Mother and Baby

Fertility A-Z: Treating Endometriosis

Endometriosis, a condition where cells like those found in the lining of the womb are found elsewhere in the body, such as the ovaries and fallopian tubes, affects 1.5 million women in the UK. That’s 1 in 10 women of reproductive age. Endometriosis can cause great pain and discomfort, particularly during periods (dysmenorrhoea) and intercourse, and can also cause bowel, bladder and fertility issues. But what treatments are available?

How is it treated?

There is currently no cure for endometriosis. There are a wide range of treatments available for endometriosis, which can vary depending on the patient’s wants and needs. These include age, patient priorities (e.g. pain/fertility), previous treatment history and so on. The severity of the condition can also dictate the treatment – for example, if a woman is approaching menopause, the symptoms of endometriosis may improve without treatment.

Pain management

Medications such as painkillers and anti-inflammatories can be prescribed to help patients manage pain, as this is a large part of endometriosis, affecting most women with the condition.  The impact of this pain on normal quality of life is often misunderstood and it can greatly impact a woman’s ability to lead a normal life.

Hormone treatment

Hormone treatments are used to stop the growth of endometriosis tissue and they work by mimicking pregnancy (when the endometrium, also known as the lining of the womb, is thin or inactive) or menopause (when the ovaries are inactive, and oestrogen is no longer produced). Male hormones can also be prescribed as they help to lower oestrogen levels, causing the growth of the endometrium to stop. However, these hormones do come with many side effects and it is important to consider this when looking into treatment with your GP.  Women seeking to conceive must place careful consideration on the impact of chronic hormone therapy on their desire to have a child.

Surgery for treating Endometriosis

A surgical procedure called a laparoscopy (or keyhole surgery) can be performed to either excise the endometriosis by cutting out the clusters of cells implanted on other tissue; or they can treat it with electrical devices producing heat or laser. Laparoscopic surgery is effective, but this doesn’t mean the endometriosis won’t reoccur – there is still a chance of this.  A surgeon must be skilled and be sure to treat the disease more completely to reduce the risk of recurrence.

Radical surgery - hysterectomy (removal of the womb) and/or oophorectomy (removal of the ovaries) – are other options, although these procedures are irreversible, and therefore require a great deal of consideration.  Again, the desire to have a baby will play a role in selecting this therapy.

Which treatment really works?

The problem with using heat or laser treatment to target endometriosis is that healthy surrounding tissue can be damaged in the process. Surgeon’s understand these risks and may not treat endometriosis on certain tissue due to this concern.  This may play a role in the high recurrence rate for endometriosis.  One treatment that is becoming more popular with UK gynaecological experts to treat endometriosis is PlasmaJet.

PlasmaJet is a treatment that uses pure plasma energy to remove endometriosis tissue in a controlled way, with minimal thermal effect, allowing for careful application on sensitive areas such as the ovaries, fallopian tubes and bowel.

“I have been operated on three times for endometriosis,” says Kitti, a patient from Cranleigh, Surrey, who received the PlasmaJet treatment. She continues: “I was diagnosed with endometriosis 2014, and we’d tried for a baby for a long time with no success. We went to the clinic to figure out the reason why we couldn’t get pregnant and they did a scan, and it was at that appointment that they found the endometriosis and said I needed an urgent operation. My surgeon used PlasmaJet for my second operation, and then I had IVF treatment. On the second cycle, we were very lucky to get pregnant with twin boys, who are 2 and a half years old now.”

Up until now, laparoscopic surgery has been the most popular treatment, but this method can harm otherwise healthy tissue. Although effective, diathermy (using heat to target tissue) carries a relatively high risk of causing collateral damage, because it is hard to control the depth the heat penetrates. In contrast, by removing only the tissue that is causing problems, PlasmaJet may help reduce the need for further surgery.

Simon Butler-Manuel, Consultant Gynaecologist at Nuffield Health Guildford Hospital, says: “PlasmaJet allows you to do things in a no-touch way which is very useful, but the key thing that makes it special is the minimal lateral heat spread, which is much less than with just about everything else - a tenth of that of electrosurgery or harmonic scalpel, so that makes it inherently safer to use. In terms of patients who wish to start families, I’ve had a few patients come to me with endometriosis who have experienced problems with infertility as a result. After the operation, some patients get pregnant naturally in as soon as two months.”

If you think you may have endometriosis

if you experience heavy or painful periods or have been experiencing issues with fertility, it is worth talking to your GP about your symptoms and exploring the possibility of endometriosis being the cause.

The PlasmaJet treatment, pioneered by Plasma Surgical Inc, and represented in the UK by Hampshire-based company Aquilant, is currently being used in around 30 centres across the UK, and is available both privately and on the NHS.

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