Endometriosis

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About endometriosis

​Endometriosis is usually found in women aged between 25 and 49 years but it can occur even in younger women.

Endometriosis is mostly found on the lining of the pelvic (peritoneum), on the ovaries, fallopian tubes and the tissues that hold your womb in place. You can also get endometriosis on urinary bladder or bowel. Rarely, endometriosis can occur in the space around your lungs or heart.

Endometriosis can cause cysts (endometrioma) on the ovaries. These cysts may cause a lump in your tummy and are usually associated with painful periods.

Symptoms of endometriosis

​The symptoms of endometriosis can vary. Some women have no symptoms at all, while others have pelvic pain, painful and heavy periods.

​Other symptoms caused by endometriosis are

• Pain during sex.
• Ovulation pain.
• Backache
• Painful bowel movements.
• Extreme tiredness.

​​Endometriosis on the bowel can cause pain when you have a bowel movement or blood in your faeces during a period. Endometriosis on the bladder can cause pain when you urinate or blood in your urine during a period.

Complications of endometriosis

• ​Repeated episodes of bleeding from these tissue deposits can cause scar tissue formation(adhesions) around the pelvic organs such as the uterus, ovaries, intestine and bladder.
• Adhesions formation around fallopian tubes and ovaries can cause infertility.
• Cysts on the ovaries can bleed or rupture, causing acute and severe pain.
• Endometriosis of the intestine can cause your bowel to become blocked or twisted.
• An increased risk of certain types of cancer, particularly ovarian cancer.

Causes of endometriosis

​The exact cause is not known. It can affect any woman of childbearing age

You’re more likely to develop endometriosis if you:

• ​have a mother or sister who has it
• have difficulty in conceiving
• have frequent, heavy or painful periods
• start your period early
• go through the menopause late

Diagnosis of endometriosis

​You will need an ultrasound scan or MRI (magnetic resonance imaging) to look inside your pelvis if endometriosis is suspected based on your symptoms and clinical examination.

However, the only way to be sure that you have endometriosis is to have a laparoscopy. A laparoscopy is a procedure that allows the surgeon to look inside your abdomen. The procedure involves passing a narrow, telescopic camera (a laparoscope) into your abdomen through a small cut in the belly button. This allows examination of the organs in your pelvis by looking at pictures sent to a monitor.

The diagnostic procedure takes about 30 minutes and is usually done as a day case under general anaesthesia. This means you will be asleep during the procedure. You usually won’t need to stay overnight in hospital.

If you have mild or moderate endometriosis, Mr Kunde will treat it at the same time. However, if the endometriosis is severe, Mr Kunde will discuss the findings with you after the operation so that the treatment options, risks and benefits can be discussed in more detail.

Treatment

​There is currently no cure for endometriosis, but treatments are available for managing the symptoms. These aim to:

• relieve pain and heavy bleeding
• shrink or slow down the growth of the endometrial tissue on other organs
• improve your fertility

Medicines used to treat endometriosis don’t improve fertility, but surgery can help if the endometriosis is interfering with the normal workings of the womb and ovaries. Some women with endometriosis who want to have children may need fertility treatment.

The type of treatment you have will depend on your age, the severity of your symptoms and whether or not you want to have children.

Medical Treatment

​Painkillers 
You can take over-the-counter medicines, such as ibuprofen which will provide pain relief. Sometimes you may need stronger painkillers to control the pain. Mr Kunde works very closely with the pain management specialists and will be able to refer you to them for further advice.

Hormonal medicines 
Hormonal medicines that reduce the amount of oestrogen in your body will reduce the size of the endometriosis and ease your symptoms. These drugs include;

1. gonadotrophin-releasing hormone (GnRH) analogues (eg buserelin)
2. progestogens (eg norethisterone, depot provera)
3. the combined oral contraceptive pill

​​These hormonal treatments all have different side-effects. You should use a barrier method of contraception (such as condoms) to prevent you from becoming pregnant while taking the medicines.

Mirena IUS

This is an intrauterine contraceptive device which has been found to be effective in controlling symptoms of endometriosis. It can be inserted in the outpatient clinic.

Treatment with medicines won’t cure endometriosis and symptoms usually return when you stop taking them.

Surgery

​The aim of surgery is to remove as much of the endometriosis as possible while still enabling you to have children. You may need surgery if:

• ​you have severe pain that isn’t responding to medical treatment
• you want to have children but are having difficulty conceiving
• you have a large ovarian cyst due to endometriosis
• the endometriosis is interfering with the normal workings of organs such as your bowel

The endometriosis may be cut away, or it can be destroyed with heat from an electric current. This can usually be done by a procedure called laparoscopy(key hole surgery). Mr Kunde specialises in this type of surgery and carries out these operations at St Thomas’ Hospital and at London Bridge Hospital. If there is involvement of bowel, then the surgery is performed as a joint procedure with a bowel surgeon.

​Sometimes it may be necessary to convert your keyhole procedure to open surgery. This means making a bigger cut on your abdomen. This is only done if it’s impossible to complete the operation safely using the keyhole technique. Mr Kunde will give you more information about which option is best for you. In some women, endometriosis can come back after surgery. Mr Kunde may recommend you take hormonal medicines after the surgery to help delay the return of symptoms.

Complementary therapies

​Some women find that complementary treatments such as acupuncture, aromatherapy, herbal remedies and homeopathy are helpful for relieving pain. However, there is no clinical evidence to support this.