A reluctance to talk about women’s health has meant many women have suffered in silence with sometimes debilitating conditions, rather than seeking help. Thankfully, recent mainstream media coverage of such issues has led to greater openness, not least about the topic of endometriosis.
Prominent women that have spoken about their experiences of endometriosis include music legend Dolly Parton, comedian Amy Schumer and movie actors Susan Sarandon, Whoopi Goldberg and Daisy Ridley. The subject has also been highlighted on screen in the BBC drama Conversations with Friends and in a recent documentary, Below the Belt. The latter, directed by Shannon Cohn, includes among its executive producers former US Secretary of State and presidential candidate Hillary Clinton, who has also suffered from endometriosis.
“Young women are becoming more educated about endometriosis due to the welcome increase in media coverage about the condition over the past couple of years, which has been very important,” says Mr Amer Raza, consultant gynaecologist leading the team at the International Centre for Endometriosis at London’s Cromwell Hospital. “Endometriosis wasn’t talked about before and was considered a taboo subject, but high-profile women sharing their experiences publicly has helped to bring about a huge change in awareness. Charities are becoming very active as well. As a result, women are visiting doctors with their symptoms much earlier than previously.”
Endometriosis is a condition where tissue, similar to the lining of your womb, starts to grow in other places, such as the ovaries, fallopian tubes, bowel, bladder and, sometimes, lungs. It can cause significant problems, including pain, problems with your bowels, feeling sick and difficulty getting pregnant. “In some women, endometriosis starts to grow inside the ovaries, which can then start to swell,” says Mr Raza. “This is known as ovarian endometrioma, or a cyst with an endometriosis, which can have an impact on fertility. About 20% of women with endometriosis experience fertility issues.”
There are a range of treatments for endometriosis. Depending on your symptoms, your consultant gynaecologist may recommend a laparoscopy (keyhole surgery) to cut away endometrial tissue.
At Cromwell Hospital, we offer robotic surgery for endometriosis. The da Vinci Xi is used for keyhole surgery and provides greater precision, control and flexibility when using surgical instruments. Mr Raza says, “the accuracy and precision of the da Vinci system works well for keyhole procedures, such ashysterectomies and complex endometriosis. Using the da Vinci Xi means our patients can leave hospital and recover more quickly.”
“When a new patient arrives at our clinic, it is most important to gather a detailed history to determine whether they have endometriosis,” explains Mr Raza. “The symptoms can overlap with other conditions that may not be endometriosis – for example, irritable bowel syndrome, which involves bloating and constipation, or bladder conditions. Once we’ve established a history, then examination is the key. A thorough vaginal examination helps us to feel the nodules of endometriosis in moderate to severe cases.”
In milder cases, examination may not be as effective in making a diagnosis, so the patient will have scans to determine the extent of their endometriosis. “The other main step in our investigation is the transvaginal ultrasound scan, from which we can detect endometriosis in the ovaries. It can also help us to see endometriosis in the back of the uterus, involving the bowel,” says Mr Raza.
“Some patients will also need a pelvic MRI [magnetic resonance imaging] scan, which is a very sensitive and detailed assessment of the pelvis that helps us understand not only the quantity or amount of endometriosis in the pelvis, but also the other organs that are involved.” Where examination and scanning cannot fully diagnose the disease, patients will then require laparoscopy – an operation under general anaesthesia to simultaneously diagnose and treat the problem.
As endometriosis is a hormonal disease, where oestrogen increases the severity of the condition, most medical treatments are based on hormonal therapies that suppress or reduce the oestrogen. “If mild endometriosis is causing pelvic pain, then treatment with hormones will suffice,” says Mr Raza. “This will include combined oral contraceptive pills, progesterone pills, and even a Mirena IUS (intrauterine system) coil – a hormonal contraceptive inserted into the uterus.”
In moderate to severe cases, where the condition is causing an impact on quality of life, a patient would proceed to laparoscopic surgery, for which robotic surgery techniques are used. Where endometriosis is present around the uterus, around the ovaries or on the pelvic side walls, laser or electrical energy is used to remove the scarring and adhesions inside the abdomen, relieving pain. Mr Raza is highly skilled with robotic surgery, having completed over 100 gynaecological surgeries with the da Vinci Xi at Cromwell Hospital.
“We felt there was a great need for a specialised centre at Cromwell, bringing together under one roof all the endometriosis expertise, such as colorectal surgery, fertility, physiotherapy, psychological support and chronic pelvic pain support,” he says. “We provide a one-stop service where a patient can come in, be seen, have their ultrasound scan on the same day and walk away with a provisional diagnosis either confirming endometriosis or excluding it.”
Rico Hayer was diagnosed with endometriosis in 2019, after having suffered with painful periods since she was young. Mr Raza was recommended to Ms Hayer by a friend. Mr Raza was able to explain to her the challenges of endometriosis and, together, they reviewed the best options for her care.
Ms Hayer decided that a laparoscopic surgery would be the best option. Two-and-a-half months after surgery she has found that her periods were now pain-free, thanks to the help of Mr Raza.
“I couldn’t thank the hospital and Mr Raza enough,” says Ms Hayer. “It was just a delight. It was almost like going to a spa. I’m happy to say to all women, my fellow ‘endo warriors’, you don’t have to suffer in silence. You don’t have to be embarrassed of having this condition. Treatment options are available.”
The International Centre for Endometriosis is well suited for overseas patients, whose treatment and recovery plans can be arranged even before they set foot in London.
“The patient journey usually begins with an online video consultation, before MRI scans are carried out at their local hospital,” Mr Raza explains. “The images are then transferred to the radiology system at Cromwell and analysed by our endometriosis experts.”
A further video consultation will then take place, during which the scan images can be displayed and discussed, before a decision on surgery is made. If surgery is required then the patient will travel to Cromwell for their operation, for which they can expect to stay in hospital for only one or two nights.
“About 60% of post-surgery recovery happens within the first week, and patients are 80% to 90% recovered after two weeks,” says Mr Raza. “At this point, most patients are able to fly home, where they will receive follow-ups via further video consultations.”
We offer next-day appointments at Basinghall Clinic, our outpatient diagnostic centre in the City, and Cromwell Hospital with our expert gynaecologists to give you peace of mind and rapid access to onward treatment. Along with our endometriosis and menopause management, our services include health-screening programmes for women, fertility treatment, surgical treatment of incontinence and pelvic prolapse and family planning.
We provide a comprehensive diagnostic service for all gynaecological conditions. In most cases we can offer same-day diagnostic tests, including ultrasound. If you receive a diagnosis for a gynaecological cancer, you will be supported every step of the way by your consultant and members of your healthcare team.
For more information about gynaecology services and the International Centre for Endometriosis, contact Cromwell Hospital: call +44 (0)20 7460 5700 or visit
cromwellhospital.com/gynaeclinic
