Endometriosis

Our team understands the difficulties you face living with endometriosis and chronic pelvic pain, quality of life, and you will be fully involved with all decisions regarding your treatment.

Our surgeons are experts in laparoscopic surgery to manage all grades of endometriosis ranging from mild disease to the most severe form involving the bladder and bowel. We also have access to dedicated Pelvic Pain clinic and Homerton Fertility Centre if further expert opinion needed.

The HEC operates an outpatient clinic with a comprehensive patient centred approach to the care of women with endometriosis and pelvic pain.  You will have the support of an endometriosis specialist nurse throughout your care in the hospital and in the community.

The British Society of Gynaecological Endoscopy (BSGE) has recently set up accredited centres for the laparoscopic treatment of advanced endometriosis to enable high standards of care to be delivered to women with endometriosis. We have recently been certified as an accredited centre by the BSGE. In line with these requirements we run a nurse-led follow-up service to audit and assess our outcomes of surgery.

What will happen at your first clinic appointment
At the first appointment, you will be given the BSGE pelvic pain questionnaire to help us understand your problems and to find the most appropriate treatments. It may also help you to formulate your thoughts on your symptoms and the way in which they can affect your quality of life.

Then a detailed history will be taken by the specialist doctor about your symptoms and the extent to which your lifestyle is being affected. This will help to build the basis upon which the treatment will be planned. 
A detailed treatment plan will be made at this visit; information will be given about endometriosis and available treatment options. At this appointment you will have the opportunity to discuss your treatment and any concerns.
Any necessary investigations will be arranged (ultrasound scan and blood tests) and a laparoscopy (looking inside the abdomen) or hysteroscopy (looking inside the womb) will be arranged.
Where appropriate a further appointment will be made to discuss the results of the investigations and plan the treatment.

What do we offer
There is a fortnightly clinic consisting of experienced Consultant Gynaecologists, two Clinical Nurse Specialists, Senior Specialist in Endometriosis and Gynaecological Ultrasound Scan that can perform scanning to plan your treatment. The nurse specialists run additional clinics on a regular basis.

Women are invited to attend for an initial assessment in one of the clinics where all the options for treatment are discussed. Investigations are arranged and the patients are given information with regards to treatment options. At the next visit the results are reviewed with one of the medical staff and the opportunity is given to ask questions and make a decision about preferred treatment options.

We participate in the national database to contribute to the pool of information with regards to the laparoscopic surgical treatment and follow up of patients with endometriosis. Please be assured that the information you provide will be kept confidential. This data will be anonymised in accordance with Data Protection legislation and entered into a central database together with the results of clinical examination and any tests that you may have. The findings and results of any surgical intervention that you may have will be recorded and assessed, as will any responses to follow-up questionnaires.

Treatments available

Hormone treatments
The aim of hormone treatments is to limit or stop the production of oestrogen in your body. If your pain is related to your menstrual cycle putting your body into an artificial state of pregnancy or an artificial state of menopause may help you.

Some of the hormone-based treatments we use are:

• Progestogens (e.g Norethisterone)
• The combined oral contraceptive pill
• Gonadotrophin-releasing hormone (GNRH) analogues (Zoladex / Gonapeptyl)

• Laparoscopic surgery
  Laparoscopy (also known as keyhole surgery) is commonly used in the treatment of various problems which include

• Endometriosis
• Hysterectomy
• Ovarian cysts
• Fibroids
• Adhesions (this is where internal organs are stuck to each other)
• It may also be used to help diagnose the cause of your symptoms and this is called a diagnostic laparoscopy.

• You will usually be able to go home on the same day as your surgery.
  For more extensive surgery, patients have an overnight stay in hospital and are discharged later after review.

• Pain management
  Learning to manage your pain rather than the pain managing you is a very important factor in your care, you will be given advice on how to take medications in conjunction with other treatments and lifestyle changes to improve your quality of life.

  Deciding what treatment
  Your gynaecologist will discuss the treatment options with you and outline the risks and benefits of each. Treatment may not be necessary if your symptoms are mild and you have no fertility problem. One course of action is to keep an eye on symptoms and decide to have treatment if they get worse. Advice on diet, exercise and complementary therapies may help you manage your symptoms.

  Philosophy of care
  We understand that endometriosis and long term pelvic pain are chronic conditions and can be very difficult to live with. As well as physical symptoms such as extreme pain, infertility and heavy menstrual bleeding, it may also cause emotional, social and economic difficulties.

  All of our team is committed to treating you with kindness, respect and dignity.
  The team will ensure that you have all the information you need regarding treatment options for your condition. You will be involved in all decisions regarding your care, and together we will create a treatment plan that suits your circumstances.
  We will continue to support you once your treatment is completed. The specialist nurse is always available for you to contact if you need advice or someone to discuss your concern.