Endometriosis

There are different types of endometriosis, and it’s possible to have more than one type. The name of each type refers to the location, amount and depth of the lesions.

The 4 types of endometriosis are:

• peritoneal (superficial) endometriosis - is the most common form of endometriosis. This is where lesions are found mainly on the pelvic peritoneum, a thin film that lines the inner surface of the pelvis and surrounds the pelvic organs. These lesions are small and superficial, with a depth of invasion of no more than 5 mm

• ovarian endometriosis (endometrioma) - is when endometriosis cysts are found in the ovaries. Lesions can vary in size from a few mm to several cm

• deep endometriosis - is found in locations such as the bladder, bowel and recto-vaginal septum (the tissue separating the vagina and the rectum). These lesions are at a level deeper than 5mm

• extra-pelvic endometriosis - is when lesions are found outside of the pelvis, such as the chest and caesarean scars. While endometriosis is relatively common within the pelvis, extra-pelvic endometriosis is considered to be rare

Endometriosis has many symptoms, and these can widely range from person to person.

The main symptoms of endometriosis to look out for are:

• pelvic pain

• painful periods that interfere with everyday life

• pain during or after intercourse

• difficulty getting pregnant

• bowel pain and rectal bleeding during periods

• abnormal vaginal bleeding

• heavy periods

• long periods

• spotting or bleeding between periods

• pain or bleeding when passing urine

• fatigue

• significant bloating around the time of periods

Endometriosis is a complex condition, and what causes it isn’t fully understood. However, experts believe that several factors may contribute to its development. These include:

• retrograde menstruation – this is where menstrual blood containing some endometrial cells flows backwards, through the fallopian tubes and into the pelvic cavity. This results in endometrial-like cells being deposited outside the uterus, where they then implant and grow on organs in the pelvis

• genetics – some research suggests that endometriosis can be passed down through genes. This means you may be more likely to develop endometriosis if someone else in your family has the condition. What causes this remains unclear

• other causes – including endometrial cell transport, immune dysfunction, environmental causes and cellular metaplasia

Endometriosis risk factors

Factors that increase your risk of having endometriosis include:

• never giving birth

• starting your period at a young age

• going through menopause at an older age

• having short menstrual cycles (less than 27 days)

• having heavy periods lasting more than 7 days

• having higher levels of oestrogen in your body

• having a low body mass index (BMI)

• having one or more close relatives with endometriosis

If you have any symptoms of endometriosis, we recommend making an appointment with one of our consultants in our outpatient Women’s Health centre. At a consultation, your specialist will ask you about your symptoms, take your medical history, perform a pelvic examination, and may also run some other tests.

In most cases, your consultant will perform a pelvic ultrasound to identify other causes of pelvic pain and, in particular, to look for endometriosis in the ovaries, where it can cause cysts called endometriomas. In some cases, particularly if severe endometriosis is suspected, a more detailed MRI scan may be helpful.

Currently, the only sure way to make a definite diagnosis of endometriosis is to perform a laparoscopy. This is a surgical procedure where a small camera is inserted through the belly button to look for lesions. This approach not only allows for accurate assessment of the pelvis, but can also be used to treat endometriosis at the same time, by removing or destroying lesions.

Currently, there is no known way to prevent endometriosis. If you suspect you have endometriosis, it’s important to seek a diagnosis as soon as you can, as early management and treatment may help to slow, or even halt, the progression of the condition and reduce your symptoms long-term.

A common concern for many women with endometriosis is how the condition might affect their fertility. Unfortunately, endometriosis is a leading cause of infertility, as the tissue that grows outside of the womb can interfere with how an egg and sperm move within the reproductive system to meet each other for conception.

In addition to this, endometriosis can cause severe pain that can disrupt your daily life and have a negative impact on your overall wellbeing. Depending on where tissue grows, endometriosis can also lead to complications like bowel and bladder problems and shortness of breath or chest pain.

The type of endometriosis treatment you may be offered depends on the severity of your diagnosis, your medical history and your unique needs.

At Welbeck, our consultants offer tailored treatment plans that take these factors into account to ensure you receive the most appropriate and effective care possible.

Treatment options for endometriosis include:

• nonsteroidal anti-inflammatory drugs (NSAIDs)

• hormonal contraception

• ovarian suppression injections (gonadotropin-releasing hormone (GnRH) antagonists or agonists)

• laparoscopic surgery

• hysterectomy

At Welbeck, our consultant gynaecologists and women’s health specialists are experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialities, our consultants are also able to refer within the Welbeck ecosystem if needed to ensure you receive the best possible treatment as quickly as possible, all under one roof.

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.

Get in touch today to book an appointment.