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As a consultant gynaecologist and mum to two girls, Ghada Salman is passionate about helping individuals with female health conditions. For Ghada, there is no better feeling for her than making a difference to someone’s life – be it through helping parents finally welcome the healthy baby they’ve always dreamed of or supporting an individual with a chronic condition such as endometriosis. This Endometriosis Awareness Month, Ghada discusses the symptoms and treatments linked to this painful yet surprisingly common condition.

About Miss Ghada Salman

Miss Ghada Salman is a consultant Gynaecologist with main interests and special skills in ambulatory gynaecology, minimal invasive surgery, early pregnancy and gynaecological imaging.
View Miss Ghada Salman’s full profile

What is endometriosis?

Put simply, endometriosis is a condition where an endometrial-like tissue – the tissue that normally lines the inside of the womb (uterus) – grows outside of the uterus in areas such as the ovaries and pelvis. 

In a similar way to a menstrual period, it bleeds every month, causing inflammation and scar tissue formation. 

Flower graphic representing endometriosis

What symptoms may people with endometriosis experience?

Symptoms vary greatly from person to person but can include painful periods; chronic pelvic pain; pain during sex; premenstrual symptoms; irregular vaginal bleeding; subfertility; painful bowel movements and blood when opening bowels; painful urination and blood in urine; fatigue; and depression. 

Depending on where the tissue grows, other symptoms can include pains in the back, leg or chest. Individuals who have had a caesarean may also notice the formation of a painful lump in their caesarean section scar if endometriosis tissue grows in that area. 

The diagnosis for endometriosis can be delayed and it can take around seven to eight years from the onset of symptoms. 

Both patients and doctors can contribute to this delay since the vague symptoms are often linked to other health conditions such as bowel tract disorders – for example irritable bowel syndrome (IBS) – or a urinary tract disorder. 

For younger people, the symptoms can also be dismissed as bad period pains.

In your experience, what impact can endometriosis have on someone’s life?

Endometriosis is a long-term condition and, since the symptoms vary, it can have an impact on many different aspects of an individual’s life, including their fertility, sex life and physical ability to study, work and attend social events.

Also, the hormonal imbalance linked with endometriosis can impact an individual’s fertility, and actually around 50% of those who suffer from female infertility will also have endometriosis.

The impact can therefore be major and it can often be both physically and emotionally debilitating. But luckily there are treatments that can help.

What is the process for diagnosing endometriosis and what advice would you give to someone who is experiencing symptoms? 

My advice to women and those assigned female at birth is to first be aware of the condition and the possibility that you may have it if you experience any of these symptoms. 

If symptoms are present, visit your GP, who can discuss these further with you and start the diagnosis process with an initial examination and investigation. They may then refer you to a secondary care provider – such as the gynaecology unit at The London Clinic – to investigate further and provide a diagnosis. 

In terms of investigations, a gynaecologist would attempt to view the endometrial tissue via ultrasound or, if ultrasound is not available, a magnetic resonance imaging (MRI) scan. 

We can also conduct a diagnostic laparoscopy, which is a minimally invasive keyhole surgery used to look at the pelvic organs.

Are there any common myths and misconceptions about endometriosis?

Yes. First of all, although it’s a rarely discussed health topic due to its taboo nature, endometriosis is actually very common. One in 10 reproductive-age women will have endometriosis, making it the second most common gynaecological condition in the UK (fibroids are the most common).

Some people think that endometriosis only affects those over 30-years-old. However, while that is more common, the condition can actually begin at any age – although it’s rare to begin before puberty as the disorder reacts to hormones. This also means the symptoms associated with the condition typically ‘settle down’ after menopause.

Another uncertainty is why endometriosis actually happens. Although there is no definite answer yet, there are many different theories as to why. 

We do know it tends to run in families, and there are theories surrounding retrograde menstruation – where some of the womb lining is discharged ‘backwards’ as period blood through the fallopian tubes and into the pelvis, eventually embedding itself on the organs of the pelvis. 

Is there a cure for endometriosis and what treatments are currently available?

As the cause of endometriosis is still unknown, there’s currently no complete cure. However, there are several effective treatments that can help, all depending on the person’s individual symptoms and personal choices. 

Initial treatments may include painkillers such as non-steroidal anti-inflammatory drugs (NSAID) and hormonal treatments such as the oral combined contraceptive pill, the progesterone-only pill or the progesterone-containing intrauterine system (coil). Usually these hormonal treatments help.

For patients with severe endometriosis, keyhole surgery to remove small spots of tissue growth or cysts may be an option. 

When the endometriosis is severe and affecting other organs, larger operations that remove ovaries, the entire womb or even part of the bowel are sometimes considered by gynaecologists, usually in a multidisciplinary approach with other specialist healthcare professionals including a colorectal surgeon and urologist.

But of course, these surgical treatments would be a decision the patient would need to make in line with their desires for future pregnancies. 

Have you seen a recent shift in the understanding of endometriosis by the healthcare industry and society in general?

I think yes, especially over the last few years amongst both healthcare professionals and patients. 

The rise of social media and availability of information online means people can search for their symptoms and talk with others who may be going through a similar experience.

Primary care professionals – such as GPs and nurses – are also becoming more aware of the condition through information shared during medical conferences, or by talking with other GPs or gynaecology experts. 

That said, there is definitely still a requirement for improved medical evidence surrounding endometriosis and further research into treatments is still needed. 

In your opinion, what more can be done to improve care for patients with endometriosis?

For me, it’s all about increased awareness, and as patients will be the ones who seek medical help, this starts with helping patients understand the condition and its symptoms. It would be great to see informative posters in public toilets, or within GP surgeries and schools. 

Similarly, we need the conversation on endometriosis to start in schools, by informing teenagers and school nurses. Since endometriosis can occur at any age, it’s also important to keep the condition in mind when talking with teenagers who experience abnormally painful periods. 

If we can catch and diagnose this condition at an early stage, early referral and treatment can take place, significantly improving the patient’s quality of life and stopping the progression of this condition. 

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