Endometriosis and Adenomyosis

Endometriosis is a progressive, chronic inflammatory disease where tissue similar to the lining of the womb is found elsewhere in the body. This disease is estimated to affect 1 in 10 women worldwide. In Ireland it is estimated that 155,000 of women are affected by endometriosis.

Pain is the main symptom of endometriosis. Endometriosis is a very complex disease, and the symptoms differ from person to person. Some symptoms of endometriosis correlate with other medical conditions, making diagnosis even more difficult. The stage of the disease does not always correlate with the level of pain. Some symptoms are due to organs being affected directly or due to the irritation caused by endometriosis lesions.

Endometriosis can be symptomatic and asymptomatic, although, with the right questions/clinical investigations, an asymptomatic patient can become symptomatic. Also, in cases of asymptomatic (pain wise) endometriosis, if fertility is affected, then this becomes symptomatic, as infertility is a symptom of endometriosis. The pain can be cyclic or acyclic, but it usually gets worse during menstruation.

In the early 1960s, when laparoscopy was introduced, endometriosis was divided into three different clinical presentations:

The classification of the sages of endometriosis are done using point scores depending on the location, extent and depth of endometriosis implants; the present and severity of adhesions, and the presence and size of ovarian endometriomas. The staging of endometriosis does not always correlate with the severity of symptoms.

Stages 1-2: ‘Minimal’ or ‘Mild’ ;

Wounds or implants that are found mostly in the pelvic region or surrounding organs. Also known as Superficial Peritoneal Endometriosis: the peritoneum is a thin membrane that covers the organs in the abdomen and pelvic cavity. Superficial lesions are typically located on the pelvic organs or the peritoneum. The lesions are initially colourless or clear which then can progress to the most known appearance of blue-black. They are known as powder burn or cigarette burn.

Stage 3: ‘Moderate’ ;

There are many deep implants with cysts present in the ovaries and thick bands of scar tissue. Also known as Endometriomas cysts: Endometriomas are dark, dense fluid filled cysts. They are common in the ovaries and vary in size. They are associated with deep infiltrating endometriosis and affect 17 – 44% of patients with endometriosis.

Stage 4: ‘Severe’ ;

Many deep implants, adhesions and cysts located on multiple organs. Also known as Deep infiltrating endometriosis: When endometriosis tissues are found deep within a tissue or organ, deep infiltrating endometriosis occurs. Although considered to be rare, deep infiltrating endometriosis is quite common. These lesions can be found in recto vaginal septum, cul-de-sac, between the bladder and the uterus, on the uterosacral ligaments and in other extraperitoneal pelvic sites.

Regardless of any stage of Endometriosis, symptoms differ between every person. A person in stage 4 could possibly experience less pain then a person with stage 1, this is why a definitive diagnosis is very important to rule out any other illnesses eg IBS.

Embarking on a journey towards improved health through endometriosis surgery requires a seamless process to ensure your comfort and well-being. Here’s a step-by-step guide to help you navigate the stages before your travel:

1. Identification of Treatment Need -Your first step is to consult with your General Practitioner (GP) or consultant who will assess and identify the necessity for endometriosis surgery – see below.
2. Initiate Contact with Healthcare Abroad – Once the need for treatment is established, either you or your GP can initiate contact with Healthcare Abroad. Our dedicated team is ready to guide you through the process of receiving surgery in an EU country under the cross border directive.
3. Referral and Diagnostic Coordination -The Healthcare Abroad team will collaborate with your GP to arrange a referral letter and any essential diagnostic tests. We streamline this process by providing the results directly to the chosen hospital.
4. Hospital and Surgeon Matching – Our team, with a vast network of hospitals and skilled surgeons, will carefully match your requirements to ensure you receive personalised care.
5. Financial Assistance – If needed, we can assist you in organising your finances through Irish credit unions, making the financial aspect of your healthcare journey hassle-free.
6. Surgery Planning and Documentation – Coordinating with the selected hospital, we facilitate the arrangement of surgery dates and ensure all necessary files are sent for review.
7. Confirmation of Travel Dates – Once your healthcare plan is confirmed, we liaise with the hospital team to finalise your travel dates and healthcare schedule.
8. Arrival and Out-Patient Appointment – Upon arrival at the hospital, you’ll have an out-patient appointment with your consultant the day before the scheduled treatment, ensuring all preoperative concerns are addressed.
9. Post-Surgery Paperwork – After your surgery, we take care of finalising all paperwork, submitting it to the Health Service Executive (HSE) on your behalf, and ensuring a prompt refund process.
10. Report to Local GP – To maintain continuity of care, your GP will receive a comprehensive report from the hospital regarding the treatment received, updating your local medical records accordingly.

You will be admitted to hospital on the morning of your surgery. You will be taken to your room by one of the nurses and you will be prepared for surgery. You will be taken to the operating room by a nurse where you will meet the rest of the team. Based on the schedule for the day and the complexity of your case, your surgery might be first one in the morning, or later on.

After surgery you will remain under observation for a few hours, maybe the whole night in the ICU. When the anesthesiologist decides it, you will be brought back to your room on a bed by the nurses, and you will be administered medication. The surgeon will visit you either on the same day or the day after. Other members of the medical team will visit you as well, including Healthcare Abroad Team before and after the surgery. The medical team will follow up closely while you remain in the hospital. If you have any questions for the surgeon while you are in the hospital please let us know and we can arrange a visit.