Endometriosis is a relatively common condition.

Cells similar to those usually found in the lining of the womb are found in the pelvis, usually around the ovaries and fallopian tubes. Despite the cells being in abnormal locations in the body they still respond to the normal, hormonal variations in the woman's body and can cause scarring and pain.

There are approximately 2 million women affected by endometriosis in the UK.

Do I have endometriosis?

The symptoms of endometriosis are varied. It is a strange condition whereby a small amount of endometriosis can cause a lot of pain and vice versa. The pain of endometriosis tends to be located in the lower abdomen, often worsening in the week prior to a period with the pain gradually reducing after the bleeding starts. The pain can occasionally be made worse by having sex or indeed when going to the toilet and opening the bowels.

Sometimes endometriosis can have no symptoms and be an incidental finding being diagnosed during investigations for difficulty conceiving or during surgery for ovarian cysts (which can occasionally be caused by endometriosis).

What investigations might be required?

Endometriosis may be suspected after a consultation; an internal examination can sometimes often detect signs of suggestive of endometriosis. An ultrasound scan may be required to look for ovarian cysts related to endometriosis. An ultrasound however will not detect the typical spots of endometriosis that usually cause the pain. The best technique for diagnosis (and treatment) is a laparoscopy (keyhole surgery) to examine the inside of the tummy.

What treatments are available?

Treatment options include a spectrum of things from simple reassurance to surgery.

Simple treatments include pain relief and coping strategies surrounding the pain. Some women find treatments such as aromatherapy and acupuncture helpful.

Medical treatments all aim to suppress the natural menstrual cycle stopping ovulation (the release of eggs). These treatments are therefore useful for symptoms of pain but cannot be used if infertility is the main problem. The common medical treatments include the combined oral contraceptive pill (COCP), progestogens or Gonadotrophin-releasing hormone antagonists. There is a relatively high recurrence rate of symptoms after treatment is stopped.

Surgery is usually performed laparoscopically. The aim of treatment is to remove all spots of endometriosis. Surgical treatment doubles a woman’s fertility and removes pain in 75 – 80% of cases, although the disease can recur in 20% of women 5 years after the operation. In severe cases, a woman may need a hysterectomy or possibly bowel surgery.

Patients with severe endometriosis may require fertility treatments such as IVF to become pregnant.

Further information

You may find further helpful information at the following websites:

Chronic Pelvic Pain

Chronic pelvic pain is a common problem affecting women of any age. The pain can occur on a regular cycle or may only occur at certain times i.e. before and after eating, while urinating, during the menstrual period. Chronic pelvic pain can often disrupt a woman’s work, movements, sexual relationships, sleep and family duties and lead to long-term problems in a woman’s menstrual and clinical health. If pelvic pain lasts for more than 6 months then it is advisable that you consult your doctor to identify an underlying cause.

The causes of pelvic pain are varied. Chronic pelvic pain may be caused by conditions such as endometriosis or fibroids. It may also be secondary to bowel, urinary or musculo-skeletal problems. Because there are varied causes of pelvic pain the process of identifying the underlying problem may be complex and time consuming. Preliminary tests required would include an ultrasound scan and if underlying gynaecological problems were suspected a laparoscopy in order to view the pelvic organs and determine whether there is a gynaecological cause for the problem.

What treatments are available?

Treatment options vary depending on the cause. Pain relief and pain management strategies are the cornerstone of management. Support regarding alternative treatments will also be offerred.

If a specific cause for the pain is found more directed treatment will then be available.

Further information

You may find further helpful information at the following website: