What is endometriosis?
The lining of your womb is called endometrial tissue. Endometriosis is a condition where this endometrial tissue in the womb grows in other places, such as the ovaries and fallopian tubes, where it does not belong. This tissue can swell and bleed the same way that the lining of your womb does each month during your monthly cycle. This swelling and bleeding is what causes pain and other symptoms.
What is endometriosis presentationOur service
Our Endometriosis Centre has been awarded national accreditation and is recognised as a Centre of Excellence by the British Society of Gynaecological Endoscopy (BSGE). We offer holistic care to patients with endometriosis.
What causes endometriosis?
The exact cause of endometriosis is unknown.
What are the symptoms of endometriosis?
Each person’s symptoms are different. Patients often have pain with coincides with their menstrual cycle.
- Pain: pelvic pain, cramping period pain, pain after sex, painful bowel movements or pain during urinating
- Periods: heavy, irregular and painful periods
- Infertility: difficulty getting pregnant
- Stomach problems: diarrhoea, constipation, nausea, bloating.
What causes the symptoms in endometriosis?
The endometrial tissue grows and bleeds in response to the hormones that your body releases to control your menstrual cycle. As your hormone levels change throughout the month, the endometrial tissue responds by swelling and bleeding. This can cause pain. This process of swelling and bleeding can cause the development of scar tissue and adhesions between your organs. This can lead to pain and difficulty getting pregnant. More information is on the Women’s Health website.
More information is on the British Medical Journal (BMJ) website.
Symptoms in endometriosis and causes presentationWhat are the stages of endometriosis?
The staging of endometriosis is typically based on visual inspection during laparoscopy (operation). There are 4 stages; I to IV or minimal to severe. Staging does not affect your treatment. Treatment is based on your symptoms.
| I Minimal | Small, superficial tissue |
| II Mild | Larger lesions, some of which are imbedded deeply |
| III Moderate | Larger lesions which are imbedded deeper and have adhesions. |
| IV Severe | Large, deep lesions with dense adhesions |
What are the potential long term complications of endometriosis?
- Fertility problems: difficulty getting pregnant. Some patients have difficulty getting pregnant and require treatment to help them become pregnant. However some patients can get pregnant without any treatment. Endometriosis is commonly associated with infertility. 25–40% in infertile women are found to have endometriosis compared with 0.5–5% fertile women having endometriosis. More information is on the National Institute for Health and Care Excellence (NICE) website.
- Adhesions and ovarian cysts
- Adhesions are sticky bits of endometrial tissue which can join organs together
- Ovarian cysts- fluid filled cysts within the ovaries which can sometimes become very large and painful
- Bowel obstruction- a complete or partial obstruction of the bowel may occur due to growth of endometrial tissue around the bowel
- Chronic pain.
More information is on the NHS website and the NICE website.
How is endometriosis diagnosed?
Endometriosis can be difficult to diagnose because:
- The symptoms are very variable
- The symptoms are similar to symptoms caused by other conditions such as irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD).
You may have the following tests done to try and determine if you have endometriosis or not:
- Ultrasound scan of the pelvis: this may be done through the abdomen and also through the wall of the vagina
- Laparoscopy: an operation under a general anaesthetic (you are put to sleep). Small cuts are made in your abdomen and a telescope is inserted to look at the pelvis for growth of endometrial tissue. This is the only way to confirm a diagnosis of endometriosis. The surgeon may also take biopsies of tissue to confirm the diagnosis.
More information is on the the Royal College of Obstetricians and Gynaecologists (RCOG) website and the NICE website.
What are the potential treatment options for endometriosis?
There is no cure for endometriosis but there are some treatment options. These are as follows:
Pain relief: medications can be used to manage your pain. These can range from over-the-counter medications such as paracetamol and ibuprofen to stronger medications prescribed by your healthcare provider.
Hormone treatments- these can be contraceptives or non-contraceptives. They can help by decreasing hormonal stimulation of the endometrial tissue. This can reduce the swelling and bleeding of the endometrial tissue which may improve symptoms and reduce damage:
- Contraceptive options- combined oral contraceptive pill, intrauterine system (such as the mirena coil), progestogens in the form of an injection, the mini pill or implant
- Non-contraceptive options- progestogens in the form of tablets or GnRH analogue injections, implants or nasal sprays. GnRH analogues are synthetic hormones which cause a temporary menopause by reducing the production of oestrogen.
Surgery: can treat or remove areas of endometriosis. The surgery varies between patients depending on where the endometriosis is and the severity of the endometriosis. This can be done when the diagnosis is made or it can be done later. Success rates vary and you may need further surgery
- Laparoscopy- also known as keyhole surgery. This uses small cuts in your abdomen to insert instruments and remove endometriosis tissue
- Hysterectomy- this is the removal of the womb. This may be considered if other treatments have not worked and you do not want to get pregnant in the future. It is a major operation which cannot be reversed. It is still possible that endometriosis symptoms may return after the operation. This is a big decision which should be discussed thoroughly with your gynaecologist.
More information is on the RCOG website and the NHS website.
Meet the team
Miss Preeti Gandhi, Consultant Gynaecologist
I have expertise in Laparoscopic Gynaecology and Complex Endometriosis surgery. I offer laparoscopic excision of endometriosis, which ranges from conservative surgery to radical clearance surgery, considering patients wishes and fertility choices.
I prioritise open communication, active listening and patient education to ensure that you are well-informed and involved in your healthcare decisions.
Academics and research
Laparoscopic radical hysterectomy with lymphadenectomy in cervical cancer: our technique and experience. D. Limbachiya, P. Gandhi et al. Gynaecol. Oncol. 2019, 40(3), 394–401
Laparoscopic Management of Mal-descended Ovary presenting with Recurrent Acute Abdomen, Eghoihunu Ireo, Muhammad Haruna, Preeti Gandhi. Gynaecology and Minimally invasive therapy 2018, Apr-Jun;7(2):74-77
Laparoscopic retrieval of a foreign body from retroperitineal space: “An interesting case” Limbachia D, Gandhi P, Gynecology and minimally invasive therapy, 2017; 6, (193-194).
Vaginal Vault Evisceration. Gandhi P, Jha S. The Obstetrician & Gynaecologists (TOG). 2011;13: 231-237.
Jane Palmer, Clinical Nurse Specialist for Endometriosis
I have been in this role for over two years now. My background started in the community before I came to work in gynaecology five years ago. Endometriosis is a condition that has affected my family and therefore, when this post came up, I knew that this was a role where I would be able to make a real difference.
The aim of my role, is to support you on your journey, offer advice, discuss the different treatments options available and provide guidance to you before and after surgeries.
Lindsey Bennett, Research Nurse
I work with the Reproductive Health and Childbirth portfolio, and work alongside Miss Gandhi and her team on the ESPriT2 clinical trial.
The ESPriT2 clinical trial is working alongside the University of Edinburgh clinical trials team and the website for the trial can be accessed here:
There is also an overview regarding clinical trials on Endometriosis UK.
Dr Muhammad Nauman Akhtar, Consultant Anaesthesia, Intensive Care and Chronic Pain Management
As a qualified and UK trained chronic pain consultant, I do two sessions per week in chronic pain at HUTH. The pain team is based at Castle Hill Hospital, and this includes both clinic and theatres for interventional pain procedures. This is on a service level agreement between NLAG and HUTH from December 2020.
As a chronic pain management consultant, I have also supported the Northern Lincolnshire Endometriosis Centre based at Scunthorpe and Goole, to secure accreditation of BSGE Endometriosis Centre from the last two years.
My role is to support patients with chronic pelvic pain with a combination of injection interventions, and advise medications for managing persistent discomfort and live well with pain. This is alongside the support from psychologist based in the team at Castle Hill Hospital, pain management program and physiotherapy services available both in hospital and community pain team.
Useful websites
National Institute for Health and Care Excellence (NICE) – Endometriosis: Diagnosis and Management
