W L WHAT
IS ENDOMETRIOSIS ?
by Nahid Gul FRCOG , Consultant Gynaecologist at Spire Murrayfield , Wirral .
Miss Gul has been in Obstetrics & Gynaecology / Gynaeoncology and a consultant in the North West for the last 20 years . She specialises in gynaecological cancer , complex gynaecological surgery , and advanced deep endometriosis . She is passionate about early and accurate diagnosis of women ’ s diseases and providing individualised care for her patients and is also a strong believer in enhanced recovery and enabling women to get back to their normal routine as soon as possible , hence she specialised in advanced complex minimal access surgery ( keyhole ). Miss Gul is trained in complex nerve sparing surgery to minimise surgical risks of bowel and bladder dysfunction and involves a multidisciplinary team in treatment planning . She is heavily involved in training and her research interests are immunology of gynaecology cancer and endometriosis . She is a BSGE ( British Society of Gynaecological Endoscopy ) recognised advanced endometriosis surgeon and member of British Gynaecological Cancer Society .
In this issue , Miss Nahid Gul wanted to highlight the causes , symptoms and treatment options for Endometriosis .
What is endometriosis ? Endometriosis is a common gynaecological condition where cells , like the cells of lining of womb ( endometrium ) are found outside the womb . Symptoms can be classified as pain or issues with fertility ( getting pregnant ) or both . The symptoms can be non-specific and atypical ; however , the clue is the cyclical pattern of symptoms . The endometriosis cells respond to normal ovarian hormones leading to bleeding , inflammation , and scarring . It is a chronic pathway and after menopause , damage can persist although menstrual cycles may not be there . Common symptoms include :
• Pelvic pain
• Painful periods
• Fatigue
• Heavy menstrual bleeding
• Painful bowel movements
• Pain during sex
• Difficulty in getting pregnant
• Urinary symptoms
Other symptoms you may have due to other organs being involved with endometriosis :
• Sciatica like a pain radiating to leg or buttock due to the involvement of pelvic nerves
• Extra-pelvic symptoms 10-12 % ( including Diaphragmatic disease or thoracic endometriosis )
How common is endometriosis ? 10 % of women ( Puberty to Menopause ) are affected with endometriosis and in the UK alone 1-5 million suffer from this disease per year . 74 % of men are not aware of this condition which may affect their daughter , sister or partner . Therefore , many patients who are affected by this condition suffer alone . Average diagnosis time is 7-8 years , as symptoms are dismissed as normal , or irritable bowel syndrome . 56 % patients have been reported to visit their GP more than 10 times and 43 % have visited hospital more than 5 times . Before COVID the average wait for surgery was 6 months which unfortunately has significantly increased now .
What causes endometriosis ? The true cause is not yet known - it is also known as the disease of theories . These include : 1 . Genetic theory ( More common in families ) 2 . Metaplastic immune theory ( Cell changes ) 3 . Retrograde theory ( Menstrual blood flowing back through the Fallopian tubes into the pelvis )
Endometriosis classification There is not a uniformly applied staging classification although stage 1 is often referred to as minimal , stage 2 mild , stage 3 moderate and stage 4 severe . The problem is that symptoms do not match the stage . For instance , a woman may have mild disease classified by the doctor but severe symptoms . Some women with severe disease have no symptoms .
Diagnosis : Many women can be diagnosed by carefully listening to their symptoms and then by careful pelvic examination .
At present there are no blood or urine tests to diagnose endometriosis . The Gold standard for diagnosis is laparoscopic ( Keyhole ) surgery to see the endometriosis ( as in many cases scans and MRI cannot detect the disease ) and in expert hands to remove ( excise ) it . Endometriosis can have many differing
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