Endometriosis treatment

Endometriosis is a long-term condition that causes tissue similar to the lining of the uterus (the endometrium) to grow outside the uterus (womb). It can grow in places such as on the ovaries, fallopian tubes, bowel, or bladder. In less common cases, endometriosis can also be found in areas of the body outside the pelvis, such as the chest.

This tissue grows and changes in response to monthly hormones in your menstrual cycle, just like the womb lining does. It builds up and bleeds each month but can’t be released through a period as your womb lining is. Endometriosis can cause pain, internal scarring (the formation of adhesions), and fertility problems, among other symptoms.

Types of endometriosis

There are four different types of endometriosis you may experience. You may also experience more than one. These types are determined by where the lesions are located, the amount, and the depth of their growth.

These include:

• Peritoneal endometriosis – this is when tissue grows on the lining of the abdomen (belly or tummy) and around the organs found in the abdomen
• Ovarian endometriosis – this is when endometriosis cysts called endometriomas are found in the ovaries
• Deep endometriosis – this type of endometriosis is found in locations such as the bladder, bowel, and tissue separating the vagina (rectum recto-vaginal septum). The lesions are at a deeper level than peritoneal endometriosis
• Extra-pelvic endometriosis – this type of endometriosis is found outside of the pelvis, such as in the chest or on caesarean scars

The cost of endometriosis treatment will depend on your individual circumstances. At the time of your appointment, your consultant will discuss all options with you and ensure all your questions are answered.

Our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant's outpatient appointment consultation fee are charged separately.

Our flexible payment options help you spread the cost of your payment across a time period that suits you.

The most common symptom of endometriosis is pain in the pelvis. You may feel this pain mildly or intensely. This pain is often felt worse just before or during your periods. You may also experience pain during or after sex and when opening your bowels or passing urine, especially during your periods.

Other common symptoms include:

• Feeling very tired (fatigue)
• Bloating
• Nausea
• Diarrhoea or constipation
• Excessive bleeding
• Trouble getting pregnant or infertility

In some cases, you may not experience any symptoms at all. Typically, people who have no symptoms discover they have the condition when struggling to get pregnant or have surgery for a different reason.

Doctors don’t know exactly what causes endometriosis. However, research is being done to find the exact reason for the condition. There are some theories about what the possible reasons may be.

These include:

Retrograde menstruation

This is when menstrual (period) blood flows back into the fallopian tubes and abdomen instead of out of the body.

Immune system condition

Your immune system may not recognise endometriosis tissue and therefore not clear away misplaced cells.

Hormonal imbalances

Changes and imbalances in your hormones, especially oestrogen, are suspected to have an effect on endometrial cells.

Family history

There has been a strong found connection between family history of endometriosis and the increased risk of the condition.

Cell changes

Cells, called peritoneal cells, are suspected to change because of hormone or immune factors into womb-like cells outside of the womb.

You know your body best, and you know when something is not right, especially when it comes to your menstrual cycle. We advise seeking a doctor if you are experiencing any of the following:

• If your periods are so painful that they interfere with daily life
• If your menstrual bleeding is unusually heavy or irregular
• If you are still experiencing pain despite taking over-the-counter pain relief (e.g. paracetamol or ibuprofen)
• If you notice symptoms of fertility issues or infertility (e.g. trying for pregnancy for over 12 months without success)
• If you notice that you are experiencing bowel or urinary symptoms linked to your menstrual cycle

At Circle Health Group, we work with experienced consultants specialised in women’s health. Our experts can thoroughly investigate your symptoms and guide you on what the best next steps may be for your condition.

If you have been diagnosed with endometriosis, there are many treatment options available to help you tackle your symptoms and manage your condition. It is important to discuss your options with your consultant, as they can help guide you on which treatments may be best for your individual needs.

Current treatment options include the following:

Non-surgical treatments

Pain relief medications

Over-the-counter pain medication, such as ibuprofen or paracetamol, can be used to help manage mild pain. If your pain is severe, your consultant may prescribe stronger painkillers to provide stronger relief.

Hormone therapy

Hormonal contraceptives are useful to help control the hormones that can trigger endometriosis. They can help make periods lighter and less painful. These can include:

• Combined oral contraceptive pill (also known as ‘the pill’)
• Contraceptive patch
• Contraceptive injections

Progestogen medications are also helpful types of hormone treatment for controlling endometriosis. They are synthetic hormones that can emulate the female hormone progesterone, which usually naturally stops the womb lining from growing. This type of treatment helps stop menstrual periods and the growth of endometriosis tissue.

These can include:

• Intrauterine system (IUS, also known as ‘the coil’)A contraceptive implant that is placed under the skin of the arm
• Birth control injections, such as Depo-Provera
• Pill treatments, such as Desogestrel, Levonorgestrel, Etonogestrel, and Medroxyprogesterone acetate

Dienogest is a new progestogen pill treatment available for patients. It helps relieve symptoms of endometriosis by lowering oestrogen levels and reducing inflammation.
GnRH injection medication (GnRH analogue) is a hormone treatment that can help manage endometriosis symptoms. It helps stop the ovaries from being stimulated, stopping the production of oestrogen. This causes endometriosis to become inactive and not grow, because endometriosis is an oestrogen driven condition. Ryeqo is also a new all-in-one tablet treatment that contains a GnRH antagonist.

Due to the ovaries being ‘turned off’, this can put you into a temporary, reversible menopause. 

Hormone treatment options are typically recommended if you have expressed that you don’t want to become pregnant, either currently or not at all.

Supporting lifestyle

Things such as heat packs, exercise, diet changes, and talking therapies (such as CBT therapy) can help you manage your symptoms.
Maintaining a healthy weight range has also been found to be beneficial for those with endometriosis.

 

Surgical treatments

Laparoscopy (Keyhole surgery)

A laparoscopy is a low-risk and minimally invasive surgical procedure used to diagnose and treat endometriosis. A long, thin tube with a small camera on the end is used to look inside the abdomen (tummy or belly). This is called a laparoscope.

During the surgery, endometriosis tissue can be removed or destroyed. This can help improve your symptoms, such as pain, and your chances of fertility. Laparoscopy is typically considered when someone has the following symptoms:

• Bleeding
• Infertility
• Pain during intercourse (sex)
• Chronic pelvic pain
• Problems urinating
• Pain during bowel movements

Hysterectomy 

This surgical procedure involves removing your womb and possibly other parts of your reproductive system to ensure that all the endometriosis tissue is removed. This is done using different techniques, depending on your case and what needs to be removed.

It is typically considered if your symptoms are very severe, other treatment options haven’t worked, and you are certain that you don’t want to conceive in the future.

 

Will I need more than one treatment?

Many people benefit from combining treatments and trying different methods together over time to see whether or not they are effective. For example, you may have keyhole surgery to remove endometriosis and then use hormone treatment, such as the pill, afterwards to help stop it coming back.

During your initial consultation, your consultant will discuss with you any relevant symptoms you have been experiencing, your medical history, and your family history. Depending on their assessment, they will recommend a number of different tests to help determine whether you have the condition.

It is important to be honest about your symptoms in this appointment, as it will help your consultant understand how your symptoms affect your daily life. It can also help them rule out other causes of your pain or bleeding and decide what the best next steps might be. To keep a track of your symptoms, keeping a diary of the type of symptoms and their frequency is very useful.

Tests that may be recommended include an ultrasound scan, pelvic exam, or an MRI scan. An ultrasound may be used to look for cysts on the ovaries. A pelvic exam may be done to check for any unusual changes. These changes can include cysts on your reproductive organs, any painful spots, irregular growths, and scars behind the womb. An MRI scan is sometimes done if the endometriosis is more complex, especially to rule out deep endometriosis or if the condition is suspected to be in the bowels.

In the past, to determine whether you definitely had endometriosis, a diagnosis could only be made if the condition was found during a laparoscopy test. Now that scan techniques have improved, endometriosis can be diagnosed without the need for a laparoscopy. A laparoscopy test may still be recommended if no endometriosis was detected with an ultrasound and MRI, and if medical treatment has not relieved your symptoms.

Blood tests are not usually recommended to diagnose endometriosis.

Your endometriosis treatment will depend on your symptoms, whether you want to get pregnant, your age, and your feelings about the options available to you. Your consultant will work with you to help you choose what feels right.

If your ability to conceive after treatment is an important consideration for you, we advise talking to your consultant about the available fertility options you may be able to undergo before treatment.

Preparation before treatment will depend on the type of treatment you will be receiving.

Preparation for non-surgical treatment

Typically, you will need little to no preparation before going through non-surgical treatment. If you are taking medication, your consultant will assess any current medication you are taking and will advise whether to stop or continue your current medication alongside endometriosis treatment.

If you are getting the coil fitted, there are some preparations to consider before going through with the procedure. These include:

• Make sure you eat breakfast or lunch beforehand
• Take a mild painkiller an hour before your appointment
• You will need to bring a sanitary pad to the procedure
• Make sure you have somebody you can contact, or bring someone you trust along, in case you feel unwell after the procedure
• Arrange to take it easy and care for yourself for the rest of the day, e.g. try to avoid work commitments

If you have any questions about any non-surgical treatment options and how they might impact your day-to-day life, please talk to your consultant, and they can answer any queries you may have.

Preparation for surgical treatment

In the days before surgery, your consultant will tell you what time to arrive, when to stop eating and drinking (you need an empty stomach during surgery) and, if necessary, when to stop or start certain medications. You will also be asked to stop smoking days or weeks before the procedure, as it can affect your ability to recover effectively.

It is recommended that you bathe or shower before your surgery, as you will not be able to shower for a while after the procedure (your incisions need to stay dry to heal).

If you are staying overnight or want to be prepared in case you are kept overnight, you should bring an overnight bag with essentials. This can include pyjamas, spare underwear, a toothbrush and paste, sanitary pads, and a spare pair of clothes.

You will need to arrange to have someone you trust pick you up after your appointment or hospital stay, as you won’t be able to drive after the procedure.

Non-surgical treatment

For non-surgical treatment, you may notice your symptoms change or improve as time goes on.

If you notice that your symptoms persist and your pain doesn’t improve or go away, it is important that you discuss this with your consultant. This is so you can consider alternative treatment options.

Laparoscopy

During a laparoscopy procedure, you will be placed under general anaesthetic and your vital signs, such as your heart rate, will be monitored by your healthcare team.

A few small incisions (cuts) will be made near your belly button or in another part of your abdomen. A tube is then passed through one of the cuts’ opening, and air is pumped into your belly. The reason this is done is so your surgeon can see your organs and the surrounding structures more easily.

The air tube is removed, and a laparoscope is then inserted through the cut. The laparoscope is used so your surgeon can see where the endometriosis has affected the body. Small tools will then be passed through the other incisions so your surgeon can work to remove or use intense heat to destroy the endometriosis tissue.

Once all the endometriosis tissue has been removed, the laparoscope and surgical tools will be guided out of the body. The incisions will then be sealed using stitches, tape, skin glue, or surgical staples.

Typically, the procedure takes one to three hours to complete, depending on how complex your case is.

Hysterectomy

During a hysterectomy, you will be placed under general anaesthetic and your vital signs will be monitored by your healthcare team.

You may have a catheter passed through your urethra to help empty your bladder during the procedure. The catheter will remain in during the surgery and for a short time after during recovery.

There are many types of hysterectomy surgical techniques. These include:

• Laparoscopic hysterectomy
• Abdominal hysterectomy
• Vaginal hysterectomy

Regardless of the technique, hysterectomy involves the surgical removal of the womb. Your surgeon may also remove your fallopian tubes, part of the vagina, ovaries, lymph glands, and or surrounding fatty tissue. What is removed will depend on how your endometriosis is behaving and whether you want to keep your ovaries. Ovaries produce the hormone oestrogen, which stimulates endometriosis and causes tissue to grow. Removing them can help prevent the condition from returning. Speak to your consultant beforehand about whether you would like to keep your ovaries, and they can help create a treatment plan tailored for your needs.

Once complete, any cuts made will be sealed using stiches, tape, skin glue, or surgical staples.

Non-surgical treatment

In general, there is little recovery needed after going through non-surgical treatment. Your consultant will discuss with you what effects your treatment will have on you and any recovery timelines.

Surgical treatment

After going through surgery for endometriosis, you will need to take time to recover as your body will need time to heal. Your journey to recovery will depend on the type of procedure you have.

Laparoscopy 

After the procedure, you will be monitored by your healthcare team for about an hour to check your vital signs and any aftereffects for concerns that may need to be addressed.

You will need to be picked up and taken home by someone you trust after the surgery, as you won’t be able to drive due to the aftereffects of the general anaesthesia.

Once home, it is important to keep your cuts clean and dry. Your surgeon will walk you through how to maintain the cleanliness of your incisions and reduce your chances of infection.

Returning to work will depend on you and how your body feels. Most people are able to return to work after two to four weeks, but this can vary from person to person. In terms of exercise, you should gradually work your way up to increasing your exercise levels during your recovery. You will be able to return to previous levels of activity within four to six weeks. If you want to be intimate with a partner, you will be able to have sex comfortably four to six weeks after the surgery.

Full recovery from the procedure can take six to eight weeks before you are able to get back to doing all activities and tasks.

Hysterectomy

Your recovery will depend on the type of hysterectomy you have.

In general, after the procedure, you will be kept in the hospital for up to five days so you can recover and be monitored by your healthcare team.

You will need to be picked up and taken home by someone you trust after the surgery, as you won’t be able to drive. You won’t be able to drive until you're comfortable wearing a seatbelt and can safely perform an emergency stop. This is typically within two to six weeks after surgery.

If you want to begin exercising, working with your consultant to create a suitable exercise routine while you recover is important. This is because it helps you to avoid overstraining yourself while helping you to speed up your return to usual activities. It is advised to avoid swimming for four to five weeks after surgery. If you want to return to heavy lifting, it is recommended not to lift anything heavy for six weeks to avoid the chances of a surgical hernia.

If you want to begin having sex again, it is usually recommended that you don’t until your incisions have healed and that usually takes at least four to six weeks.

Returning to work will depend on the type of work that you do. If your job doesn’t involve any manual labour or heavy lifting, you may be able to return within six to eight weeks. Ask your doctor for advice on when it may be feasible to return to work after surgery.

Non-surgical treatment

If you are taking hormone therapy, you may experience side effects while taking treatment.

These side effects can include:

• Low mood
• Headaches
• Bloating
• Weight gain
• Oily skin
• Irregular bleeding
• Breast pain
• A decrease in bone density

Some hormonal treatments, such as GnRH medication, can cause temporary menopausal side effects. These can be symptoms such as hot flushes, cold sweats, vaginal dryness, low mood, or depression.

Surgical treatment

Generally, surgery for endometriosis is safe. However, like with any surgical procedure, going through a laparoscopy or hysterectomy carries some risk of complications.

General risks that can happen during any surgery include:

• Bruising
• Swelling
• Scarring
• Pain
• Bleeding
• Blood clots
• Infection
• A reaction to the anaesthesia
• Nerve damage
• Death (very rare)

Specific risks of having a laparoscopy operation may include injury to the organs within the abdomen, hernia at the incision sites, and carbon dioxide gas passing into places other than the abdomen.

Risks and complications that can happen because of a hysterectomy include damage to your urinary tract, bowel, or other nearby organs, menopause at an early age (even if the ovaries aren’t removed), vaginal issues such as prolapse, and ovary failure.

Going through surgical treatment for endometriosis also doesn’t guarantee that the condition will be treated fully or improve symptoms. There is a risk that you may not see any improvements after the procedure.

Complications are typically rare. Your consultant will walk you through the chances of developing these complications and discuss your questions and concerns about any surgical procedures you may have.

Can I live normally with endometriosis?

What people consider ‘normal’ will be individual to them. It is possible to live a ‘normal’ life if you are able to get your symptoms under control with treatment.  Your quality of life may be lowered if your endometriosis pain affects you at work and in your everyday life, so it’s important to get treatment.

Can endometriosis grow back after surgery?

It is possible for endometriosis to persist after surgery. This happens if some of the endometriosis tissue is left behind, or it can recur from new cells. If endometriosis recurs, your consultant will discuss with you what your next steps will be.

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to fit your routine
• The freedom to choose which hospital and consultant suits your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard and delicious, healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about treatment for endometriosis, book your appointment online today or call a member of our team directly.

1. What is endometriosis?, Endometriosis UK
2. Endometriosis, World Health Organization (WHO)
3. Laparoscopy, John Hopkins Medicine
4. Hysterectomy, MedlinePlus