Mr Haider Jan, Consultant Gynaecologist at Ashtead Hospital has specific expertise in managing women with pelvic pain and endometriosis.
What is Endometriosis?
Endometriosis is a common condition affecting 11% of the population (1.5 million women), where cells that behave like those in the lining of the womb (the endometrium) are found outside the womb. They embed themselves around the pelvis causing inflammation, which may lead to pelvic pain, back pain and cramps during a period, very painful periods, heavy bleeding during periods, pain during sex and pain on passing urine or during bowel movements. Not only can this pain be debilitating, it can also affect the ability to fall pregnant. More rarely, these cells can invade into the bladder, bowel and other organs. Though it’s not life threatening, for some it can certainly be life altering.
Are scans helpful?
Although scans such as ultrasound and MRI may sometimes be helpful, they are not accurate in detecting Endometriosis. The only way to diagnose it is for a trained specialist to do a laparoscopy.
What is the best treatment?
Thankfully, this same procedure (Laparoscopy) can both find and treat the disease. Previously, laser ablation of the Endometriosis was considered the gold standard.
What does the latest research show?
The latest randomised controlled trial now shows that excision of Endometriosis is significantly more effective than laser and thus is the new standard at laparoscopy.
As you can see from the graph, the excision is far superior at 12 months following surgery with significantly less chance of the the pain coming back. It is important to note that excisional surgical techniques require a high degree of precision, skill and meticulous attention to detail, as such they are not commonly practiced.
What about medical treatment?
Surgery is not the only option, but it is the only option that both improves pain and infertility. Sometimes, taking medicine such as the pill can be helpful in masking symptoms but it does not help with reducing or slowing the disease. The Mirena coil is also useful in some cases at preventing the recurrence of pain following surgery. In extreme cases, a medicine called Zoladex can be used, which switches off the hormones temporarily causing shrinkage and regression of Endometriosis. Unfortunately, it has to be used carefully because of the side effects. Finally, there is a medicine that’s very effective called Dienogest, and though it is licenced and available in the UK privately offering many women fantastic relief of their symptoms, it is unfortunately not currently available on the NHS.
What should I do if I think I have Endometriosis?
Endometriosis can cause significant pain and infertility severely impacting the quality of life of women. The best option if you think you, or someone you know may have endometriosis is to ask your GP to refer you to a specialist, who is both trained and experienced in excisional surgery for endometriosis.