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See Dr Morton’s manage periods and understand endometriosis
During most gynaecology clinics I see women who present with symptoms of pelvic pain. One such woman aged 26, had previously been seen by several doctors and health care professionals to try and help with her pelvic pain. She had tried painkillers and contraceptive pills to no avail. Several potential diagnosis were contemplated but none were positively proven. After discussion she opted to have a laparoscopy (keyhole surgery), where endometriosis was diagnosed and treated.
Endometriosis is a common gynaecological condition affecting 1 in 10 women – that is approximately 1.5 million women in the UK. It is a condition where the cells lining your womb (endometrium) are present and implanted in various degrees throughout your pelvis. No one truly knows exactly what causes it, only theories exist.
It can cause painful periods and embarrassing symptoms like painful sex and pain between periods. It may potentially affect a woman’s fertility and can be confused with bowel and bladder problems. It may take a long time for women to be treated, because it can only be diagnosed definitively by laparoscopy.
It has been shown in studies that the average time from first visiting your GP to diagnosing and treating endometriosis can be as long as 7-8 years. Therefore, if you have any of the symptoms mentioned it would be advisable to seek medical advice from your general practitioner in the first instance.
Your GP may request an ultrasound scan which could identify endometriotic cysts on your ovaries or endometriosis elsewhere in your pelvis. In most instances, the ultrasound will be normal however.
Most women can simply manage their symptoms with painkillers prescribed by their GP, commencing the pill or by having a Mirena coil (progesterone coated intrauterine device) sited in their womb.
Some women however, will be resistant to such treatment and will require a laparoscopy to ultimately confirm the diagnosis and treat it. A majority of endometriosis present in women will be slight or superficial in nature and most gynaecologists will be able to manage and treat these using a whole plethora of laparoscopic devices available. These devices are able to destroy the endometriosis. In most cases this is all that will be required, although as this is a chronic condition it can come back and further treatment in the future may become necessary.
In some cases though the endometriosis may be more deep seated in the pelvis, particularly involving the bowel or bladder. These cases require surgery and treatment in specialist centres, which have the expertise, and experience in managing such cases.
The good news is that in both superficial and deep endometriosis, evidence exists which shows that most women get better in terms of their symptoms with an improvement in their fertility and chances of getting pregnant (which in itself improves their symptoms during the pregnancy).
In the case of the woman I saw in clinic her pain began to improve significantly within six months following her surgery. She is very happy with the outcome and is contemplating starting a family in the near future.