Endometriosis. Mr Mostafa Metwally answers the FAQs…
Mr Mostafa Metwally, Consultant Gynaecologist
Claremont Clinics: Tuesday PM
What is Endometriosis?
It is a condition where cells that are like those lining the womb are found in other parts of the body. Often, they are found in the pelvis, on the bowel, bladder or ovaries. These cells will act in the same way as they would during your period, where they build up and break down leading to bleeding. However, it does not work the same way as your period as the bleeding has no way of leaving the body. Therefore, the bleeding and tissue remain inside and cause inflammation, pain, and the formation of scar tissue.
How common is Endometriosis?
It is actually a surprisingly common condition, with one in ten women in the UK suffering from it, a similar figure to the number that has diabetes. Sadly, no definite single cause for the condition has been discovered yet, but the increased awareness for endometriosis has definitely helped improve the amount of research into the condition.
How is Endometriosis Diagnosed?
It is not easy to diagnose endometriosis, and it does require a professional in the area. Once your GP has referred you to a gynaecologist, an ultrasound is usually performed to see if there are any cysts caused by the condition in the body. This will give a better idea of how you have been affected. The only way to confirm that you have it, however, is for a surgeon to perform a laparoscopy. This is where a small tube with a camera on it is passed through a small incision (usually near your belly button), enabling the specialist to see if there is any endometriosis tissue in the body. During this procedure, it is also possible to remove the affected tissue.
How Can Women Spot The Symptoms?
Here are some of the most common symptoms of endometriosis:
- Severe period pain that cannot be relieved fully by painkillers
- Pelvic pain that occurs either during your period or all the time
- Pain during and after sex
- Painful bowel movements and/or blood in your poo
- General fatigue or tiredness
- Difficulty getting pregnant
If you have some or all of the symptoms listed here, then it is important that you speak to your GP, something that we will look at in the next section.
When to Talk To Your GP
Getting a diagnosis of endometriosis is not always an easy task and sometimes it can take considerable time to reach a diagnosis. With more awareness of the condition, however, the diagnosis has been received much earlier. If you would like to be tested for endometriosis, then here is how I recommend women to bring it up with their GP:
- Make sure you have written all of your symptoms down ready to discuss with your GP. That way, when you go to see them, you will not forget anything. The condition can be hard to diagnose as it requires specialist training, but it is still important to discuss with your GP as they will be able to refer you to a gynaecologist.
- If you feel strongly about your need to be tested and your GP disagrees, however, you can ask for a second opinion. Your health is paramount, and you are the only one who truly knows your body.
How is Endometriosis Diagnosed?
When endometriosis is suspected, usually a laparoscopy is needed to make the diagnosis. This involves insertion of a telescope through the belly button (umbilicus) under a general anaesthetic to diagnose and treat the areas of endometriosis with keyhole surgery. Other investigations may also be useful such as an ultrasound scan.
Can Endometriosis Affect Fertility?
Yes, endometriosis can lead to problems conceiving through many different mechanisms, e.g. causing problems with the egg, ovary or tubes. Often treatment of endometriosis can improve your chances of getting pregnant and when achieved, pregnancy has a protective effect preventing or delaying the recurrence of endometriosis.
At this point in time, there is no permanent cure for the condition. However, the earlier it is caught, the less severe your symptoms are likely to be. Some cases get better themselves, others do not. There are a few ways you can help to relieve endometriosis including:
- Anti-inflammatory painkillers
- Hormone medicines and contraceptives
- Surgical removal of the endometriosis tissue
- A hysterectomy (removal of the womb)
In the case of the hysterectomy, this will not always relieve the condition. If this is suggested as your only course of action, it is important you talk about the implications of this in detail with your gynaecologist.
Treatment of endometriosis will depend on many factors including your age, symptoms and desire for fertility. In women hoping to conceive, surgery is usually needed. This is usually done through keyhole surgery (laparoscopy) and involves treating the areas of endometriosis with a high energy current (diathermy). Surgery can also involve removing ovarian cysts that can result from endometriosis (endometriomas) or scar tissue (adhesions). Surgery may also be needed to open the tubes if they have been blocked by endometriosis scar tissue.
In older women who have completed their families and have had endometriosis for many years, treatment is often more permanent and may involve removing the ovaries which are the source of oestrogen. In the absence of oestrogen, endometriosis tends to shrink and disappear. Sometimes surgery involves removing the uterus as well (hysterectomy). Again, this type of surgery is often performed through the keyhole route.
Are There Any Medications To Treat Endometriosis?
Yes, sometimes surgery is not needed or indeed not necessary, particularly for long-term symptom relief, e.g. chronic pain. Some treatments aim to counteract the effect of oestrogen (which is responsible for the growth of endometriosis) such as giving hormonal treatments containing progesterone, e.g. the contraceptive pill or the Mirena coil. Other treatments aim at temporarily stopping oestrogen production altogether thus inducing a state of artificial temporary menopause, e.g. GnRH analogue (Zoladex or similar drugs) monthly injections. Sometimes medications are used in addition to surgery.
An initial consultation with Mr Metwally costs £200 Claremont if you don’t have health insurance. To book an appointment, just call our friendly Private Patient Team on 0114 263 2114. You will need a referral letter from your GP or you can see one of our Private GPs quickly for this if you prefer.
Mr Metwally provides comprehensive testing including ultrasound scanning, imaging, blood tests and surgery (laparoscopy) to treat endometriosis.
Copyright Mostafa Metwally, 2019.