Endometriosis: Advanced Diagnosis and Personalised Treatment

Endometriosis is a condition where tissue similar to the lining of the womb grows outside the uterus, commonly on the ovaries, fallopian tubes, or pelvic lining. This tissue responds to hormonal changes during the menstrual cycle, causing inflammation, pain, and sometimes scarring.

Endometriosis affects approximately 1 in 10 women of reproductive age and can significantly impact quality of life. With expert diagnosis and treatment, most women experience substantial improvement in symptoms and overall wellbeing.

Endometriosis symptoms vary widely. Some women experience severe pain, while others have minimal symptoms. Common signs include:

• Painful periods (dysmenorrhoea) that may worsen over time
• Chronic pelvic pain, particularly around menstruation
• Abdominal or lower back pain between periods
• Pain during or after intercourse
• Pain with bowel movements or urination during periods
• Heavy or irregular menstrual bleeding
• Spotting or bleeding between periods
• Difficulty conceiving

If you experience persistent pelvic pain or symptoms that affect your daily life, seek medical assessment. Early diagnosis can prevent progression and improve long-term outcomes.

Diagnosing endometriosis typically involves several steps:

• Detailed medical history and symptom assessment
• Pelvic examination to check for tenderness, nodules, or masses
• Ultrasound scan to identify endometriotic cysts or deep lesions
• MRI scan for detailed pelvic mapping in complex cases
• Diagnostic laparoscopy — the gold standard for diagnosis, allowing direct visualization and biopsy of endometriotic tissue

Laparoscopy not only confirms the diagnosis but also allows for immediate treatment of visible endometriosis during the same procedure.

Treatment depends on your symptoms, the extent of disease, age, and personal circumstances. Options include:

Medical Management:

• Pain relief medications
• Hormonal treatments to suppress endometriosis activity and reduce symptoms
• Combined approach with specialist pain management when needed

Medical therapy can help control symptoms, especially for mild to moderate disease.

Surgical Treatment:

• Diagnostic laparoscopy with removal of visible endometriosis
• Robotic or laparoscopic excision surgery — complete removal of endometriotic tissue and adhesions using precision instruments through small incisions
• Conservative surgery preserving organs when appropriate
• Hysterectomy with or without removal of ovaries — considered for severe or recurrent cases, particularly where there is extensive scarring or when other treatments have not provided relief

Surgical treatment aims to remove endometriotic tissue while preserving healthy anatomy. Advanced laparoscopic and robotic techniques allow for thorough treatment with minimal recovery time and excellent visualization.

Even during hysterectomy, all visible endometriosis should be excised to optimize long-term relief. Combining surgical treatment with post-operative hormonal therapy often provides the best long-term outcome.

Dr Mohamed Otify is a Consultant Gynaecologist and Gynaecological Oncologist with advanced training in minimally invasive and robotic surgery for endometriosis. He specializes in complex endometriosis excision and works within a multidisciplinary team to provide comprehensive, individualized care.

His approach prioritizes:

• Accurate diagnosis through expert laparoscopic assessment
• Complete excision of endometriotic tissue using advanced robotic and laparoscopic techniques
• Organ-preserving techniques when appropriate
• Minimal recovery time with modern surgical methods
• Long-term symptom management and support
• Personalized treatment plans tailored to individual circumstances

If you're experiencing symptoms of endometriosis, persistent pelvic pain, or have been diagnosed and seek specialist surgical treatment, book a consultation for expert assessment and personalized treatment planning.