Endometriosis is a silent condition that often causes severe pain for women and can lead to infertility. Roughly 10% of the female population is affected when the cells lining the uterus migrate to other areas in the abdomen and set up camp there. These cells continue to behave as the lining of the womb does each month during a period.
As you can see from the diagram above, common sites for endometrial cells to land are around the bowel, bladder and the ovaries. Then they continue to proliferate and shed, just like in the womb, but causing inflammation and extreme pain in unfamiliar territory. This seriously affects a woman’s well-being – interfering with mood, sleep, sex, relationships and exercise, studying, work and even career choice and prospects. Women complain of debilitation and needing a lot of time off work off work on really bad days.
What to do?
Apart from surgery and laser treatment there is no effective cure for the condition. A complete new guide has been issued by NICE – The National Institute for Health and Care Excellence – to aid doctors in recognising and treating endometriosis. It lays out diagnostic, treatment and referral criteria for earlier care of patients.
Symptoms of Endo
Symptoms include period pain, painful sex, painful bowel motions, painful peeing, blood in the pee and delay in getting pregnant. Some women get a swollen abdomen known as ‘endo belly’ and diet changes offer help here. My clients tell me of long delays, often many years before they get a diagnosis of their condition. The NICE report concurs – in the UK women can wait from 4 years up to 7-8 years from a first visit to the GP to receiving a diagnosis.
The new guidelines plans to reduce this time and encourages awareness of the condition among doctors. Delay in diagnosis see a continued progression of the disease while women suffer the effects of severe chronic pain. Symptoms vary between sufferers, each presenting with her own signature indicators. This makes diagnosis more difficult. The guide provides a handy checklist for doctors and recommends blood tests – serum CA 125 levels along with ultrasound scans
As of yet, there are no definitive treatments or cures for endometriosis. Laser surgery via laparoscopy removes outgrowths of offending cells. Depending on location and spread some areas are more difficult to access. This procedure offers temporary respite and offers a window of hope for women facing infertility and may be repeated later on. Conservative care for women with endo consists in pain management. The contraceptive pill is sometimes prescribed with uncertain efficacy, with a rationale of starving those oestrogen-dependent rogue cells. Doctors advise patients to keep a detailed diary of symptoms to help manage the symptoms.
Need for referral to a variety of endo specialists
The guidelines recommend that doctors refer women on to a variety of different-area medical specialists who have experience in working with this condition. NICE recommends the screening of young women, from the age of 17, who present with this array of symptoms. Interestingly, it also states that there is no clear scientific evidence for any benefits in using Traditional Chinese Medicine.
Well worth a read
These guidelines are well laid out, easy to read and understand. Hopefully they will encourage doctors to search for diagnoses, develop confidence in this area and improve the quality of patients lives.