Endometriosis Obstetrics & Gynaecology Women and Children's Group - This leaflet has been designed to give you important information about your ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Endometriosis Obstetrics & Gynaecology Women and Children’s Group This leaflet has been designed to give you important information about your condition / procedure, and to answer some common queries that you may have.
What is endometriosis? and 20% of women with fertility problems will
have endometriosis. Furthermore if your
Endometriosis is the presence of tissue sister or mother has endometriosis then your
similar to the womb lining, occurring outside risk of endometriosis increases.
the womb (uterus). This endometrial- like
tissue can implant in many places in the What are the symptoms of
pelvis including the ovaries, bladder and
bowel, on the ligaments attached to the back endometriosis?
of the uterus and the space between the Endometriosis may present with a number of
vagina and bowel. Endometriosis may also different symptoms though some women
develop outside the pelvis in abdominal may not have any symptoms at all. The
surgical scars, the lungs and kidneys, in fact following symptoms may be caused by
in almost any other organ in the body. endometriosis – painful periods
(dysmenorrhea), painful intercourse
How does endometriosis start? (dyspareunia), chronic pelvic pain and
ovulation pain.
There are many theories that may explain
how endometriosis starts. One of the Pain may also be felt on opening the bowels
explanations supports the idea of backward (dyschezia) or on passing urine and on
menstruation. This suggests that at occasions blood may be passed from these
menstruation, some menstrual blood flows organs at menstruation. Some women may
backwards through the fallopian tubes onto only experience non-specific symptoms such
pelvic organs. The blood contains some as bloating, nausea and vomiting.
viable endometrial cells which then seed and Endometriosis may significantly adversely
grow into endometriosis implants within the affect the outcome of fertility depending on
pelvis. its severity.
In another theory, endometrial cells at
menstruation may enter blood vessels in the How does it produce symptoms?
uterus and be carried to distant sites outside Endometriotic cells that have implanted and
the pelvis. In some women cells of one type grow outside the uterus respond to
of tissue may spontaneously change into hormones that are produced during a
endometrial cells. We do not know why woman’s normal menstrual cycle. Just as
endometrial deposits continue to grow in the endometrial tissue inside the uterus
some women but not in others but this may bleeds monthly, so do the ectopic
be because of an altered immune response endometrial deposits outside the uterus
in women who later develop endometriosis. (womb).
Some women may have a genetic
The endometriotic deposits bleed, irritating
predisposition for endometriosis.
the surrounding tissue and then heals over
by scarring. The scar tissue may form into a
What is the risk of getting tender nodule or, if the endometrial tissue is
endometriosis? in the bowel or bladder, it may cause
Endometriosis is a common condition and bleeding when passing urine or stools at the
occurs in about 5-10% of the female time of a period. Adhesions, (scar tissue)
population. 1 in 6 women with pelvic pain formed as a result of endometriosis, maycause fixation of the normal movement of Medical Therapy
some organs such as the bowel and this will
usually result in pain. Drug treatment may include analgesia (pain
relief tablets) or hormone therapy. Analgesia
How is the diagnosis made? that helps to control pain in endometriosis
may include paracetamol codeine phosphate
Internal (vaginal) examination revealing a and drugs that will suppress the pain of
fixed uterus, tender support ligaments of the painful periods like ibuprofen (Nurofen),
uterus or enlarged painful ovaries suggest mefanamic acid, or diclofenac (Voltarol).
endometriosis. Visible endometriotic nodules This is useful in patients who are desirous of
can also sometimes be seen in the vagina or pregnancy or prior to surgery. The mainstay
on the cervix (the neck of the uterus). of treatment is surgery but medical therapy
Ovaries that are enlarged by endometriotic may be the choice if there is delay in surgery
deposits (called endometriomas) can usually especially in the early stages of the disease.
be diagnosed by ultrasound or other imaging Medication should be taken as per the
techniques. However visual inspection of the manufacturer’s instructions.
pelvis by a laparoscopy, (an operation at Hormonal medication prevents cyclical
which a telescope is inserted into the tummy bleeding and can make endometriosis tissue
when you are asleep), is the best way to become inactive and this may help to
make a diagnosis of endometriosis. improve symptoms. Hormones may be
administered in the form of progesterone
What does endometriosis look like? tablets or the oral contraceptive pill. Either of
At laparoscopy endometriosis may appear as these is usually taken for 6-9 months without
dark brown or black powder burn patches on a break. This may mean that you do not
the peritoneum (the lining of the inside of the have a monthly bleed - this is not abnormal
abdomen or tummy). Other endometriotic and may in fact help to reduce new
lesions may comprise bluish black nodules or endometriotic tissue growth by reducing
red implants. backward menstruation.
Endometriotic cysts swell the ovaries and Hormonal treatment for endometriosis can
may contain thick dark tar like fluid also be delivered by the Mirena intrauterine
surrounded by scar tissue. Biopsy of any of coil and there is good evidence that
these lesions may help in establishing the symptoms from pelvic endometriosis are
diagnosis of endometriosis but may not improved.
necessarily be conclusive. Another type of hormone prevents oestrogen
production from the ovaries, thereby stopping
How is endometriosis treated? stimulation of endometriotic tissue. These
Endometriosis may be treated by medication drugs are called Gonadotrophin–Releasing
or surgery. The aims of treatment are to try Hormone Analogues (GnRHa). GnRHa is an
to suppress endometriosis associated pain, injection administered on a monthly basis for
improve quality of life, or to help you try and 6 months. Longer use may result in thinning
get pregnant, when appropriate. of the bones though this can be prevented by
the additional administration of hormone
replacement therapy (HRT).This may extend overall treatment with outlined in the leaflet on laparoscopic
GnRHa to 9 months or longer. HRT may surgery.
also help to make some of the side effects of In the very severe type of endometriosis
GnRHa treatment which are similar to the affecting the ovary, removal may be
menopause less intrusive. These include hot inevitable though the ovary can be
flushes, night sweats, mood swings and conservered especially in the reproductive
headaches. Though up to 7 in 10 patients age group. Nevertheless some women who
will have improvement of their endometriois - have completed their families and have
associated pain the benefits may be short severe endometriosis are best treated by a
lived. hysterectomy and removal of both ovaries.
Medical treatment suppresses endometriosis Hysterectomy is usually combined with
symptoms but annual recurrence rates are 5- excision of all endometrial implants to
10% with recurrence rates of up to 75% after improve the benefits of the surgery.
5 years. Medical treatment is most effective
in early stage disease, 2-3 months prior to Endometriosis can be quite a difficult
surgery for advanced disease and after the condition to treat. Even though medical or
operation to treat remaining invisible surgical treatment may initially cure your
endometrial deposits. Medical treatment has symptoms, it is not unusual for similar
not been shown to be effective in the presenting symptoms to return after a while.
treatment of endometriosis associated If this happens to you, you will probably need
infertility. further treatment and should make an
appointment to see your General Practitioner
Surgical Therapy for another referral to your Gynaecologist.
The aim of surgery is to remove or destroy Treatment of Ovarian
as much or all of the visible / palpable
endometriosis to improve pain or help Endometriosis
fertility. Surgery offers more long term and When endometriosis affects the ovaries it
effective treatment for endometriosis without may present as deposits on the surface or by
the unpleasant side effect of medical ovarian cysts called endometriomas.
therapy. Conservative (uterine and ovarian Implants on the surface of the ovary can be
sparing) surgery for endometriosis is ideally burnt or cut off with diathermy or laser.
performed by the Laparoscope –
Endometriomas can be treated by aspiration
laparoscopic (keyhole) surgery.
drainage of the cyst alone, or by aspiration
Endometriotic deposits and scar tissue can and diathermy or stripping / excision of the
be cut out or diathermised with cautery (heat) cyst wall. Studies show that recurrence rates
or laser, whilst endometriotic cysts of the are highest with just aspiration alone (about
ovaries can be drained and treated. Surgery 80%). Furthermore pregnancy rates in
may also help women who have infertility by infertile women are highest with excision.
releasing scarring around the fallopian tubes Laparoscopic surgery is the ideal way of
or the ovaries. The procedure, risks and treating ovarian endometriosis.
recovery from laparoscopic surgery are asOccasionally your doctor may advise that the and planning the NHS, training and
whole ovary needs to be removed if it is very educating staff, research etc.).
badly affected by endometriosis or that a Everyone working for the NHS has a legal
hysterectomy and removal of both ovaries is duty to keep information about you
the best option for managing your confidential. Information will only ever be
endometriosis. shared with people who have a genuine
need for it (e.g. your GP or other
Conclusion professionals from whom you have been
Endometriosis affects many women and receiving care) or if the law requires it, for
usually presents with pain or reduction in example, to notify a birth.
fertility. It may significantly affect quality of Please be assured however that anyone who
life but the symptoms can be treated by receives information from us is also under a
either medication or surgery. Your doctor will legal duty to keep it confidential.
discuss the best management option with
you depending on your individual Zero Tolerance - Violent,
circumstances.
Threatening and Abusive Behaviour
Concerns and Queries The Trust and its staff are committed to
providing high quality care to patients within
If you have any concerns / queries about any
the department. However, we wish to advise
of the services offered by the Trust, in the
all patients / visitors that the following
first instance, please speak to the person
inappropriate behaviour will not be tolerated:
providing your care.
For Diana, Princess of Wales Hospital Swearing
Alternatively you can contact the Patient Threatening / abusive behaviour
Advice and Liaison Service (PALS) on Verbal / physical abuse
(01472) 875403 or at the PALS office which
is situated near the main entrance. The Trust reserves the right to withdraw from
treating patients whom are threatening /
For Scunthorpe General Hospital abusive / violent and ensuring the removal of
Alternatively you can contact the Patient those persons from the premises.
Advice and Liaison Service (PALS) on All acts of criminal violence and aggression
(01724) 290132 or at the PALS office which will be notified to the Police immediately.
situated on C Floor.
Alternatively you can email: Risk Management Strategy
nlg-tr.PALS@nhs.net The Trust welcomes comments and
suggestions from patients and visitors that
Confidentiality could help to reduce risk.
Information on NHS patients is collected in a Perhaps you have experienced something
variety of ways and for a variety of reasons whilst in hospital, whilst attending as an
(e.g. providing care and treatment, managing outpatient or as a visitor and you felt at risk.Please tell a member of staff on the ward or © NLGFT 2013 in the department you are attending / visiting. Moving & Handling The Trust operates a Minimal Lifting Policy, which in essence means patients are only ever lifted by nursing staff in an emergency situation. Patients are always encouraged to help themselves as much as possible when mobilising, and if unable to do so, equipment may be used to assist in their safe transfer. If you have any questions regarding moving and handling of patients within the Trust, you may speak to any member of the nursing staff, the designated keyworker within the department or the Trust Moving & Handling Coordinator. Northern Lincolnshire and Goole NHS Foundation Trust Diana Princess of Wales Hospital Scartho Road Grimsby 01472 874111 Scunthorpe General Hospital Cliff Gardens Scunthorpe 01724 282282 Goole & District Hospital Woodland Avenue Goole 01405 720720 www.nlg.nhs.uk Date of issue: December, 2013 Review Period: December, 2016 Author: Advanced Nurse Practitioner / Nurse Colposcopist IFP-781
You can also read
