Endometriosis: symptoms, diagnosis and treatment in London

What is endometriosis?

Endometriosis is a condition where tissue similar to the lining of the womb (endometrium) grows outside the womb, most commonly on the ovaries, fallopian tubes, and the tissue lining the pelvis. This tissue responds to the menstrual cycle the same way the womb lining does: it thickens, breaks down, and bleeds each month. Because the blood has no way to leave the body, it causes inflammation, pain, and scar tissue (adhesions).

Around 1 in 10 women in the UK have endometriosis. The average time from first symptoms to diagnosis is 7-8 years, largely because the symptoms overlap with other conditions and because many women are told their pain is "normal."

It is not normal. If your period pain stops you from working, disrupts your sleep, or does not respond to standard painkillers, it needs investigating.

Symptoms

Endometriosis symptoms vary widely. Some women have severe disease with minimal symptoms. Others have mild endometriosis with debilitating pain. The most common symptoms are:

• Painful periods (dysmenorrhoea). Pain that starts before your period and continues during bleeding. Often worsens over the years. Not adequately controlled by paracetamol or ibuprofen.
• Pain between periods. Chronic pelvic pain that is present throughout the cycle, not just during menstruation.
• Pain during or after sex (dyspareunia). Deep pain during intercourse, typically felt internally rather than at the vaginal entrance.
• Pain during bowel movements or urination. Particularly during your period. Can be mistaken for IBS or a urinary tract infection.
• Heavy periods. Flooding, passing large clots, or periods lasting longer than 7 days. Other causes include uterine fibroids.
• Difficulty getting pregnant. Endometriosis is found in 30-50% of women who have difficulty conceiving. It can affect fertility by distorting the pelvic anatomy, damaging the ovaries, or creating an inflammatory environment that impairs egg quality or implantation.
• Fatigue. Chronic tiredness that does not improve with rest. Often underestimated as a symptom but consistently reported by women with endometriosis.

If you recognise several of these symptoms, a gynaecological assessment is a reasonable next step.

How endometriosis is diagnosed

There is no blood test for endometriosis. Diagnosis involves a combination of clinical history, examination, imaging, and, in some cases, surgery.

Consultation and examination

Mr Hikmat Naoum, Consultant Gynaecologist (MRCOG), will take a detailed history of your symptoms, their timing, and their impact on your daily life. A pelvic examination can sometimes identify tender areas, nodules, or ovarian cysts associated with endometriosis.

Pelvic ultrasound

A transvaginal ultrasound can detect endometriomas (chocolate cysts on the ovaries) and deep infiltrating endometriosis affecting the bowel or bladder. Ultrasound cannot detect all forms of endometriosis (particularly superficial peritoneal disease), but it is a valuable first-line investigation and can be done on the same day as your consultation.

Laparoscopy

Laparoscopic (keyhole) surgery is the definitive way to diagnose and, in many cases, treat endometriosis. A small camera is inserted through a cut near the navel, allowing the surgeon to see endometriosis deposits directly, assess their extent, and remove them during the same procedure.

Mr Naoum has admitting rights at London's leading private hospitals and can arrange laparoscopy when indicated. For straightforward cases, he performs the procedure himself. For more complex disease involving the bowel, bladder, or deep pelvic structures, he will discuss the best surgical approach with you, which may involve working alongside a specialist endometriosis surgeon. He will explain the options and what to expect before any decision is made.

Treatment options

Endometriosis treatment depends on your symptoms, severity, age, and whether you are trying to conceive.

Pain management

Simple painkillers (ibuprofen, naproxen) taken from the first day of your period can help with mild symptoms. If these are not enough, your Consultant will discuss stronger options.

Hormonal treatment

Hormonal treatments work by suppressing ovulation and reducing oestrogen levels, which slows the growth of endometriosis tissue. Options include the combined pill (taken continuously without breaks), the progesterone-only pill, the Mirena coil (which also reduces period heaviness), and GnRH analogues for short-term use in more severe cases. GnRH analogues are available through the clinic and work by temporarily lowering oestrogen to menopausal levels; they are usually used for 3-6 months and combined with "add-back" HRT to manage side effects.

The Mirena coil is a particularly useful option for women with endometriosis who also need contraception. The local progestogen delivery thins the womb lining and reduces pain and bleeding.

Laparoscopic surgery

If hormonal treatment is not effective, not tolerated, or not appropriate (for example, if you are trying to conceive), laparoscopic excision of endometriosis can reduce pain and improve fertility. Mr Naoum performs laparoscopic surgery at a private hospital under his admitting rights for straightforward cases, and will coordinate specialist surgical input for more complex disease. He will discuss the expected outcomes, recovery, and risks with you before any procedure.

Recovery from diagnostic laparoscopy is typically 1-2 weeks. More extensive excision surgery may require 2-4 weeks.

Fertility support

If endometriosis is affecting your ability to conceive, treatment is tailored accordingly. Hormonal suppression (which prevents pregnancy) is not appropriate in this situation. Instead, laparoscopic removal of endometriosis deposits can improve natural conception rates. If surgery alone is not sufficient, referral to a fertility specialist for IVF may be recommended.

A fertility check can assess your ovarian reserve and help plan next steps.

Endometriosis and your GP

Many women with endometriosis spend years being told their symptoms are "just bad periods." If your GP has dismissed your pain, prescribed repeated courses of painkillers without investigation, or told you to "wait and see," a private gynaecological assessment can give you a clear answer.

This is not about bypassing your GP. It is about getting the investigation your symptoms warrant, on a timeline that does not leave you in pain for months while waiting for an NHS referral.

Frequently asked questions