We perform a wide range of investigations in our practice which may then lead onto surgical management to resolve the outstanding symptoms.

Smear Abnormalities

Urinary Incontinence

Prolapse

Menstrual Disorders

Pelvic Pain and Endometriosis

Hysterectomy

Infertility

Contraception

Endometrial Ablation

Non-Invasive Prenatal Testing

Pelvic Pain and Endometriosis

Introduction

Endometriosis is a very common condition affecting at least 1 in 10 women. This equates to 179 million women worldwide (many of whom are in the reproductive age range). The condition affects all ethnicities and social backgrounds, and a family history of endometriosis can increase the chances of endometriosis six fold.

What causes endometriosis?

The exact cause of endometriosis is unknown. The most commonly accepted theory relates to menstrual or period blood passing backwards along the fallopian tube from the uterus and spilling into the pelvis. The cells then implant in the pelvis and continue to grow as endometriosis.

Where endometriotic cells implant within the muscle of the uterus (myometrium) we refer to this condition as adenomyosis.

What are the symptoms of endometriosis?

The most common symptoms are pelvic pain, painful periods, pain during or after sex, impaired fertility and pregnancy loss. Some women have pain when they open their bowel or pass urine, while some women have no pain or symptoms of any kind. Others only discover they have endometriosis when investigated for fertility. 

Other symptoms associated with endometriosis are; low mood, fatigue, poor sleep, headaches and anxiety, and even significant depression. Adenomyosis may contribute significantly to heavy menstrual loss and pelvic pain.

How is it diagnosed?

It can be difficult to diagnose endometriosis on the basis of symptoms only. Often symptoms will mimic other conditions such as irritable bowel syndrome, pelvic inflammatory disease, normal period pain or bladder inflammation. The only way to make the definite diagnosis is by laparoscopy (keyhole surgery). 

Referral to a pelvic pain / endometriosis specialist:

Where initial investigations have failed to reveal an underlying cause for pelvic pain, referral to a pelvic pain specialist is recommended. A full assessment by the specialist will cover all related areas of concern as well complete a set of investigation in order to initiate the best treatment plan possible to provide the best outcome for you.

Management

Unfortunately, many women go an average of nearly a decade before their symptoms are accurately diagnosed and appropriately treated. Early referral to a pelvic pain specialist is recommended.

Treatment plan for Pelvic Pain / Endometriosis will include:

1. Complete Initial assessment and examination.
The initial assessment may take up to 45 minutes to complete. Your specialist will then review investigations which have been completed to date and arrange for any additional tests that may be required.

2. Treatment plan for each symptom.
A management plan to deal with the presenting symptoms will be developed. Symptoms particularly focused on are:

  • Fatigue, low mood, poor sleep, anxiety, chronic pain conditions

  • Painful period.

  • Muscular pelvic pain and pain with sex.

  • Bladder and bowel symptoms.

3. Medical options:

A wide range of effective treatments are available. The most effect option is a combination of specific drug therapy combined with surgical investigation and treatment. Surgery is most commonly undertaken as Keyhole surgery, also referred to as laparoscopy. Each woman will have a treatment plan customised for the severity of her condition. In addition, complementary medical therapy, dietary advice and life style modifications may also be considered by the pelvic pain team.

How to make a decision about treatment
Each woman will be given specific information about the different options available to her and how she may benefit from these. Some factors may influence her decision, such as;

  • Age

  • Symptoms

  • A wish to have children

  • revious treatments and their effectiveness

  • Feelings about surgery

  • Other medical problems

  • Living with endometriosis

Pelvic pain is often multi-factorial.  It is important to review other possible causes in addition to endometriosis.

Complementary therapies have been used by some women to relieve pelvic pain symptoms; e.g. Yoga, naturopathy, dietary modification, gentle exercise and life style modification. We can help you with these options. Joining a support group has been found to helpful for some women.

In some cases it may be more appropriate to help manage symptoms rather than focus on treatment. If a partner is willing to become involved in your treatment their support and understanding of your pain and associated problems becomes part of the management programme. A counsellor with expertise in pain management can be arranged to see you and your partner, as part of the management.