It can often be dismissed as “women’s troubles” but endometriosis is a serious condition and if left untreated can be severely debilitating. It is something which affects as many as one woman in 10, of reproductive age – according to Endometriosis UK who also say it is the second most common gynaecological condition in the UK. It affects 1.5 million women – which is comparable to the amount of women affected by diabetes.
But despite these numbers it can often go unreported and undiagnosed or misdiagnosed for years and women simply put up with the pain. Women can also find that there are long NHS waiting lists to see a specialist.
At Benenden Hospital there is a women’s health team who specialise in the diagnosis and treatment of the condition. Private patients can be seen quickly by one of the specialist and expert consultants. The Hospital also caters for members of Benenden and some NHS patients under the e-referral scheme.
One member of the team is Gynaecologist Elias Kovoor. Mr Kovoor is an endometriosis surgeon, who also works at the Maidstone and Tunbridge Wells NHS Trust Endometriosis Centre, which is accredited by the British Society for Gynaecological Endoscopy. Much of his training was in France and Japan where advanced laparoscopic treatment is carried out on patients who have the condition.
Mr Kovoor said: “It is very important that endometriosis is diagnosed and treated early. Studies have shown that on an average it takes seven years for diagnosis but fortunately this is now getting better due to increased recognition.
“Pain and fertility issues are the most common problems caused by endometriosis. In advanced cases it may also affect the function of other pelvic organs like the bowel and kidneys. Referral to an endometriosis specialist is recommended If patients get breakthrough period pain in spite of being on hormonal treatment or if they have dyspareunia (pain during sex), dyschezia (pain on opening bowels during periods) or bleeding from the back passage. Hormonal interventions like the Pill can effectively control symptoms and stop progression of the disease.”
Endometriosis is a common condition where tissue that behaves like the lining of the womb (endometrium) is found in other parts of the body.
It can appear in many different places, including the ovaries, fallopian tubes, inside the tummy and in or around the bladder or bowel. Caesarean section scars are also another common site of endometriosis.
Endometriosis mainly affects girls and women of childbearing age. It's less common in women who've been through the menopause.
Diagnosis is confirmed by laparoscopy where a surgeon passes a thin telescope through a small cut in the tummy to see if there are any patches of endometriosis tissue in the patient’s body. Ultrasound scans are not good enough to see endometriosis unless the ovaries have endometriotic cysts. MRI scans may sometimes be required if there is suspicion of severe disease.
Currently there is no cure, but there are treatments which can help ease symptoms, such as painkillers, hormone medicines like contraceptives and surgery.
Mr Kovoor said: “Endometriosis can affect fertility and is one of the major causes of female infertility. There is good evidence that surgical excision of endometriosis in early stages improves fertility. However, in advanced cases the role of surgery in fertility is less clear.
“Apart from fertility, surgical intervention is often needed when symptoms are severe or if there is compromise of organ function. Surgery in severe endometriosis can be quite complex and hence is best done by specialist surgeons. Following surgery patients need to stay on hormonal treatment to prevent recurrences unless they are trying for pregnancy.
"Hysterectomy and removal of ovaries is often considered as the last resort in patients who have completed their family. This requires careful assessment and it is important that all endometriosis outside the uterus is also removed at the time to prevent any relapse of symptoms."
Endometriosis is being seen more commonly now than before. This could be because of increased awareness and recognition both by healthcare professionals and by patients. Pregnancy and breast feeding can cause regression of the disease. Delaying pregnancies and having fewer children may play a role in disease progression.
It is very important that endometriosis is diagnosed and treated early. Studies have shown that on an average it takes seven years for diagnosis but fortunately this is now getting better due to increased recognition".
Mr Elias Kovoor
Published on 31 July 2017