What happens at the first appointment?
At the first appointment (30 mins) a detailed history is taken and a carefully examination is performed. Patients are asked about their symptoms and the extent to which their quality of life is being affected. A trans-vaginal Ultrasound scan is used to visualise the pelvic organs.
The information gathered forms the basis upon which a detailed individual treatment plan is made in discussion with the patient.
Information is provided about endometriosis and all available treatment options. At this appointment there is also the opportunity to discuss issues concerning details of treatment and any future fertility concerns. Any other necessary investigations are arranged (blood tests, MRI) and if indicated a laparoscopy (looking inside the abdomen) and/or a hysteroscopy (looking inside the womb) are arranged. If desired, these can normally be performed within a few weeks.
Following investigations or surgery there is a further consultation. This is arranged to check patient progress and review findings. This includes a review of all the scans MRI and surgical images to further improve understanding of the nature of the endometriosis and the surgery that has been performed.
This is also an opportunity to discuss fertility plans and future treatment options.
Treatment for Endometriosis
Aims of treatment:
- Pain relief
- Reducing endometrial growth
- Removing the endometriosis by excision
- Delaying recurrence of the disease
- Optimizing and preserving fertilitypro
For effective long-term treatment of endometriosis various treatments are available. The treatment varies according to a variety factors:
- Age at diagnosis
- The severity of symptoms
- The severity of the disease
- Most importantly, the desire to have children
The treatment is carried out as a partnership between the patient and doctor.
Conservative management (‘wait and see’)
If the symptoms are very mild, fertility is unaffected or if menopause is approaching, this approach may be suitable.
Pain Management in endometriosis:
- Diclofenac (Voltarol)
Painkillers reduce pain but do not treat the endometriosis. They reduce inflammation and block pain receptors.
Neurogenic pain is best treated with nerve blocks or drugs that work directly on the nervous system. We have close links with a pain management team if these are deemed necessary.
We need to be careful on how readily we give out powerful pain killers as they are addictive and their efficacy decreases with time.
Many women will seek to use complementary therapies to help with their endometriosis. This may often help to deal with difficult, persistent symptoms, or energy levels, which can be very low in endometriosis. At present there are no clinical trials that conclusively show benefit but many women still find this approach extremely useful. Options include acupuncture, Chinese or Western herbs, homeopathy and dietary changes.
We have close ties to various clinics within the Harley Street area and can arrange appointments, if this is an area, which needs to be pursued.
It always feels good to take control and to take positive action.
Drug treatment for endometriosis
- May bring about an improvement in the pain symptoms
- May shrink or slow down the progression of the condition
- Is commonly used before surgery or before IVF treatment
- Delays recurrence of the disease
- Is NOT effective in the long term
Commonly used drugs:
- Medroxyprogesterone (Provera)
- Dyhydrogesterone (Duphaston)
- Norethisterone (Primulut)
- Triptorelin (Gonapeptyl)
- Goserelin (Zoladex)
- Leuprorelin (Prostap)
GnRH virtually stop all ovarian activity. They stop the ovaries working and thus reduce the production of oestrogen. This results in a temporary but reversible state of menopause (not actual menopause). These drugs are used prior to surgery to shrink and reduce the vascularity in the endometriosis and to facilitate surgical treatment.
These drugs are given as an injection once a month for three to six months but may be sometimes used for longer.
- Combined oral contraceptive pill
- Mirena coil
- Depo- Provera
With the exception of the oral contraceptive pill the Mirena coil and Depo-Provera, none of these drugs offer effective contraception and alternative contraception must be used.
All of the hormonal treatments have potential hormonal side effects, these include:
- Hot flushes, sweating
- Mood wings
- Vaginal dryness
- Decreased sex drive
- Osteoporosis with longer use
If these menopausal side effects are severe or treatment is prolonged then Hormone Replacement Therapy is given in the form of Tibolone, a synthetic steroid with oestrogen like activity.
Gonapeptyl or Zoladex must NOT be taken:
- If there is any suspicion of possible pregnancy
- During breast feeding
- If abnormal vaginal bleeding is present
Because there is an initial hormone surge with this treatment, symptoms of endometriosis and ovarian cyst size may temporarily increase with the first injection of GnRH. Similarly, the first period after the injection may be irregular and painful. These problems usually settle down after the second injection. Gonapeptyl is not a cure, as the symptoms recur when the treatment is discontinued, although the interval of reappearance of symptoms varies from one person to another.
It is important to remember that the use of Gonapeptyl or Zoladex does not guarantee contraception.
Medical treatments can be tailored towards the symptoms in individual patients.
The number of periods and the severity of periods are reduced by taking hormones. The disadvantage is that these are also contraceptive and are therefore not always acceptable.
Pain killers may help but can be addictive.
Sometimes the medical choices that are available are not terribly appealing!
Treating Endometriosis and Preventing Recurrence:
Endometriosis is a chronic disease that can also recur with the painful symptoms coming back. About 25% of women are likely to have recurrence of endometriosis within five years of treatment. In a few women, this recurrence comes earlier. This probably depends on how well the initial surgery is performed and how much of the endometriosis is removed, however, it is important to discuss the various medical methods of reducing the risk of recurrence.
For further information:
The National Endometriosis Society
Westminster Palace Gardens
1-7 Artillery Row
Tel: 0207 222 2781
Tel: 0870 7743665