Mr C P Lim, Consultant Gynaecological Surgeon and Endometriosis Specialist
Mr C P Lim gives us a broad insight into Endometriosis, pelvic pain, associated signs and symptoms and more.
What is Endometriosis?
When women have periods, they bleed from the lining of the womb. For reasons often unexplained, tissue similar to the lining of the uterus is sometimes found elsewhere in the pelvis and other parts of the body, most commonly causing pelvic pain during the time of periods. The presence of the tissue outside of the womb is what we call Endometriosis. During periods, the tissue outside of the lining of the womb also bleeds, causing inflammation and pain and when this happens in an ovary, a blood cyst usually develops over a period of time.
How common is Endometriosis?
An estimated 1.5 million women in the UK suffer with Endometriosis. Studies estimate that 1 in 10 women have Endometriosis. Women who have difficulties falling pregnant can also tend to have Endometriosis, as it is reported in up to 50% of women with subfertility.
Is Pelvic Pain always Endometriosis?
Not necessarily. However, extremely painful periods are a common symptom of Endometriosis. If the pelvic pain is significantly affecting quality of life, Endometriosis should be considered as a possible underlying cause. Often, the pain starts to build up the week before an individual’s period begins and can persist until the cycle has ended.
If a woman’s pelvic pain is not related to her periods, it is less likely to be Endometriosis. Other gynaecological causes to consider could be Ovarian Cysts or scarring from previous surgery.
Doctors often offer women complaining of pelvic pain an ultrasound scan as a first line investigation. But a normal ultrasound scan does not exclude Endometriosis – it is advised that you book an appointment with a Gynaecologist to go through a detailed clinical history and assessment.
Are there any other symptoms that can point towards Endometriosis?
- Severe pain and discomfort during sex
- Pain during bowel movement
- Deep shooting pain within the back passage
- Significant bloating
- Fatigue
How can a woman discuss referral to a Gynaecologist with a GP if they think they may have Endometriosis?
It’s important to remember that you know your body best. If something doesn’t feel quite right and you have been experiencing any of the symptoms associated with Endometriosis, you should be direct with your GP regarding your concerns and let them know that you would like to be referred. Having said that, it is not unreasonable for GPs to start by trying a period of hormonal contraceptives as initial treatment for Endometriosis. This is because hormonal contraceptives often work in reducing pain so if this works in the first instance, women could avoid or delay more invasive intervention.
What will the Gynaecologist do when are referred for consideration of Endometriosis?
We would usually take a detailed history from the woman and review any scans that may have already been done. If the likelihood of Endometriosis is high, the woman will be offered a variety of available treatment options. These can vary from pain management, hormonal medication to surgery. Sometimes women may require a Hysterectomy dependent on the severity of the condition. We individualise the care to each woman because every woman is different. If surgery is required, the vast majority of surgery for Endometriosis is best done by Laparoscopy. This is commonly referred to as ‘key-hole surgery’ because it involves making a few incisions 1cm in size in various parts of the abdomen assisted by a high-definition camera. If a Hysterectomy is required, this can often also be done by key-hole surgery now by many Gynaecologists. These operations must be done under general anaesthetic.
Is there a difference between an Endometriosis specialist and a general Gynaecologist? Do all women with possible Endometriosis need to see a specialist?
Women can be reassured that the majority of general Gynaecologists are very well qualified in managing Endometriosis, both surgically and non-surgically. Endometriosis specialists have additional expertise in advanced Laparoscopic surgery in order to tackle more complex endometriosis that may be situated in unusual locations when the disease is very advanced. If endometriosis is found to be particularly complex by the Gynaecologist, they can refer the case to a specialist Endometriosis surgeon.
Where can women get more information?
There is an established charity called Endometriosis UK, their website offers wealth of useful resources and accurate information on Endometriosis. It is also worth taking a look on social media to try to establish whether there are any informative accounts or support groups that you can join. To get the most individualised information, it would be best to discuss your symptoms or previous treatment experience with a doctor or Gynaecologist.
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