Welcome to the Endometriosis Centre

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 endometriomas.
  • You have recurrent endometriosis.
  • You have significant pain or infertility problems.

In which case, your care will be transferred under Mr Kremer.

The Mid Yorkshire NHS is a BSGE accredited endometriosis centre. (British society gynaecology endoscopy)  Mid Yorkshire NHS Endometriosis Centre BSGE Certificate 2020 

What this means to you

  • Mr Kremer is a dedicated consultant who is specifically devoted to patients with moderate to severe endometriosis. Supporting consultant is Mr Oboh who cares for patients with mild to moderate endometriosis.
  • 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.
  • 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.
  • Care  at a specialist endometriosis centre is within a MDT (multi-disciplinary team) This means that named consultants from colorectal, urology and pain management support the service and attend complex surgery where necessary and participate in giving the best advise surgery and follow-up care.
  • You will have access to a Specialist endometriosis nurse who will be available for support.

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

Please click on the links below to find out more information:

What is Endometriosis?
Endometriosis treatment
Meet the Endometriosis team
Endometriosis support & events

 

What is endometriosis?

womb

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 1 in 10 women have endometriosis and it takes an average of 7 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.
 

How do I get referred?

There are two routes

  1. Your GP will have to refer you into the hospital for assessment
  2. Another consultant may refer you to Mr Kremer/team 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 is fertility issues link to Calderdale fertility services
  • if surgical and medical management is required
  • women request a referral.

What will happen at my appointment?

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

  • You will be asked to complete a pelvic pain questionnaire before your appointment.
  • You will have your weight, height and BMI (body mass index) measured.
  • A complex history will be taken by the consultant.
  • A vaginal examination may be required.

Click here for a list of questions that will be asked and useful information to bring to your appointment.

 

Investigations

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

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

 

Treatment options

The aims of treatment is to take into account your circumstances, symptoms, priorities, desire for fertility, aspects of daily living, work, study, physical and emotional issues.

In cases of severe/complex endometriosis we have an MDT (multi-disciplinary team) to review best management.

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 see link - 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

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. Extra list are on occasion at Dewsbury. No gynaecology surgery is performed at Pontefract.

Where can I access the service?

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 large restaurant, costa coffee shop, Lloyds pharmacy and a WHS Smiths. Water fountains and Vending machines for drinks and snacks are located throughout the hospital.

Working hours and contact details

  • Mr Kremers specialist endometriosis clinic is held on a Thursday afternoon 1330 – 1700
  • Mr Oboh Pain and endometriosis clinic is held on a Tuesday morning 0900-1300 and Thursday afternoon 1330-1700.
  • Endometriosis nurse- Joanne Pursglove works Tuesday, Thursday and Friday 0830-1700.
  • Messages can be left at any time via the endometriosis nurse voice mail service on 07803 440236 and will be picked up on the next working day.
  • Alternatively email midyorks.endometriosis@nhs.net
  • Mr Kremer and Mr Oboh's secretary Karen Field 01924 543811
  • Waiting list office 01924 214138
  • Diagnostic Appointment Centre 0844 902 0004 or 01924 512266 The centre is open between 0830am and 6.00pm Monday – Friday. The busiest time is between 0830am – 11.00am


Further help and resources

NHS information on endometriosis - https://www.nhs.uk/conditions/endometriosis

Coping with the symptoms of endometriosis can often lead to feelings of isolation and depression, and a lack of understanding and support from family and friends. Information on support groups can be found www.endometriosis-uk.org 

Forums are often very useful sources of information and support from other women with the same disease can be very therapeutic.

Endometriosis UK has a Covid -19 and endometriosis information hub on medical and self-care advice.

  • Personal Independence Payment (PIP). Help with living allowances - Information on this is on the government website.
  • NICE patient decision guide - Hormone treatment for endometriosis symptoms -  What are my options  https://www.nice.org.uk/guidance/ng73/resources/patient-decision-aid-hormone-treatment-for-endometriosis-symptoms-what-are-my-options-pdf-4595573197
  • PIP can be applied for whether you are working or not. There is also a helpful tool on Citizens advice bureau website on how to fill out the application with guidance and tips.
  • Citizens advice bureau – free, confidential, independent advice on a variety of issues including financial, legal, disability, housing, employment www.citizensadvice.org.uk  
  • Expert patient programme – free courses aimed at helping people who live with long term chronic conditions to manage their condition on a long term basis. www.expertpatients.co.uk
  • The British pain society – the patient section of the website contains lists of UK based pain clinics and suggested reading section. www.britishpainsociety.org
  • Bladder and Bowel Community -This charity provides information and support services, including a confidential helpline anyone who suffers from bladder and bowel control problems.  B&BF www.bladderandbowel.org
  • British Association for Nutritional Therapy (BANT) -Provides information on nutritional therapy and nutrition, how to find a registered nutritionist and how to prepare for a nutritional consultation. Contains a searchable database to allow you to search for local nutritionists. www.bant.org.uk


Meet the Endometriosis team
Endometriosis support & events