One of London’s lead gynaecologists has warned that a ‘one size fits all approach’ is no longer appropriate for treating women diagnosed with endometriosis. The patient’s symptoms, expectations and circumstances all need to be taken into account and discussed with the multidisciplinary team (MDT), as well as with the patient before options are considered. For example, if the endometriosis has been found incidentally or as part of a screen and there are no symptoms, then no treatment may be needed at all.
When treatment is needed it is important to have a multidisciplinary approach to ensure that the woman has access to appropriate surgical or medical treatment expertise, pain management, psychological support and fertility advice. For this reason in many countries, including the United Kingdom, the trend is towards establishing endometriosis centres where patients can find all these expertise in one place. These centres usually have gynaecological surgeons with advanced minimal access (keyhole) surgery experience, colorectal and urological surgeons, fertility specialists, pain management specialists, psychologists or counsellors, clinical nurse specialists and sometimes complimentary medicine practitioners.
Consultant Gynaecologist for University College London and The Portland Hospital for Women & Children, Mr Ertan Saridogan says:
Some women with symptoms suggestive of endometriosis may choose to have empirical treatment to control their symptoms with medication such as analgesics or the combined oral contraceptive pill. If the symptoms improve with this approach without significant side effects it would be reasonable to continue with it without an established diagnosis. However symptoms do not improve in some women, others may experience significant side effects of the medication and some simply may not be happy to take medicine without knowing what the cause of their symptoms is. In this situation it would be appropriate to consider a diagnostic laparoscopy. If the procedure is carried out by a gynaecologist with experience in laparoscopic treatment of endometriosis, it would be important to discuss possible treatment at the same time to avoid repeat surgery.