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Endometriosis

We have expertise in a number of key areas and we approach all problems with the same philosophy, by combining a compassionate and caring manner, together with the safest and most advanced, innovative minimally invasive techniques.

As specialists in Endometriosis we have collated some information about the condition below to help you make a decision regarding your care.

What is Endometriosis?

Endometriosis is a common condition where cells that behave like those in the lining of the womb (the Endometrium) are found outside the womb.

What problems can it cause?

The Endometriosis cells embed themselves around the pelvis causing inflammation which may lead to pain, and the inability to fall pregnant. More rarely, these cells can invade into the bladder, bowel and other organs. Though its not life threatening, for some, it can certainly be life altering.

How common is it?

Many women suffer with Endometriosis. 11% of the population are thought to have it which is approximately 1.5 million women in the UK. That is as many as those with Diabetes. The majority of people will have heard of Diabetes though the same cannot be said for Endometriosis. This leads to significant delays in diagnosis.

Could I have endometriosis?

Symptoms women may feel include lower tummy pain lasting more than 6 monthsback pain and cramps during a period, very painful periodsheavy bleeding during periods, pain during sex and pain on passing urine or during bowel movements.

Can it stop me having children?

If women have been unable to fall pregnant or have had failed IVF, they may have endometriosis as it is well known to interfere with fertility. Moreover, removing it has also shown to improve fertility outcomes.

Why haven’t I been diagnosed already?

On average we found that women visit their GP 11.6 times before being diagnosed and the average delay in diagnosis is 9.2 years. Indeed, 83% of women are told their pain was normal and 51% of patients felt their pain was not taken seriously. This high number of women suffering in silence together with the delay in diagnosis results in the declaration that this is a hidden epidemic.

How do I know if I have it?

Though scans such as ultrasound and MRI may sometime be helpful, they are not accurate in detecting Endometriosis. The only way to diagnose it is for a trained specialist to place a camera through the belly button and look directly inside the tummy, this is called a Laparoscopy (Key hole surgery)..

How is it treated?

Thankfully, this same procedure (Laparoscopy) can both find and treat the disease. This wasn’t always the case, there was a time where many in the medical profession didn’t believe that the condition existed, or that it caused significant pain. It wasn’t until the 90’s that it was finally shown that Laser treatment to Endometriosis can improve pain. It was ground breaking at the time as finally women had an option not only to help with their pain, but also to improve their chances of falling pregnant.

Laser Endometriosis
This picture shows some Endometriosis being vaporised by a Laser.

Many other kinds of treatments have been tried as not every hospital had a Laser, though up until now none have been shown to be as effective.

What does the latest research show?

The latest research now shows that excision, (cutting out with an ultrasonic knife) of Endometriosis is significantly more effective than laser and thus is the new standard at laparoscopy.

Excision vs laser Endometriosis
Graph showing pain scores following laser surgery (Red line) vs excisional surgery (Grey Line). The lower the score the better

As you can see from the graph above, the excision is far superior at 12 months following surgery with significantly less chance of the the pain coming back. It is important to note that excisional surgical techniques require a high degree of precision, skill and meticulous attention to detail, as such they are not commonly practiced.

What is the best treatment?

Surgery is not the only option, but it is the only option that both improves pain and infertility.

What about tablets?

Sometimes, taking medicine such as the pill can be helpful in masking symptoms but it does not help with reducing or slowing the disease. The Mirena coil is also useful in some cases at preventing the recurrence of pain following surgery. In extreme cases, a medicine called Zoladex can be used which switches off the hormones temporarily causing shrinkage and regression of Endometriosis. Unfortunately, it has to be used carefully because of the side effects. Finally, there is a medicine that’s very effective called Dienogest, and though it is licenced and available in the UK privately offering many women fantastic relief of their symptoms, it is unfortunately not currently available on the NHS.

What should I do if I think I might have Endometriosis?

In summary, Endometriosis can cause significant pain and infertility severely impacting the quality of life of women. The best option if you think you, or someone you know may have the disease is to ask your GP to refer you to a specialist who is both trained and experienced in Excisional surgery for endometriosis.

About the author

Dr Haider Jan is a consultant Gynaecologist specialising in minimally invasive surgery including Endometriosis. He was awarded the Carlo Romanini prize as a co author for his research on Excisional surgery for Endometriosis in 2014 and has had numerous International presentations and publications in this field.

 Read more about Dr Haider Jan..

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