Endometriosis

Mr Moiad Alazzam, is a recognised expert for the management of severe, multi-organ endometriosis and treats a high volume of endometriosis patients. He pioneered minimally invasive laparoscopic and robotic procedures used for treating endometriosis. He established the first BSGE recognised endometriosis centre in Ireland. He is frequently invited to national and international congresses, speaking and demonstrating surgical techniques for treating gynecological pathologies.

Mr Alazzam has a long-standing high-volume surgical practice. Referrals from across the UK and abroad are welcomed. Mr Alazzam offers both virtual (video) consultations asnd face-to-face consultations in his offices in Oxford, UK

To book an appointment with Mr Alazzam, please click here

Endometriosis Q & A

What is endometriosis?

Endometriosis is a chronic, progressive, estrogen-dependent inflammatory disease. It results when a tissue similar to the lining of the womb, endometrial-like cells, is present in other areas of the body. Endometriosis is most commonly found in the pelvic cavity on the uterus, fallopian tubes and ovaries, however it is frequently found in extra-genital areas such as the bowel, bladder, and ureters, and is known to affect the diaphragm, lungs, and many other organs and locations.

It is estimated that at least 11% of women have endometriosis, which a mounts to a staggering 156 million worldwide. In the UK, it is thought to be affecting over two million women.

There is no definitive cure for endometriosis but it can be effectively managed medically and surgically.

What are the symptoms of endometriosis?

Often there is no indication that anything is wrong and the endometriosis is only discovered by chance. However, for many women, it can be incredibly uncomfortable and distressing. Symptoms include:

  • Painful periods: Lots of women accept period pain as an inevitable part of being a woman. But periods should not be so painful that they affect your life, your work, and your relationships.

  • Pelvic pain: The pain of endometriosis can be severe and although it is often associated with your period the ongoing inflammation can cause pain that lasts throughout the cycle

  • Fatigue and malaise: many women with endometriosis feel weak, tired and generally unwell

  • Painful sex: especially deep pain, which can continue after intercourse has stopped

  • Difficulty getting pregnant: the bleeding in the pelvis can lead to the tubes and ovaries getting inflamed and stuck together which can affect fertility

  • Pain on opening the bowels or passing urine: this can be a sign of a more severe form of endometriosis that affects the bowel and the bladder.

  • Irritable bowel syndrome like symptoms: these typically are cyclical and change in intensity with the menstrual cycle.

How is endometriosis diagnosed?

Endometriosis can be tricky to diagnose and many doctors haven’t had enough experience in identifying and treating this condition. However, your symptoms can provide lots of clues:

  • Pelvic examination: On examination it is possible to feel ovarian cysts and swellings, identify painful endometriotic nodules or note areas of tenderness

  • Ultrasound scan: An ultrasound scan can show cysts on the ovaries and show if previous inflammation has caused the pelvic structures to be stuck together or pulled out of position. Ultrasound can also help spot some nodules of endometriosis

  • Laparoscopy: A laparoscope is a telescope that is inserted through a small incision in the tummy button to look inside the abdomen and pelvis. It is the best way of accurately diagnosing and identifying endometriosis.

Endometriosis commonly goes undiagnosed or is misdiagnosed and it typically takes 6 to 10 years from the time a woman experiences her first symptoms to the time she receives a diagnosis.

What are the risk factors for endometriosis?

Endometriosis is predominately found in women of reproductive age, but it also affects teenage girls who have not yet menstruated, post-menopausal women, and women who have had their uterus or ovaries removed.

  • Prolonged estrogen exposure

  • Beginning menstruation at an early age

  • Having frequent or long-lasting periods

  • Heavy menstrual bleeding

  • Not having had children

  • Congenital genital anomalies


What treatment options does Mr Alazzam offer for endometriosis?

The right treatment will depend on your symptoms, the extent of your disease and whether any of the vital pelvic structures such as the bladder, bowel and the ureters (tubes that take urine from the kidneys to the bladder) are affected. Sometimes, no treatment is necessary and it is better to simply monitor your endometriosis.

Medication and surgery can both help. The best treatment for your individual needs can be decided after a detailed discussion, considering your preferences and whether you plan any future pregnancies.

Medical Management: Pain killers and hormonal treatments can be effective in controlling the symptoms, but side effects can be problematic, and they do not stop the progression of disease.

  • Non-steroidal anti-inflammatories (NSAID’s)

  • When the endometriosis has caused nerve sensitivity or damage, other treatments may become necessary such as pregabalin or gabapentin.

  • Oral contraceptive pills

  • Progestins

  • GnRH agonists and antagonists

  • Androgens

  • Aromatase inhibitors

Surgical Management: The standard of care is to perform minimally invasive surgery (laparoscopy) to remove/destroy endometriosis implants. The goal is to restore normal anatomy and maintain organ function, to reduce pain, and to preserve fertility. In experienced hands, the benefits of surgery outweigh the risks.


Endometriosis and Cancer Q & A

Similar to the way gynaecological cancer patients are managed; Mr Alazzam believes that every endometriosis patient must be followed by a specialist in endometriosis, preferably a minimally invasive surgeon, for possible endometriosis recurrence and possible malignant transformation of endometriosis.

Epidemiological, histological, and molecular studies suggest a link between endometriosis and certain ovarian cancers, particularly the histological subgroups: endometrioid, clear cell, and low-grade serous ovarian carcinoma.

The lifetime risk of ovarian cancer among women with endometriosis is 1·80% which is still fewer than two women in 100. The life time risk of ovarian cancer in women without endometriosis or other risk factor is 1.3%.


Am I going to get ovarian cancer?

  • Most women with endometriosis never develop ovarian cancer. Although several studies report an increased ovarian cancer risk, evidence suggests that the overall likelihood of you developing ovarian cancer is low. Thus, you should be aware of, but not worried about, the effect of endometriosis on your ovarian cancer risk.

  • Although 1·3% of women in the general female population will develop ovarian cancer in their lifetime, this proportion is still less than 2% in women with endometriosis. Thus, although the risk is increased, your lifetime risk is low and is not substantially different from that in women without endometriosis. To put the risk in perspective, according to recent estimates, 39% of women who inherit a harmful BRCA1 mutation and 11–17% who inherit a harmful BRCA2 mutation—the rare genes that predispose to breast cancer—will develop ovarian cancer by 70 years of age. Furthermore, as a woman in the general population, your risks of breast (12%), lung (6%), and bowel (4%) cancers are still higher than your risk of developing ovarian cancer.

  • Certain types of ovarian cancer are more commonly associated with a history of endometriosis. These endometriosis-associated cancers tend to be detected at an earlier stage and have a better prognosis than other types of ovarian cancer.

What can I do to lower my cancer risk?

  • No clear evidence exists that transvaginal ultrasound or serum CA-125 measurements can detect ovarian cancers early or that risk-reducing surgery to remove the ovaries can save lives. Generally, to improve health and reduce the risk of cancer, try to have a balanced diet with low intake of alcohol, exercise regularly, maintain a healthy weight, and do not smoke.

Reference: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33049-0/fulltext