Managing endometriosis and its symptoms

Endometriosis is very common, affecting one in 10 women of reproductive age. It brings about painful symptoms that, in some cases, can severely affect patient quality of life. So how is this condition and its symptoms managed? And what should women do who are worried they may have endometriosis?  

Leading consultant gynaecologist in East London Mr Michael Magro answers these frequently-asked questions in detail, alongside other common queries, in this informative article.

What is endometriosis?

Endometriosis is a condition which affects women of reproductive age, in which tissue similar to the lining of the uterus (endometrium) grows outside the uterus, commonly the peritoneum (lining of the abdomen), ovary or fallopian tube. The exact cause of endometriosis is not known but it often affects members of the same family. ome of the commonly associated causes are:

• retrograde menstruation (when your period flows upward through your fallopian tubes and into your pelvis instead of out your vagina);
• hormonal imbalance;
• scars from surgeries such as a C-section or hysterectomy;
• immune system problems and genetics.

What are the symptoms of endometriosis?

It is a long term condition that can have a significant affect on quality of life and often presents with pelvic pain, painful periods (dysmenorrhea), pain during sexual intercourse (dyspareunia) or if the bowels are affected, pain during passing stool (dyschezia). These symptoms can also be caused by other conditions, which is why it is important to seek specialist help from a gynaecologist who can help you decide what investigations may be needed.

The symptoms of endometriosis are different in each individual, with some women with severe endometriosis having limited or no symptoms, and some women with seemingly mild endometriosis having severe symptoms, which is why treatment is targeted at improving quality of life and symptom control.

How is endometriosis treated?

There is currently no cure for endometriosis but there are a variety of methods used to treat the symptoms caused by endometriosis. These include painkillers, hormonal contraceptives such as birth control pills, patches and vaginal rings which help control the hormones responsible for the build-up of endometrial tissue or medication to block the production of ovarian-stimulating hormones, lower oestrogen levels and prevent menstruation.

What surgical options are available for endometriosis?

Laparoscopic (keyhole or minimally invasive) surgery can be performed both to diagnose and treat endometriosis for some women. Most cases of endometriosis can be treated this way and involves the insertion of a laparoscope (camera) through a small incision in your belly button and usually 2 or 3 other small (<1cm) holes to insert instruments to remove the endometrial tissue. Most women will go home the same day after laparoscopic surgery.

There are three basic types of surgery for endometriosis;

• conservative;
• complex, and
• radical.

Conservative treatment is performed to remove (excise) or destroy (using heat or laser) the endometriosis deposits causing symptoms.

Complex surgery is usually needed if there is endometriosis deposits (nodules) which affect the bladder or bowels and this surgery is often performed by a endometriosis team which may involve a bowel surgeon. This type of surgery may need to be performed in a tertiary endometriosis centre.

Radical surgery usually is reserved for women who have completed their families or where other treatments have failed and may involve a hysterectomy (removal of the womb) and/or oophorectomy (removal of the ovaries). Some women may then wish to use hormone replacement therapy (HRT) and this should be discussed pre-operatively as HRT can worsen endometriosis symptoms.

How can endometriosis be managed day to day?

Endometriosis can be a debilitating condition and as such can affect your mood, energy levels and self confidence. It is important to educate yourself as much as possible as this will empower you to have the right discussions with your gynaecologist. Endometriosis UK is a charity that supports women with endometriosis and is an excellent resource.

There is no clear evidence that adjusting your diet affects endometriosis and this is still being investigated by researchers, but some women have found that avoiding certain foods can help reduce endometriosis symptoms. In addition to these lifestyle changes, medications such as non-steroidal anti-inflammatory drugs and painkillers like ibuprofen are often used to treat pain.

Can exercise ease endometriosis?

Exercise releases serotonin and as such can also help to reduce pain and improve quality of life for some women with endometriosis. Some women have found that low-impact exercises such as yoga, Pilates, and swimming are helpful.

How does endometriosis affect fertility?

Many women with endometriosis will understandably be worried about their fertility, even if they are not planning on trying for a pregnancy in the near future. The good news is that the majority of women with endometriosis will be able to fall pregnant naturally and without assistance.

The effect of endometriosis on fertility is complex and ranges from women not being able to have sexual intercourse due to pain to blockage of the fallopian tubes secondary to scarring and a variety of other factors which should be considered when discussing treatment options.

For some women, laparoscopic excision of peritoneal endometriosis can improve the chances of falling pregnant.

What should I do if I’m worried I may have endometriosis?

If you are worried that you have symptoms suggestive of endometriosis then it is important to speak to your GP in the first instance, as there are other conditions that can cause similar symptoms that your GP would be best placed to consider.

It's also important however that women seek specialist help from a gynaecologist who specialises in endometriosis at an early stage if they are concerned. The average wait between onset of symptoms and a diagnosis of endometriosis is roughly 8 years, with many women having to put up with debilitating symptoms until a diagnosis is made.

As described above, a gynaecologist would consider several factors when determining the best treatment for endometriosis symptoms, including:

• relieving pain;
• removing endometriosis tissue;
• improving fertility, and;
• reducing the chance of endometriosis returning.

If you’re looking for expert assistance regarding endometriosis, pelvic pain or menstrual irregularities in East London, arrange a consultation with Mr Magro via his Top Doctors profile.