Mr Russ Luker is an established Consultant Gynaecologist at Bath Clinic. He specialises in laparoscopic, hysteroscopic and open pelvic surgery and is a core member of the Gynae cancer service”. Mr Luker has a particular interest in “endometriosis” and so to mark Endometriosis Awareness month, and help raise awareness of this debilitating condition, Bath Clinic Medical Secretary Lucy Edgell who herself suffers with the condition spoke to Mr Luker to get some answers to her questions, with a view to helping fellow sufferers gain a better understanding of the condition.
What is Endometriosis?
Endometriosis is a condition where tissue similar to the lining of the womb starts to grow in other places, such as the ovaries and fallopian tubes. Endometriosis can affect women of any age. It is a long-term condition that can have a significant impact on your life, however there are treatments that can help.
What interested you to get into Women’s Health, specialising in Gynaecology & Obstetrics?
I had an epiphany as a medical student! I had thought that I would become a paediatrician until I delivered my first baby in Stoke on Trent. From then on I couldn’t imagine doing anything else.
What are the most common symptoms that patients present with in clinic?
The classic symptoms that we associate with endometriosis include Dysmenorrhea (painful periods), Dyspareunia (painful sex) and Dyschezia (pain on opening the bowels). It is too simplistic to stop there though, every patient has their own story to tell. Discomfort may affect the whole abdomen and sometimes even the chest. Occasionally we see endometriosis in scars following childbirth. Most of the time the menstrual cycle makes the symptoms worse, however this isn’t always the case. The most important thing that any Surgeon can do is to consider the whole story and concentrate on how to improve quality of life, not just to treat the endometriosis on its own.
Brain fog and fatigue - what are the connections with endometriosis?
The effect that endometriosis has on women’s ability to function normally is seriously underrated. Living with pain is incredibly draining especially when sleep is disrupted – we are beginning to appreciate how much good ‘sleep hygiene’ improves our ability to cope. Additionally, some of our treatments can have a big impact on ability to concentrate especially opiate painkillers which in the long term do not offer a great deal of pain relief but have a lot of side effects. Fortunately, we work closely with the chronic pain team who offer holistic support from medication to psychotherapy, we will even recommend acupuncture if it might help!
What are the different non-invasive treatments available before proceeding with definitive surgery?
Making a positive diagnosis of endometriosis is not always necessary before offering medical treatment and if we can improve our patient’s quality of life using simple pain relief or controlling the menstrual cycle with an assumed diagnosis then we might avoid the unnecessary risks and inconvenience of having an operation. Many hormonal treatments are based on contraceptives to avoid the cyclical effect of the menstrual cycle. Alternatively, we can buy fantastic respite from pain by inducing a temporary menopause and use risk free HRT to avoid menopausal side effects. The choice about how to treat the problem changes with each patient; I’m always guided by individual experiences and priorities not least when or if patients wish to become pregnant.
“Raising awareness of bad experiences even before attending a consultation”- how do you make a patient feel confident and safe when seeing you in clinic?
It’s sad to say that women still find it difficult to get to speak with a gynaecologist about whether they might have endometriosis. “Only today I heard from a patient who was told that women should put up with period pain – I was appalled!”
Many patients don’t really know what to expect when they get to see me and perhaps the very best thing I can do is to just listen and try to make sense of the whole story; that might not be possible in just one visit! It’s not just the physical symptoms or even the endometriosis itself – we need to consider how to improve overall quality of life.
Pain with sex - what is out there to help?
Wow! How long have you got? Endometriosis can affect relationships (not just sex!) in so many ways. Explaining about the effect that chronic illness has on our patients sex lives has revealed firstly there is plenty that we can do and secondly illness need not be a barrier to a fulfilling sex life. We shouldn’t concentrate only on the effect of pain during intercourse but consider how this affects the relationship as a whole.
Endometriosis in the workplace, what are your thoughts on this, why is this still a stigma?
I find it amazing that some women have fantastic supportive workplaces who accommodate when work can be challenging. However, many women still feel the stigma of talking about something that is deeply personal. Fortunately we have all had to reassess how we can work most efficiently in trying circumstances and Endometriosis.org’s friendly employer scheme will help make that discussion easier (https://www.endometriosis-uk.org/endometriosis-friendly-employer-scheme).
What do you hope for the future of endometriosis?
The more I look at endometriosis and the more stories that I hear, I understand how subtle and complicated endometriosis and pelvic pain is. Sometimes I meet patients with minor endometriosis disease but who have life changing pain and I realise (again) that the endometriosis itself is not the important part of the diagnosis. There isn’t going to be a miracle cure for a long time to come, however I do believe that improving access to good quality holistic care is going to reduce the amount of misery that our women have to face.
