Endometriosis is a common gynaecological condition where tissue similar to the lining of the womb grows outside the uterus. It can affect the ovaries, fallopian tubes and the lining of the pelvis, and in some cases can involve the bowel, bladder or other areas.
For some women, endometriosis causes significant pain and can have a considerable impact on everyday life, relationships, work and fertility. Others may have very few symptoms or may not realise they have the condition.
At Gynae Solution, we understand that living with persistent pelvic pain or difficult periods can be frustrating, particularly when you have not yet been given an explanation for your symptoms. Our aim is to provide thorough specialist assessment, an accurate diagnosis and personalised treatment based on your symptoms, priorities and future plans.
What Is Endometriosis?
Endometriosis occurs when tissue similar to the endometrium, the lining of the womb, grows in other parts of the body.
This tissue can respond to hormonal changes during the menstrual cycle. It can become inflamed and bleed, but unlike the lining of the womb, this blood cannot leave the body normally. This can cause inflammation, pain and, over time, scar tissue and adhesions.
Endometriosis can occur in different locations, including:
- The ovaries
- Fallopian tubes
- Pelvic lining
- The area behind the womb
- The bowel
- The bladder
In some cases, endometriosis can form ovarian cysts known as endometriomas.
The condition is generally associated with the reproductive years, although symptoms can sometimes continue after the menopause.
Endometriosis is not cancer and it is not an infection. However, it can be a long-term condition that requires ongoing management.
Symptoms of Endometriosis
Endometriosis affects everyone differently. Some people experience severe symptoms, while others may have relatively mild symptoms.
Importantly, the amount or extent of endometriosis does not always correspond to the severity of your symptoms. A relatively small area of endometriosis can sometimes cause significant pain, while more extensive disease may cause fewer symptoms.
Common symptoms can include:
- Painful periods that interfere with everyday activities
- Pelvic or lower abdominal pain
- Lower back pain
- Heavy or difficult periods
- Pain during or after sexual intercourse
- Pain when passing urine
- Pain when opening your bowels
- Bloating or bowel symptoms, particularly around your period
- Fatigue or extreme tiredness
- Difficulty becoming pregnant
- Bleeding from the bowel or bladder during your period in some cases
Some people also experience symptoms that are not obviously linked to their menstrual cycle.
Endometriosis can have a significant impact on quality of life, including relationships, work, education and emotional wellbeing.
If period pain is severe enough to stop you doing your normal activities, or your symptoms are affecting your everyday life, it is important to seek medical advice.
Causes and Risk Factors
The exact cause of endometriosis is not fully understood.
There are several theories about why endometriosis develops, and research continues into the factors that may contribute to the condition.
Endometriosis can sometimes run in families, meaning that having a close relative with the condition may increase your likelihood of developing it.
It is important to understand that endometriosis is not caused by simply having painful periods, and experiencing severe period pain does not mean that you definitely have endometriosis.
Because the causes are not fully understood, there is currently no guaranteed way to prevent endometriosis from developing.
How Is Endometriosis Diagnosed?
Endometriosis can sometimes take time to diagnose because its symptoms can be similar to other conditions, including adenomyosis, fibroids, pelvic inflammatory disease and irritable bowel syndrome.
Your diagnosis will begin with a detailed discussion about your symptoms and medical history.
Mr Abu may ask about:
- When your symptoms started
- How your symptoms relate to your menstrual cycle
- The severity and location of your pain
- Your periods and any changes to your normal pattern
- Pain during sex
- Bowel or bladder symptoms
- Previous treatments and whether they have helped
- Your fertility and whether you are planning a pregnancy
- Any family history of endometriosis
Keeping a diary of your periods and symptoms can be particularly useful and may help identify patterns.
Pelvic Examination
Depending on your symptoms, a pelvic examination may be recommended. This can sometimes identify tenderness, an ovarian cyst, pelvic masses or other signs that may suggest endometriosis.
You will be given an opportunity to discuss the examination beforehand and ask any questions you may have.
Ultrasound
An ultrasound scan may be recommended to examine the womb, ovaries and surrounding pelvic structures.
A specialist ultrasound can sometimes identify ovarian endometriomas or features suggesting deeper endometriosis and can also help identify other possible causes of your symptoms.
Importantly, a normal ultrasound does not necessarily rule out endometriosis. Some areas of endometriosis cannot be seen on an ultrasound scan.
MRI Scan
An MRI can provide detailed images of the pelvis and may be particularly useful when deep endometriosis is suspected.
It can help identify the location and extent of disease and may be useful when planning treatment.
Laparoscopy
A laparoscopy is a minimally invasive surgical procedure that allows the pelvis and abdominal cavity to be examined using a small camera inserted through a small incision.
Where appropriate, a laparoscopy can allow endometriosis to be diagnosed and treated during the same procedure.
Laparoscopy is particularly useful when symptoms persist despite initial treatment, when significant disease is suspected or when surgery is being considered.
Not everyone with suspected endometriosis will require surgery. Your specialist will discuss the most appropriate approach based on your symptoms, investigations and individual circumstances.
Treatment Options
There is currently no single treatment that permanently cures endometriosis, but there are several approaches that can help manage symptoms, improve quality of life and, where appropriate, address fertility concerns.
The right treatment will depend on your symptoms, the extent and location of your endometriosis, previous treatment and whether you are trying to become pregnant.
Treatment options may include:
Pain Relief
Pain-relieving medication may be recommended to help manage symptoms, particularly painful periods and pelvic pain.
The most appropriate medication will depend on your individual circumstances and medical history.
Hormonal Treatment
Hormonal treatments can help manage endometriosis symptoms by suppressing or altering the hormonal cycle that stimulates endometriosis tissue.
Options may include the combined contraceptive pill, progestogen treatments or other hormonal medications.
Hormonal treatment is not appropriate for everyone and generally cannot be used when you are actively trying to become pregnant.
Laparoscopic Surgery
If medication is not controlling your symptoms, or if significant endometriosis is identified, surgery may be considered.
Laparoscopic surgery, often referred to as keyhole surgery, can be used to remove or treat areas of endometriosis, release adhesions and, where appropriate, treat ovarian endometriomas.
The aim is to treat visible disease while preserving healthy surrounding tissue wherever possible.
Treatment of Deep Endometriosis
Endometriosis can occasionally affect organs such as the bowel, bladder or ureters.
Deep endometriosis involving these organs may require assessment and treatment within a specialist endometriosis service, sometimes involving a multidisciplinary team with expertise in gynaecology and other surgical specialties.
Hysterectomy
For some women with severe symptoms, particularly when other treatments have not been successful and fertility is no longer a priority, a hysterectomy may be considered.
A hysterectomy involves removing the womb. Whether the ovaries also need to be removed is a separate decision and depends on the individual circumstances.
A hysterectomy is not automatically a cure for endometriosis, as endometriosis can occur outside the womb. The potential benefits, limitations and risks should therefore be carefully discussed before surgery.
Endometriosis and Fertility
Endometriosis can sometimes make it more difficult to become pregnant. This may be due to inflammation, scar tissue, adhesions or changes affecting the ovaries and fallopian tubes.
However, having endometriosis does not mean that you will be unable to have children. Many people with endometriosis become pregnant naturally.
If fertility is important to you, this should be discussed before starting treatment. Some treatments are designed primarily to control pain and symptoms, while others may be considered with fertility preservation or pregnancy in mind.
NICE recommends that treatment decisions take your fertility priorities into account. Where endometriosis-related fertility problems are present, specialist fertility input may be appropriate.
Recovery and Aftercare
Your recovery will depend on the treatment you receive and the extent of your endometriosis.
If you undergo laparoscopic surgery, you will receive advice about wound care, managing discomfort, gradually returning to normal activities and recognising any symptoms that may require medical attention.
Recovery times vary depending on the type and extent of surgery. More complex procedures, particularly those involving the bowel or bladder, may require a longer recovery period.
Endometriosis can also recur after treatment. Surgery can significantly improve symptoms for many people, but it does not guarantee that symptoms will never return.
Following treatment, you may therefore benefit from ongoing management, which could include hormonal treatment, pain management, further review or additional investigations if symptoms return.
Risks and Benefits of Treatment
Every treatment has potential benefits and risks, and these will depend on your individual circumstances.
The potential benefits of treatment may include reducing pain, improving your quality of life, treating endometriosis-related cysts or adhesions and, in some circumstances, improving fertility.
Surgery carries general risks such as bleeding, infection, blood clots and complications associated with anaesthesia. Depending on where the endometriosis is located, there can also be risks to nearby organs, including the bowel, bladder, ureters, ovaries or blood vessels.
Surgery involving the ovaries can also affect ovarian reserve, which is an important consideration if you are hoping to become pregnant.
There is also a possibility that endometriosis symptoms may return following treatment.
Before recommending surgery or another treatment, Mr Abu will discuss the potential benefits, risks and alternatives with you. Your symptoms, fertility plans and personal priorities will all be taken into consideration.
Living With Endometriosis
Endometriosis can have an impact far beyond period pain. Persistent pain, fatigue and uncertainty about symptoms can affect work, relationships, intimacy, fertility and emotional wellbeing.
If your symptoms are affecting your everyday life, you do not simply have to accept them as a normal part of having periods.
Endometriosis is a recognised medical condition and there are treatments available to help manage its symptoms. NICE guidance emphasises the importance of considering the physical, sexual, psychological and social impact of the condition when planning care.
Specialist Endometriosis Care
Living with unexplained pelvic pain or painful periods can be frustrating, particularly if you have previously been told that your symptoms are simply part of having a period.
At Gynae Solution, we understand that every patient's experience of endometriosis is different. Mr Jafaru Abu will take the time to understand your symptoms, investigate the possible causes and discuss the treatment options that are appropriate for you.
Whether you are seeking an explanation for persistent symptoms, have already been diagnosed with endometriosis or are considering surgical treatment, our aim is to provide clear information, specialist expertise and personalised care throughout your journey.
If you are experiencing symptoms that could be associated with endometriosis, contact Gynae Solution to arrange a consultation with Mr Jafaru Abu.
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