Endometriosis

There is a weekly clinic consisting of consultant gynaecologists, two clinical nurse specialists, and a subspecialty trainee in advanced laparoscopic surgery. Expertise includes gynaecological ultrasound, fertility management, pain management, medical management of endometriosis and advanced laparoscopic (key-hole) surgery. The nurse specialists run additional clinics on a weekly 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.

If severe endometriosis is not suspected either from previous laparoscopy or scan, you will be offered follow up in one of the consultants other clinics. These are set up to treat endometriosis that is not recto-vaginal or severe. These arrangements ensure that we comply with specialist commissioning and enable are waiting times to be kept as low as possible

These include:

• Expectant treatment: If symptoms are very mild of if the menopause is approaching, this option may be suitable. Alternatively treatment with pain-killers (analgesics e.g. mefenamic acid) may be recommended.
• Medical treatment
• Surgical treatment
• Alternative therapies: There are no clinical trials reporting the efficacy of complementary therapies as a treatment of endometriosis. However, options include acupuncture, aromatherapy, Chinese or western herbs, homeopathy, reflexology, naturopathy, reiki and osteopathy. These may lead to an improvement in pain symptoms.

Sometimes due to the chronic nature of endometriosis, the pain does not fully recede even after the condition has been fully excised. This has been proven by well-conducted randomised controlled trials and other studies. In such clinical situations, our specialist pain management team offer an excellent pain management service.

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 applied to be an accredited centre. In line with these requirements we run a nurse-led follow up service to audit and assess our outcomes of surgery.

In summary we offer an integrated service provided by a multidisciplinary team comprising of gynaecologists and nurse specialists in the first instance when a decision about treatment choices is discussed and decided upon. Where the condition is severe, joint surgery is carried out with laparoscopic bowel surgeons and/or urologists. There is also specialist input by the gastroenterology team where necessary. At follow up residual pain is treated within the pain management service. There is nurse-led follow up clinic to enable long-term outcomes to be assessed.

We participate in the national database to contribute to the pool of information with regards the laparoscopic surgical treatment and follow up of patients with severe and recto-vaginal endometriosis. The information you provide is confidential. These data are are stored in accordance with Data Protection legislation and entered onto 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. These questionnaires are emailed but can be sent out by post if you prefer. The data will help inform best treatments in the future.