Endometriosis

Endometriosis

Overview

Endometriosis is defined as, the presence of endometrial – like tissue outside the uterus/womb, which induces chronic and inflammatory reactions.

The lining of your womb/uterus is called the endometrium, every month a women’s body goes through hormonal changes. Hormones are released causing the lining of the womb to thicken in preparation for a fertilized egg, if pregnancy does not occur the lining (endometrium) is shed resulting in a period (menstruation) Endometriosis cells react in the same way except they are located outside the womb. Each month the cells grow, then break down and bleed, unlike a period there is no way for the blood to leave the body. This leads to inflammation, pain, and the formation of scar tissue (adhesions).

Endometriosis is most commonly found inside the pelvis, around the ovaries, the fallopian tubes, on the outside of the womb and ligaments (which holds the womb in place) or the area behind the rectum and womb called the pouch of Douglas. It can also be found on the bowel, bladder, the intestines, the vagina and the rectum. You can also have endometrial tissue growing in the muscle layer of the womb (this is another condition called adenomyosis). Endometriosis can grow in existing scars from previous operations such as caesarean section.

While some women experience painful symptoms and infertility, others have no symptoms at all.  Women of any age can be affected by endometriosis but it is rare for the condition to manifest before a girl has her first period.

It is estimated that one in 10 women have endometriosis and it takes an average of seven years for most women to be diagnosed. Endometriosis can often be confused with IBS (irritable bowel syndrome).

For more information about endometriosis, the cause and the symptoms please click here.

What do I do if I think I might have endometriosis?

Make an appointment with your GP if you have symptoms of endometriosis, especially if they're having a big impact on your life.

It may help to write down your symptoms before seeing a doctor.

Endometriosis UK has a pain and symptoms diary you can use.

What will happen at my consultation appointment?

We will request that you complete a pelvic pain questionnaire before your appointment.

During the consultation:

  • We will measure your body mass index (BMI) and take your weight and height measurements
  • the consultant will take a detailed medical history
  • you may be asked to have a vaginal examination.

The consultation will help you to make an informed decision about the personalised care you receive. You’ll be offered treatment based on your preferences, priorities and symptoms.

Investigations

Please note that although some of these investigations may have been performed via your GP/consultant. These may need to be repeated.

How do I get referred for treatment?

There are two routes

  1. Your GP refers you into the hospital for assessment.
  2. Another consultant may refer you to our eam for an expert opinion and treatment.

When is a referral into hospital necessary?

Suspected Endometriosis can be treated in primary care by your GP. Referral to a Gynaecologist or a specialist centre should be considered if:

  • there is any suspicion or uncertainty over the cause of pain
  • if pain is severe and treatment fails in primary care
  • if severe/complex endometriosis is suspected e.g. endometrioma
  • if there are fertility issues link to Calderdale fertility services
  • if surgical and medical management is required.

Patients with Endometriosis will be referred to any of our general gynaecology consultants for treatment and management unless:

  • severe Endometriosis has already been diagnosed.
  • there is a higher likelihood of your Endometriosis being severe because you have 1 or 2 endometrioses.
  • you have recurrent Endometriosis.
  • you have significant pain or infertility problems.

Questions that will be asked at your appointment

A complex history will be taken by the consultant, below are a list of the questions you will be asked, it may help to make some notes to bring with you to your appointment to enable you to remember.

Thinking about your pain

How long have you had it?

Location e.g. low abdomen, radiating into the legs, in the lower back

How long does it last for?

Does anything relieve or make it worse?

Does is coincide with your periods?

Does your pain have an effect on your home/social/work life on your relationship?

Do you have pain on intercourse, opening your bowels, passing urine, physical activity, when eating food?

Analgesia you take

How many day in the month is analgesia required?

Any other coping strategies i.e. hot water bottles, tens machines, yoga?

Bowel- Do you have any of the following symptoms?

Urgency, constipation/diarrhoea, pain when opening your bowels, blood in your stools, bloating

Bladder– Do you have any of the following symptoms?

Frequent voiding in the day or night, Pain or stinging on passing urine, leakage of urine when you urgently need the toilet or when exercising. Is there any blood in your urine?

Previous treatments tried for pelvic pain endometriosis and how effective they were.

Have you had any recent investigations for endometriosis, swabs, scans etc. date of test and location?

Previous surgeryperformed not just for endometriosis

Medical illnesses that you may have– diabetes, heart conditions, thyroid, blood pressure, DVT, asthma

List of current medications and allergies

Smear history date of last smear

Any abnormal smears in the past and treatment undertaken?

Periods/menstruation

Date of your last period, the regularity of your periods, how heavy they are how long you bleed for and pain.

Family

How many children you have, is your family complete or are you trying to get pregnant and how long have you been trying for. Is your wish to not have any children?  Are you using any contraception?

The aim of your consultation is to enable you to make an informed decision; offered treatment based on your preferences, priorities and symptoms not the stage of disease.

Treatment options

The aim of deciding the most appropriate form of treatment is to take into account your individual circumstances, symptoms, priorities, desire for fertility, aspects of daily living, work, study, physical and emotional issues.

In cases of severe/complex endometriosis we have a multi-disciplinary team (MDT) to review how to best manage this.

Medical treatment

  • analgesia – paracetomol, codeine, tramadol -  Pain relief at home following surgery
  • NSAID - brufen, naproxen, diclofenac, ponstan, mefanemic acid, prostaglandins blocking drugs, prostaglandins are produced in response to injury and disease and cause pain and inflammation
  • pain modifiers – amitriptyline block neurotransmitters and affects the way the body manages pain signals
  • hormonal treatments
  • oral hormonal treatments such as the combined oral contraceptive pill
  • progesterone only pill
  • medroxyprogesterone acetate (MPA) or norethisterone.
  • depo injection
  • GnRh antagonists – drug that is given to stop the production of hormones released by the ovaries putting you into a temporary state of menopause - Gonapeptyl and Prostap
  • intra uterine hormones such as the mirena IUS -  Intrauterine system (IUS)

Surgical treatment

Surgery to remove the endometriosis and adhesions by either:

  • excision
  • ablation
  • diathermy
  • laparoscopic hysterectomy with or without removal of the tubes and ovaries
  • laparoscopic salpingo oopherectomy

Other therapies

  • TENS machines – release natural endorphins to help relieve pain
  • Physio – helps with alignment and mobility to relieve pelvic pain - 6 simple exercises to help with endometriosis pain
  • Beyou monthly patches and CBD oil https://beyouonline.co.uk/

Please download this pdf which contains a Pelvic Exercise Programme

Where is surgery performed?

Surgery is performed predominantly at Pinderfields Hospital on a Monday, Thursday or Friday. 

 

The specialist endometriosis clinic is only available at Pinderfields hospital. On the day of your appointment you will need to check in at the main reception which is located on level B. You will be directed to the communal waiting area on level B. The screen in the waiting area will indicate when you need to go to Gate 8B, gynaecology department. You will need to check in once again at the reception on Gate 8B.

In the main reception, there is a coffee shop, pharmacy and a WH Smiths. Vending machines for drinks and snacks are located throughout the hospital.

 

Your appointment will be in a specialist endometriosis clinic, where all degrees of severity of endometriosis are treated, but because we are an accredited centre, severe cases of endometriosis can be treated at our centre.

 

Mr Kremer is a dedicated consultant who is specifically devoted to patients with moderate to severe endometriosis. The supporting consultant is Mr Oboh who cares for patients with mild to moderate endometriosis. You will also have access to a specialist endometriosis nurse who will provides further support.

 

The BSGE ensures that gynaecologists work in appropriate clinical teams, audit their outcomes and maintain their surgical skills by maintaining sufficient workload of complex cases.

 

At our specialist endometriosis centre, you will be cared for by an expert multi-disciplinary team. We work with specialised consultants from colorectal, urology and pain management to deliver a high quality service and follow up care.

 

Our specialists have the expertise to perform complex surgery where necessary.

 

A full list of endometriosis centres can be found online at the BSGE website.

Meet our Endometriosis team

Mr Kremer - Consultant Gynaecologist

Mr Kremer graduated from Medical School in 1984 at University Louis Pasteur in Strasbourg, in France. He worked several years as a volunteer in the Himalayas and in Papua New Guinea and moved to the UK in 1990 and did all his postgraduate training in O&G in the UK. He became a member of the RCOG in 1995 and obtained a Medical Doctorate from the University of Leeds in 2001. He has been a Consultant in O&G at the Trust since the year 2000.
Mr Kremer worked as a general gynaecologist with an interest in keyhole surgery for the first 10 years then developed an interest in chronic pelvic pain. Since 2014 he has been the lead clinician of the Mid Yorkshire NHS endometriosis centre.

Mr Oboh  - Consultant Gynaecologist

Mr Oboh graduated from medical school in 1994, University of Benin Medical school Nigeria. He had his postgraduate training in obstetrics and Gynaecology in the United Kingdom and awarded the CCT in 2008. He has further postgraduate training advanced laparoscopic and hysteroscopic surgery and medical law. He was appointed a consultant obstetrician and gynaecologist in 2008 at Hull University Teaching Hospitals NHS Trust (HUTH).  At HUTH, He provided gynaecology and obstetrics care for high risk women and also a senior clinical tutor at the Hull and York Medical School. He joined the Mid Yorkshire endometriosis team as consultant gynaecologist in April 2020.

Joanne Pursglove - Clinical Nurse Specialist

Joanne qualified as a registered nurse in 2000 from the Huddersfield school of nursing. She worked on the dedicated gynaecology ward at Pontefract Hospital caring for elective surgery and acute gynaecology patients. In 2005 she took on the specialist nursing role in Urogynaecology until August 2017. Joanne was part of the Urogynaecology team nominated for the British medical journal (BMJ) award at the Governor Hotel in London 2009. Since starting the role in August 2017 Joanne has developed more comprehensive patient information leaflets and resources, improved patient contact with a dedicated telephone and email address. Commenced acute, pre and post-operative ward visits, for support and advice. Joanne organised the first information day in association with Endometriosis UK and was also involved in establishing the support group for Wakefield.

Mr Adeshina Fawole - Colorectal Surgeon

Mr Fawole graduated from the University of Ibadan, Nigeria in 1991 and had his specialist General and Gastrointestinal Surgical training in Yorkshire and Leicester. He has a Medical Doctorate from the University of Keele and is a Fellow of the Royal College of Surgeons of England, Edinburgh and Glasgow. He has worked as a substantive Consultant Surgeon at our Trust since 2006. He has a specialist interest in minimal access gastrointestinal surgery.

Mr Mohantha Dooldeniah – Urologist

Mr Dooldeniah studied at Charing Cross and Westminster (Imperial College) and completed basic surgical training on the Hammersmith rotation. He has a PhD in Immunology from the Imperial college. He completed higher surgical training in Yorkshire and was a Consultant in Urology as a pelvic cancer surgeon at Southend Hospital. He returned to our Trust as a Consultant in Urology to set up the minimally invasive cancer service.

Dr Dimple Vyas  - Pain Management Specialist

Dr. Vyas is a Consultant Anaesthetist with special interest in chronic pain management. She has had her undergraduate and postgraduate training in Bombay, India and further training in the UK and has been a consultant for 11 years. Her special interest has been to improve the quality of care for patients suffering from chronic conditions and she has led quality improvement projects and has spent a year at the Institute for Healthcare Improvement in Boston, USA.

Useful resources

Further help and resources