Endometriosis Treatment in London
What is endometriosis?
The endometrium is the lining of the womb, and changes in hormone levels during the menstrual cycle cause first its thickening, then its shedding at the time of a period. Endometriosis occurs when cells similar to those lining the womb are found at sites outside the womb, commonly behind the womb or on the ovaries.
It has been estimated that endometriosis is present in 10 to 25% of women presenting with gynaecological symptoms in the UK. Women of any age can be affected by endometriosis, although the condition is most common in the 30s to 40s age groups. Endometriosis is recognised as a long-term condition, although there are several treatments which have proven effective in addressing it.
Endometriotic tissue also responds to cyclical changes in hormone levels associated with the menstrual cycle. Cyclical bleeding from the deposits occurs, leading to pain, scarring and if the ovaries are involved, cysts can occur.
The most common symptoms are; pain in the pelvic region (lower stomach or back), which get worse during a period; intense period pain which prevents the sufferer from doing standard activities; pain after, or during sex; pain when going to the toilet while on period; difficulty becoming pregnant; feeling constipated, having diarrhoea, feeling sick, and the presence of blood in the urine and diarrhoea.
Endometriosis sufferers can experience heavy periods which require the use of many tampons, and even bleed through the clothes. Women may also be impacted by the disease in the form of mental conditions, such as depression and anxiety.
There appears to be little relationship between the severity of symptoms and the severity of the disease.
When should you see your GP?
If you are experiencing the endometriosis symptoms which are listed above, you should see your doctor for a check-up. If you are experiencing several of these symptoms, you could write them down to help you remember them.
Because of the varying symptoms of endometriosis – and the fact that other conditions can cause these symptoms, too – it is not always easy to diagnose the condition. Your doctor may ask to examine your vagina and stomach in the process of making a diagnosis.
Initial treatments can be recommended by a GP for endometriosis, and if these prove ineffective, typically you would be referred to a gynaecologist who can conduct further tests such as an ultrasound scan or a laparoscopy, whereby a surgeon inserts a thin tube into the stomach, via a small incision, in order to make a conclusive diagnosis.
Treatments for endometriosis
Although there is no recognised cure for endometriosis, there are several treatment paths. Treatments can be medical or surgical, or a combination of the two.
Medical treatment usually starts with pain management, the form of simple pain killers like paracetamol or ibuprofen. Pain killers can be purchased from pharmacies, and have minimal side effects. If you have already been taking pain killers, and are still in pain, you should notify your doctor.
There is also the option of hormonal treatments to stop ovulation and thereby prevent the cyclical changes in hormone levels causing menstruation. These include the contraceptive pill, progestogens, and the Mirena IUS.
While these types of treatments are recognised as being equally effective in the treatment of endometriosis, they can cause varying side effects. Hormone treatments can reduce the chances of getting pregnant, but it should be noted that they are not all licensed contraceptives. The hormone treatments included above do not have a long-term effect on fertility.
Surgical treatment can involve cauterising or removing endometriotic deposits or cysts. This is done using keyhole (laparoscopic) surgery, usually as a day case procedure. A laparoscopy involves the surgeon making small incisions in the stomach, to allow a small tube with a camera to transmit images from inside the body. Fine instruments are then used to apply a laser, electric current, or heat in order to destroy the targeted patches of tissue. A general anaesthetic is typically used for the procedure. In some cases, hormone treatment can be administered before and following surgery, in order to avoid the recurrence of problems if some tissues are left behind.
In a small number of women, once their family is completed, the ultimate cure for endometriosis can be a hysterectomy. This involves the removal of organs – either partially, or in their entirety – which are affected by endometriosis. A hysterectomy is a major operation which needs to be carefully considered – this can involve discussions with your gynaecologist and your GP. Endometriosis is more likely to return if ovaries are left in place during the operation. If ovaries are removed, Hormone Replacement Therapy (HRT) may be needed afterwards.
In some cases, endometriosis symptoms can subside on their own accord, and so doctors can recommend waiting to see if symptoms improve before recommending treatments.
Which endometriosis treatment is right for me?
Each treatment option has its own risk and benefits. Among the factors which will be considered by you and your gynaecologist when discussing treatment are; the nature and severity of your symptoms; your age; how many treatments you have previously tried; if you want to get become pregnant; and your general feelings about undergoing surgery. If a woman is coming to the end of the menopause or is not having fertility problems, there is a chance that symptoms may improve without treatment being necessary. In many cases, symptoms can be monitored on an ongoing basis, to see if they get worse before treatment is decided upon.
Fertility problems related to endometriosis
Not being able to get pregnant is one of the main problems encountered by women with endometriosis. This problem is not yet fully understood, but damage to the ovaries or fallopian tubes could be the cause. Surgical treatment is able to address the problem through the removal of endometriosis tissue, but it is never certain that women will be able to get pregnant following the procedure. It should be noted that not all women with endometriosis do encounter fertility problems.
It is recognised that women with endometriosis classed as moderate to severe have a lower chance of becoming pregnant with the in vitro fertilisation (IVF) treatment.
Adhesions and ovarian cysts
Some women with endometriosis will develop ovarian cysts, which are cysts filled with fluids that can grow to become painful, and adhesions, which are areas of ‘sticky’ endometriosis tissue that can result in the binding of organs. While ovarian cysts and adhesions can be treated with surgery, if the endometriosis returns in the future they may come back.
Complications with endometriosis surgery
It should be noted that surgical treatments for endometriosis carry a risk of complications, as with all surgical procedures. These can include minor bleeding, bruising around a wound, and a wound becoming infected. Rare complications include blood clots, organ damage and severe bleeding in the stomach.
Bladder and bowel endometriosis
Bladder and bowers issues as a result of endometriosis can be among the most difficult problems to treat. There is a chance that they will require major surgery. Part of the bladder can be cut away during surgery, and a urinary catheter may be required in the days following the procedure. In other cases, a urostomy can be required, allowing you to pee into a bag which is attached to a small hole in the stomach.
Those who have endometriosis in the bowel may require part of the organ being cut out. Sometimes a temporary colostomy is needed during the healing process following this procedure; this involves using a bag to collect waste, with the bowel being diverted via a hole in the stomach.