Endometriosis is a condition where cells similar to those within the lining of the womb are found elsewhere in the body. It can be a chronic and painful condition for some women. Around 2 million women in the UK are affected by endometriosis. It is a long-term condition that causes painful or heavy periods and lower abdominal, pelvic or lower back pain. It may also lead to fertility problems.

Presenting Features:

  • Severe Dysmenorrhoea (Painful periods)
  • Deep Dyspareunia (Pain during sex)
  • Chronic pelvic pain
  • Cyclical /Premenstrual pain
  • Infertility
  • Chronic fatigue
  • Dyschezia (painful defaecation)

There is no known cure for endometriosis, although symptoms may be controlled by hormone treatments or painkillers. Women who do not respond may be offered minimally invasive (keyhole) surgery to remove the diseased tissue. This treatment is applied through a special tube called a laparoscope. The standard keyhole procedure to treat this condition is laparoscopic removal or burning of tissue with electrodiathermy (a procedure in which tissue is heated to destroy abnormal cells).

Treatment of endometriosis

  • Medical management (analgesics, COC, progesterone, androgenic agents, GnRH analogues)
  • Laparotomy
  • Laparoscopy (excision or fenestration/ablation)
  • Medical management of endometriosis-related pain with non-hormonal drugs such as non-steroidal anti-inflammatory drugs (NSAID) can cause symptom relief¬†(Grade A, RCOG) (Kauppila et al 1985)
  • All medical treatment seems to be equally effective in relieving pain during treatment (Hughes et al, 2003)
  • Symptom recurrence following six months of medical treatment may be as high as 50% in the 12 – 24 months after treatment is stopped (Matorras R et al, 2002)
  • Laparoscopic ablation/excision of minimal to moderate endometriosis has been shown to relieve pain (Grade A, RCOG)

Effect on fertility

Laparoscopic resection or ablation of mild to moderate endometriosis improve the chances of pregnancy (Marcoux, 1997). This study found that 30.7% of patients became pregnant in the laparoscopic ablation/resection group compared with 17.7% in the diagnostic laparoscopy group (p<0.006).