very common condition where cells of the lining of the womb (the
are found elsewhere, usually in the pelvis and around the womb, ovaries
fallopian tubes. It mainly affects women during their reproductive
can affect women from every social group and ethnicity. Endometriosis
is not an
infection and it is not contagious. Endometriosis is not cancer.
could endometriosis mean for me?
main symptoms of
endometriosis are pelvic pain, pain during or after sex, painful,
heavy periods and, for some women, problems with getting pregnant.
affect many aspects of a woman’s life including her general
emotional wellbeing and daily routine.
common and many women may have no symptoms. An estimated two million
the UK have this condition.
long-term condition which affects women of all ages during their
years (from the onset of menstrual periods to the menopause). It
from all social and ethnic groups.
experience symptoms may have one or more conditions:
periods (dysmenorrhoea) which do not respond to over-the-counter pain
relief. Some women have heavy periods.
- pain during
or after sexual intercourse (dyspareunia)
- pelvic pain
which can be long-term
- difficulty in
getting pregnant or infertility
- pain related
to the bowels and bladder (with or without abnormal bleeding)
women do not
have any symptoms at all.
is a common
symptom of endometriosis. The pain can be a dull ache in the lower
pelvis or lower back. Pain affects each woman differently: where it
it hurts and how much it hurts. The pain, and the effects of
make you feel depressed.
endometriosis get pain in the area between their hips (known as the
the tops of their legs. Some women get pain only at certain times, such
during their periods, when they have sex or when they open their
women have pain all the time.
endometriosis become pregnant easily while others have difficulty
pregnant. The pain may get better during pregnancy and then recur after
birth of the baby. Some women find that their pain resolves without any
cycle, under the influence of the female hormones estrogen and
the lining (endometrium) of the womb thickens in readiness for a
egg. If pregnancy does not occur, the lining is shed as a period.
when the cells of the lining of the womb are found in other parts of
usually the pelvis. Each month this tissue outside the womb thickens
down and bleeds in the same way as the lining of the womb. This
bleeding into the pelvis, unlike a period, has no way of leaving the
causes inflammation, pain and damage to the reproductive organs.
where endometriosis can be found
commonly occurs in the pelvis. It can be found:
- on the
ovaries where it can form cysts (often referred to as ‘chocolate
- in or on the
anywhere on, behind or around the womb
- in the
peritoneum (the tissue that lines the abdominal wall and covers most of
the organs in the abdomen).
endometriosis may occur on the bowel and bladder, or deep within the
wall of the uterus (adenomyosis). It can also rarely be found in other
does endometriosis occur?
is not yet known
why endometriosis occurs. A number of theories have been suggested but
been proved. The most commonly accepted theory is that, during a
‘backward’ bleeding carries tissue from the womb to the
pelvic area via the
fallopian tubes. This is called ‘retrograde menstruation’.
soon can I expect to get a diagnosis?
many women, it
can take years to get a diagnosis. Doctors say that this is because:
- no one
symptom or set of symptoms can definitely confirm a diagnosis of
- the symptoms
of endometriosis are common and could be caused by a number of other
conditions such as irritable bowel syndrome (IBS) and pelvic
inflammatory disease (PID)
women have different symptoms
- some women
have no symptoms at all.
is no simple
test for endometriosis. The only way to make a definite diagnosis is by
surgical operation known as laparoscopy (see What treatment can I
is not performed on every woman.
you have painful
periods and no other symptoms, your GP may suggest that you try pain
before having further surgical investigation or treatments.
diagnosis can be distressing. Many women may fear the worst about why
in pain or why they are having problems becoming pregnant. They may
they have cancer (see Other organisations).
happens when I see a specialist?
you may be asked specific questions about your periods and your sex
life. It is
important that you provide as much information as possible, as this
your doctor find the correct diagnosis. You may find it helpful to
your symptoms beforehand and take your notes along to the appointment
In this way, you will be sure to provide all the information required.
women find it helpful to take a friend or partner along with them as
should also have
an opportunity to ask questions (for further information see
Direct in Useful organisations).
may examine your pelvic area, this will include an internal
doctor will discuss the best time to do this. This may be when you are
your period. If you have concerns about this, you should have an
types of tests might I be offered?
should be given
full information about the tests that are available. These may include:
You may be offered a scan. This can identify whether there is an
cyst in the ovaries. A normal scan does not rule out endometriosis.
For most women, having a laparoscopy is the only way to get a definite
diagnosis; because of this, it is often referred to as the ‘gold
test. A laparoscopy is a small operation which is carried out under
anaesthesia. A small cut is made in your abdomen near your tummy button
(navel), then a telescope (known as a laparoscope), which is about the
a pen, is inserted. This allows the gynaecologist to see the pelvic
clearly and look for any endometriosis. This is usually carried out as
with any surgical
procedure, there are risks and benefits. These should be fully
explained to you
when you are offered the test.
you have a
laparoscopy, you should be given full information about your results.
a decision about treatment
should be given
full information about your options for treatment. This should also
information about the risks and benefits of each option.
influence your decision about treatment. These include:
- how you feel
about your situation
- your age
- whether your
main symptom is pain or problems getting pregnant
- whether you
want to become pregnant – some hormonal treatments which help to
reduce the pain will stop you from becoming pregnant
- how you feel
treatment you have had before
- how effective
certain treatments are.
may decide that
no treatment is the best way forward. This could be because your
mild, you have not had problems getting pregnant or you are nearing the
menopause, when symptoms may get better.
treatment can I get?
treatment may be:
Pain-relieving drugs reduce inflammation and help to ease the pain.
There is a range of hormone treatments to stop or reduce ovulation (the
of an egg) to allow the endometriosis to shrink or disappear.
below are contraceptives and will prevent you from becoming pregnant:
- The combined
oral contraceptive (COC) pill or patch
These contain the hormones estrogen and progestogen and work by
preventing ovulation and can make your periods lighter, shorter and
intrauterine system (IUS): this is a small T-shaped device which
releases the hormone progestogen. This helps to reduce the pain and
makes periods lighter. Some women get no periods at all.
below are non-contraceptive, so contraception will be needed if you do
to become pregnant:
- Use of
hormonal progestogens or testosterone derivatives
- GnRH agonists
– these drugs prevent estrogen being produced by the ovaries and
cause a temporary and reversible menopause.
Surgery can be used to remove areas of endometriosis. Surgery including
hysterectomy does not always successfully remove the endometriosis.
different types of surgery, depending on where the endometriosis is and
extensive it is. How successful the surgery is can vary and you may
further surgery. Your gynaecologist will discuss this with you before
The gynaecologist removes patches of endometriosis by destroying them
or cutting them out.
endometriosis is severe and extensive, you may be offered a laparotomy.
This is major surgery which involves a cut in the abdomen, usually in
the bikini line.
have surgery to remove their ovaries or womb (a hysterectomy). Having
this surgery means that you will no longer be able to have children
after the operation. Depending upon your own situation, your doctor
should discuss hormone replacement therapy (HRT) with you if you have
your ovaries removed.
if I am having difficulty getting pregnant?
be a problem for some women with endometriosis. Your doctor should
with full information about your options such as assisted conception.
Infertility Network provides information about this (see Other
there any side effects?
will be given
full detailed information about the risks and benefits of any
surgical procedure and treatment suggested. The side effects will vary
woman to woman.
all cases of
endometriosis can be cured and for some women there is no long-term
that helps. With support many women find ways to live with and manage
provide invaluable counselling, support and advice
therapies include reflexology, traditional Chinese medicine, herbal
and homeopathy. They may be effective at relieving pain. Many women
that dietary changes such as eliminating certain food types, such as
wheat products, may help to relieve symptoms. Therapies such as TENS,
acupuncture, vitamin B1 and magnesium help some women with painful
There is currently insufficient evidence to show whether such therapies
effective at relieving the pain associated with endometriosis.
there anything else I should know?
- Taking the
combined oral contraceptive (COC) pill or contraceptive patch treats
the symptoms of endometriosis.
- If you become
pregnant, endometriosis is unlikely to put your pregnancy at risk.
- Some women
find that recreational exercise improves their wellbeing, which may
help to improve some symptoms of endometriosis (for further information
- No treatment
is guaranteed to work all the time for everyone.
groups are run locally for women with endometriosis (see Other
forums may be the first place many women turn to for support. The
quality of information can be variable.
2/ Surgery for stress incontinence: information for you
- When you have
stress incontinence, you accidentally leak urine during normal everyday
activities (for instance if you cough, sneeze, laugh, exercise or
- What you do
about stress incontinence will depend on how far it affects you and
what you feel you can cope with. Physiotherapy and/or practical advice
from a continence nurse specialist on managing your daily life may
- Not everyone
with stress incontinence needs surgery, but if your problems persist,
your doctor may suggest it.
- Surgery for
stress incontinence aims to give you more control over your bladder. It
cannot always cure the problem completely.
- There are a
number of possible operations; what is suitable for you will depend on
procedures for stress incontinence are not usually suitable if you
still plan to have children, or think you might want to in the future.
intended to help women who have stress incontinence and are considering
to have surgical treatment for it. It is based on the Royal College of
Obstetricians and Gynaecologists (RCOG) guideline
- what stress
recommendations the guideline makes for the UK about the most effective
surgical treatments for stress incontinence .
aims to help you
and your health care team to make the best decisions about your care.
It is not
meant to replace advice from a doctor, nurse or continence adviser
does not look at
treatments for stress incontinence that do not involve surgery.
- Some of the
recommendations here may not apply to you; this could be because of
some other illness you have, your general health, your wishes, or some
or all of these things. If you think the treatment or care you get does
not match what we describe here, talk about it with your doctor or with
someone else in your health care team.
is stress incontinence?
muscles of the
pelvic floor (see diagram below) support the bladder and usually help
closed or open as necessary. Stress incontinence usually happens when
muscles become weak. So when there is sudden extra pressure
(‘stress') on your
bladder, it cannot stay closed as it should and some urine leaks out.
leakage happens during normal everyday activities, and most often when
cough, sneeze, laugh, exercise or change position. Whether you leak a
large amount of urine, stress incontinence can be embarrassing and
can be triggered by pregnancy, childbirth or the menopause. If the
develops while you are pregnant or after you have a baby, it usually
with time for most women. Sometimes it happens again later on and a few
may need to consider surgery.
view of a
woman's bladder, pelvic floor muscles and nearby organs
I need an operation?
stress incontinence do not involve surgery. Not everyone with stress
incontinence needs an operation. Whether you choose to have surgery
on how far stress incontinence affects your daily life and what you
can cope with. You may want to consider surgical options if other
as exercises to help strengthen the muscles in the pelvic floor) have
for stress incontinence are not usually suitable if you still plan to
children, or think you might want to in the future.
doctor or nurse
should already have asked you about the problems you have been having.
have had a urine test to check for infection. You may also have had
bladder tests (known as urodynamics).
have had advice from your doctor or a continence nurse specialist about:
your daily routines to help you cope better
- how you can
help yourself by losing weight if you are overweight
- managing a
chronic cough if you have one
physiotherapy exercises to make your pelvic floor muscles stronger and
improve control of your bladder
- giving up
also help to improve the results of surgery, if you have it.
you have seen no
improvement after doing pelvic floor exercises, your doctors may
consider surgery. If you are offered the choice of surgery, it is up to
decide if and when you should have it.
operation will I be offered?
for stress incontinence aim to improve support for the muscles around
bladder entrance, in order to help the outlet (known as the urethra) to
closed when it should and prevent it leaking.
operation can be
guaranteed to cure your stress incontinence, but most offer a good
making an improvement. The benefits of some last longer than others.
of developing extra problems (known as complications) also varies
can find more
information about the main operations used to help stress incontinence
tables on the following pages. They are:
- Vaginal tapes
can also find out
about procedures that are used less often. They are:
offer you a choice of one or two methods, depending on your
his or her own expertise. He or she will take into account such things
general health, age, weight and previous operations and should explain
reasons for recommending a particular operation to you. Some operations
very specialised and are only offered in special centres.
your surgeon is
not able to offer the operation that best meets your individual needs,
be able to find another who can. You should discuss this with your GP.
you may need to have a temporary catheter. This is a tube which is put
your urethra (the tube leading out of the bladder) or your lower
order to empty your bladder when necessary. The length of time you need
spend in hospital after the operation will vary depending on the type
operation and how quickly you recover.
might happen if I don't have an
remain the same, or get worse, or improve over time. There is no sure
is often no
need to rush into having surgery. Some people prefer not to have an
and find ways of adapting. Your continence adviser can tell you more
techniques are being developed all the time. You should talk to your
adviser and/or your consultant to find out if there is anything new
be more suitable for you.
is not yet
enough evidence about a procedure called paravaginal repair to show how
effective it is. More research is needed.
who have a
prolapse, where part of the bladder pushes through the vaginal wall,
offered a procedure known as anterior repair. The surgeon makes a cut
the front of the vaginal wall, to remove the extra tissue from the
restore the muscle support. If you also have stress incontinence,
sling procedures are more effective than this operation.
no longer recommended:
(MMK) colposuspension used to be common but has been replaced by other
suspension has been replaced by safer, more effective procedures.
there anything else I should know?
- As you can
probably tell from previous sections, all operations carry some risks.
Your doctors should discuss with you the risks of any operation they
- You have a
right to say whether there are any procedures you do not want the
surgeon to carry out.
- You have the
right to be fully informed about your health care and to share in
making decisions about it. Your health care team should respect and
take your wishes into account.
- No treatment
can be guaranteed to work all the time for everyone.
based on the Royal College of Obstetricians and Gynaecologists (RCOG)
smear result: What this means for you