Pelvic Pain Treatment in London


Medication

The purpose of medication is to cause the endometriotic tissue to regress. To achieve this result hormonal preparations such as progesterone, or the combined oral contraceptive pill, are a first line treatments. Occasionally none of these are completely effective and stronger treatment such as GnRH analaogues (Zoladex) are required. Due to vasomotor symptoms and low oestrogen status this is a short term treatment of 3-6 months. It can be combined with adback HRT.

Surgical

The destruction of endometriotic tissue is an important goal in the treatment of endometriosis. Laparoscopic laser surgery is extremely successful at accurately removing endometriosis and improving pain and fertility resulting in better outcomes. The recovery from surgery is far quicker with laparoscopic compared with conventional abdominal surgery.

Management

Endometriosis is often a long standing condition that requires a good understanding between the patient and clinician. At all times improvements should be measured using quality of life and visual analogue pain scores. The needs of the patient are paramount when deciding further management.

Treatment

Management of abnormal uterine bleeding can be divided in to medical and surgical depending on the underlying cause. Most cases of premenopausal bleeding do not have an identifiable cause. A common cause of irregular menstruation is polycystic ovaries and regularity of the menstrual cycle can be achieved with use of the oral contraceptive pill. In the presence of hirsuitism and acne, Dianette oral contraceptive pill is very effective due to its antiandrogen properties.

Women with menorrhagia are best treated with tranexamic acid, an anti-fibrinolytic agent at a dose of 1g three times a day from day 1 to day 5 of the menstrual cycle. Studies have demonstrated a reduction of up to 50% in menstrual blood loss on this treatment regime. Oral Progestogens such as norethisterone or medroxyprogesterone acetate (provera) are not an effective treatment for menorrhagia. They are however useful for arresting heavy bleeding and can be used to induce a withdrawal bleed in women with amenorrhea secondary to polycystic ovarian syndrome. Second line medications such as GnRH agonists, danazol and gestrinone are effective in reducing heavy menstrual blood loss but side effects such as menopausal symptoms and osteopenia limit their long term use.

Surgical Options

Endometrial pathology such as polyps or submucosal fibroids can be removed by hysteroscopic resection under general anaesthetic. This is often performed as a day case with a full and speedy recovery.

Microwave and balloon thermoablation

New safe endometrial ablative techniques include balloon thermoablation and microwave ablation. These procedures are performed as day case surgery and occasionally under local anaesthetic. The operation takes less than 10 minutes and significant reductions in blood loss in over 80% of cases. These new procedures are safe and are superceding endometrial resectors.

Transcervical resection of the endometrium (TCRE)

The procedure is performed hysteroscopically as a day case and is most effective after the endometrium has been thinned by inducing a hypooestrogenic state with gonadotrophin releasing hormone analogues. Significant reduction in blood loss occurs in up to 85% of cases with amenorrhea resulting in 20% of patients. For women with severe dysmenorrhoea this procedure is not recommended as the pain may worsen.

Myomectomy

For women with large fibroids myomectomy or hysterectomy is the treatment of choice. Women wishing to preserve their uterus would opt for myomectomy. This can be performed laparoscopically where a solitary fibroid is present up to 8cm in diameter otherwise a conventional abdominal myomectomy would be carried out.

Hysterectomy

The final treatment option for severe menorrhagia is a hysterectomy. The commonest method is an abdominal incision – pfannenstiel (suprapubic transverse) especially when the uterus is greater than ten weeks size. For a smaller uterus then a vaginal hysterectomy is preferable. In a post menopausal woman the ovaries are often removed and a laparoscopic assisted vaginal. Hysterectomy can be performed. In a few UK specialist centres laparoscopic hysterectomy is performed with significantly quicker recovery rates compared with conventional abdominal surgery.

GENERAL ENQUIRIES

Make Appointment/Enquiry

For all further information, if you have questions or to discuss treatment please contact Mr Colin Davis on:

Telephone : 020 7034 5000 Fax:020 7034 5080 Email: secretary@gsc.uk.com

From the first consulation with Mr. Davis | immediately felt confident in his abilities and expertise. He explained everything | needed to know about endometriois and PCOS so that we could make decisions to fix the problems and avoid fertillty issues...