Conditions

Endometriosis occurs when cells, similar to those that line the uterus, are found outside the uterus in the pelvic cavity.  

Each month these cells respond to hormones in the same way they would if they were in the uterus and bleed. This bleeding causes scar tissue to form in the pelvis causing pain.

Endometriosis affects approximately 10% of women.

No one is completely sure how endometriosis occurs, however;

• We suspect that during foetal development in your mother’s uterus, the cells that will form the lining of the uterus (the endometrium) lie near the cells that will form the lining of the pelvis (the peritoneum)
• These two groups of cells can intermingle, with islands of endometrial cells growing within the lining of the pelvis as it develops
• At puberty the hormones that cause a period to occur also activate the endometrial cells in the pelvis. They start to bleed and this leads to scarring and subsequent pain

Endometriosis can be diagnosed by listening to your story. Common symptoms include:

• Heavy, painful periods
• Pain with bowel motions at the time of a period
• Pain passing urine
• Painful intercourse
• Mid cycle pain
• Pain throughout the month often similar to period pain but at a lower level and getting worse at the time of a period
• Bleeding between periods

Up to 50% of women with endometriosis have heavy periods. This may be due to adenomyosis;

• This is a cousin of endometriosis where the endometrial cells infiltrate into the muscle layer of the uterus
• When these cells bleed each month the muscle layer of the uterus swells and can cause heavy, painful periods, and on occasion bleeding between periods

Many women with endometriosis also have irritable bowel syndrome;

• They both affect the same population group i.e. women between the ages of 15 and 50
• However, there is no actual association between the two conditions

Women who have suspected endometriosis fill out a pain score assessment prior to seeing Mark (see table below);

• 0 = no pain
• 10 = most severe pain

This assessment is also carried out post any operative procedure and assists with measuring the success of treating your condition.

If you wish to print the pre-operative assessment - simply click on the image to expand it, and then print.

Treatment of Endometriosis

 If endometriosis is suspected, a Laparoscopy is required for formal diagnosis and treatment of the disease.

• One operation is usually all that is required to diagnose and treat the condition

A Laparoscopy involves:

• General anaesthetic (being put to sleep)
• A telescope is inserted through the tummy button (umbilicus)
• A photo is taken of the pelvis
• If endometriosis is found it is removed through three small incisions below the umbilicus.

The surgery takes on average 1 to 2 hours.  When you wake after surgery you have a small stitch in each of the incisions. Most women require two nights in hospital and on your return home you are able to walk, lift, and drive a car within 4-5 days.  You are generally able to return to work in 7-10 days.

In 95% of cases all endometriosis can be removed, however 5% will have “severe endometriosis”.

• This is extensive disease which involves the bowel wall (the rectum) and the ovaries.
• Although endometriosis can be removed safely from the bowel it requires a second operation.
• For women with severe endometriosis the findings are discussed after surgery and subsequent surgery arranged.
• Appropriate bowel preparation is necessary and a General Surgeon is available if required.

The endometriosis pain you have experienced can take up to three months after surgery to start to improve.

• This happens because the nerves in your pelvis that were irritated by the endometriosis are also irritated by the removal of the disease.

After surgery over 80% of women require no further operative treatment;

• Between 10 and 20% of women have recurrence of their symptoms
• This does not always indicate that endometriosis has returned
• If a second look laparoscopy is performed the majority of cases have post operative scarring rather than endometriosis as the reason for their discomfort
• Scarring occurs following all surgery to a greater or lesser extent. 5-10% will scar more than others  
• By dividing the scar tissue the symptoms will often improve considerably

Approximately 60% of women with endometriosis can conceive although it may take a little longer than usual.

• In those women having difficulty conceiving, where no other cause for their infertility has been identified, removal of endometriosis will markedly improve their chances of becoming pregnant.
• Surgical risks and complications are low.

 Surgery will improve the pain syndrome related to endometriosis, however, it has little effect on heavy periods. The heavy periods can be managed medically using one of the following:

• Cyclokapron
• Oral contraceptive pill
• Mirena IUCD
• Anti-inflammatories (will also help any residual discomfort)

Mark does not use danazol, gestrinome or LH analogues as they suppress rather than cure symptoms, and can have significant side effects.

 Mark finds managing women with endometriosis rewarding as outcomes following surgery are generally very good.

Click here - to view some endometriosis images and a video clip of endometriosis being removed Laparoscopically.