Ask the Doctor: ‘I believe I’m suffering from symptoms of endometriosis. How can I be sure and what are my best treatment options?’

“I believe I’m suffering from symptoms of endometriosis, and I am struggling to manage the pain day to day. I don’t know what next steps to take. How can I be sure and what are my best treatment options?”

Answer from Dr Deborah Galvin, Consultant in Pain Medicine & Anaesthesia

Endometriosis is an often-painful disorder where endometrial-type tissue grows outside of the uterus. It effects approximately 10% of women in Ireland of reproductive age and symptoms can include painful periods, pain during sexual intercourse, bowel movements and urination, pain between periods, abdominal bloating, nausea, fatigue, symptoms of depression, anxiety and infertility. The large spectrum of symptoms makes it difficult to treat and while there is no known cure for endometriosis, controlling and management of symptoms is the ultimate goal.

Treating the pain associated with endometriosis can be difficult as by nature, it is cyclical and changes throughout a woman’s cycle. However, with a multidisciplinary approach, treatment can be very effective.

In the first instance, it would be useful to arrange a consultation with your GP to discuss your symptoms. Your GP, a gynaecologist, pelvic floor physiotherapist, psychologist and a pain medicine specialist can all play an important part in managing your endometriosis if that is the diagnosis.

Working with a pelvic floor physiotherapist is important, as they can assess and assist with pelvic floor dysfunction, which can cause significant pain for endometriosis sufferers. Attending a gynaecologist for both medical and surgical treatment is also important. Hormonal therapy can control some of the symptoms including painful and heavy periods while surgical excision of lesions can also improve symptoms.

When it comes to pain management, simple analgesics are effective in managing flare-ups. When symptoms are particularly bad, regular paracetamol and anti-inflammatories can provide excellent relief. Strong painkillers are best avoided due to the adverse side-effects, but advanced pain procedures can be considered in certain patients which may provide some longer-term relief. For patients who are finding working with a pelvic floor physiotherapist particularly painful, those procedures can provide a window of opportunity, where the pain is effectively managed, and they can engage with physio.

In an ideal scenario, the healthcare workers involved in your care work collaboratively so that treatments can occur simultaneously and ultimately you can manage the symptoms of your disease effectively.

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