March 20, 2020

ENDOMETRIOSIS is a chronic condition where the lining of the womb is found outside of the uterus and is commonly found in the pelvis, but occasionally can be found in multiple places, like the umbilicus, caesarean section scars.

With every menstrual cycle there is an inflammatory response due to the endometriosis causing inflammation, scarring and adhesion formation in the pelvis.

The incidence is around 10-13 percent, however, the true prevalence of this disease is not known.

An Endometriosis Centre improves the level and standard of care for patients with endometriosis and is evidenced-based and found to improve outcomes.

It can have no symptoms at all or be symptomatic, when symptomatic endometriosis causes lower abdominal pain, which is usually chronic and is one of the causes for deep painful intercourse and is one of the major causes of infertility.

Traditionally care for mild and complex endometriosis was not multidisciplinary and diagnosis wasn’t achieved until women were in their 30s and 40s. In addition, some patients would have been previously told that there was nothing more that could be done for them, especially if what was found at laparoscopy was a ‘frozen pelvis’ where the pelvic organs were ‘stuck’ together by adhesions.

The difference an Endometriosis Centre makes is multi-fold, it begins with the delivery of care and the multidisciplinary team, under one specific location and determination to best manage this condition.

Firstly, the Paediatric and Adolescent aspect where endometriosis can be diagnosed by a gynaecologist with expertise in Paediatric and Adolescent Gynaecological problems, this improves the early diagnosis and pick up rate in this young age group, because endometriosis is usually diagnosed in the 3rd decade of life. The aim is to early diagnose and treat endometriosis and educate the patient and to prevent future pain and infertility problems.

The adult gynaecological aspect overlaps with the paediatric and adolescent gynaecologist with the emphasis on early diagnosis.

All newly diagnosed cases are discussed regarding optimal management and complex cases, which involve deep infiltrating endometriosis, and are discussed with relevant imaging studies and the optimum management is planned.

For deep infiltrating endometriosis where bowel is involved, this is where the 3rd member of the team comes in – the Laparoscopic bowel surgeon – whose role is to assist the gynaecologist with this difficult surgery.

If deep infiltrating endometriosis involves the bladder, the expertise of the urologist is needed in relation to either stenting the ureters or dissecting or resecting bladder away from the uterus.

Pain is a major factor in endometriosis and usually controlled by the gynaecologist, however, some patients are complex and may need the assistance of the 5th member of the team, which is the Pain expert/ Anaesthetist, who can provide differing types of anaesthetic blocks to help with pain.

Patients with endometriosis and their family can have emotional and psychological problems and this is the domain of the psychologist who is one of the most important members of the team.

This provides a holistic approach in the level and standard of care.

There is access to fertility services once patients have been treated as most patients would be young and wanting to conceive.

In conclusion the formation of an endometriosis centre is a necessary addition to the management of patients in St Vincent and patients will benefit from a planned multidisciplinary input.

Dr John Barker has completed the Advanced Training Skills Module in Gynaecological Oncology and Benign Surgery in the UK and runs Specialist Endometriosis Clinics in Barbados and is founder of the Endometriosis Centre in Barbados(JRB Medical Centre) (instagram@ gynaestvincent, facebook@ gynaestvincent)