with or without bleeding or pain
• Chronic pelvic pain
• Back passage pain on opening the bowels
• Pain passing urine
• Ovulation pain
• Heavy and prolonged periods
• Pre-menstrual spotting
• Passing blood on opening the bowels during a period
• Blood in the urine

Endometriosis may be suspected with one or more of the above symptoms but there is a considerable overlap of symptoms with other conditions such as irritable bowel syndrome and pelvic infection. There is often a delay between symptom onset and diagnosis. The average time-lapse between the onset of symptoms and a definitive diagnosis is 7 years.  It is generally said that it takes 5 years for patients to be referred by their GP to a specialist and then another two years for a diagnosis.  The disease often commences in the teens but diagnosis is often delayed due to difficulty in distinguishing endometriosis from common menstrual pain.

For a definitive diagnosis, laparoscopy is the gold standard investigation.

Since the cause of endometriosis remains unknown, curative treatment has yet to be discovered. The management and treatment of severe/deeply infiltrating endometriosis is, however, complex and centres of excellence, where a multidisciplinary approach is offered, are the only way forward.  Choosing a treatment comes down to the individual needs depending on symptoms, age and fertility wishes.  Treatment may vary from simple pain relief to many hormonal treatments, all of which try to temper the production of oestrogen, supressing menstruation and inhibiting the growth of endometrial implants. Complimentary therapies and patient support groups have also proven to be useful for patients.

No. But it can be treated as many women manage their symptoms through a combination of medical, surgical and alternative treatments.

In mild disease, endometriosis can be excised at the time of a laparoscopy. Endometriosis or ovarian cysts do not respond to medical treatment and need surgery to remove them.  Other indications for surgical treatment are failed medical treatment for symptom control, infertility and endometriosis causing obstruction (e.g bowel or kidney).

Surgical removal of endometriotic lesions, including superficial and severe, deep, infiltrating disease may reduce endometriosis associated pain.  Some women choose, as a last resort to have a hysterectomy, however, this does not guarantee complete pain relief. If a hysterectomy and removal of both ovaries is performed there will be improved pain relief.  All visible endometriosis should be removed at the same time.

No, not necessarily. A referral is always ideal from your GP however if you are self-funding, we are happy to accept without.

Clinics are held on Monday, Wednesday and Thursdays at the Spire Tunbridge Wells Hospital. Everyone is welcome whether you are self-funding or have private medical insurance. For more information please contact the Customer Services team on 01892 741150.