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Endometriosis and Adenomyosis

This condition, affecting roughly 1 in 10 women and those assigned female at birth in Ireland, can be debilitating yet remains widely misunderstood.

Endometriosis: A Complex Disease

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.

Endometriosis signs and symptoms

Common symptoms can include;

  • Pain before, during or after periods
  • Painful ovulation
  • Pain or bleeding with bowel movements
  • Pain during or after intercourse
  • Pelvic pain
  • Painful urination
  • Partial bowel obstruction
  • Leg and back pain
  • Right/left chest and shoulder pain
  • Bloating and severe lower abdominal
  • Discomfort
  • Pain when breathing
  • Pain when sitting down
  • Infertility
  • Fatigue
  • Nausea and vomiting
  • Heavy periods

Delayed Diagnosis

Endometriosis can be difficult to recognise because the symptoms can vary. Many other conditions can cause similar symptoms. For this reason, your GP may want to exclude other serious conditions before making a diagnosis of suspected endometriosis.

Endometriosis is a complicated disease that requires a laparoscopy to obtain a definite confirmation what current stage you may have. A laparoscopy involves extracting a tissue sample that we can then send to our pathologist to examine. Only after a laparoscopy can we determine what pathway to take to help you.

At Healthcare Abroad we are fully equipped with a specialised team in the diagnosis and treatment of Endometriosis. Having an expert team solely for Endometriosis enables us to provide you with time and care in the prognosis of this disease and arrange a suitable treatment plan uniquely catered to your needs.

Stages of Endometriosis

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.

Treating Endometriosis

Treatment of confirmed Endometriosis includes the following depending on the diagnosis:

  • Hormonal medication
  • Pain medication
  • Ablation- removal of tissue
  • Excision- removal of adhesions and tissue
  • Bowel resection

Diagnosis of Endometriosis in Ireland

Talk to your GP if you have symptoms of endometriosis, especially if they are severe. If you delay getting help, it can make treatment less effective.

Write down your symptoms before seeing your GP.

Endometriosis can be difficult to recognise because the symptoms can vary. Many other conditions can cause similar symptoms. For this reason, your GP may want to exclude other serious conditions before making a diagnosis of suspected endometriosis.

What to expect

Your GP will ask about your history of symptoms and may ask to examine your abdomen. Based on your symptoms and medical history, your GP may recommend you try medication to help with your symptoms.

If they do not help, your GP may refer you to a gynaecologist for some further tests. For example, an ultrasound scan or a laparoscopy. A laparoscopy is where a surgeon passes a thin tube through a small cut in your abdomen. This lets them see any patches of endometriosis tissue and confirm that you have endometriosis.


Also called internal endometriosis, it is when the endometrium (inner layer of the uterus where menstruation occurs) infiltrates the wall of the uterus, formed by a muscle that is the myometrium.

Like endometriosis, symptoms of Adenomyosis can change from patient to patient. An MRI or Ultrasound can give a suspected diagnosis for this disease, but can only be definitively diagnosed once a hysterectomy is performed and sent to pathology to confirm.

Common symptoms can also have many of the same symptoms of Endometriosis and also include;

  • Pain during menstruation
  • Heavy bleeding and intermenstrual bleeding (metrorrhagia)
  • Adenomyosis pain is described to seem much stronger than endometriosis pain
  • In many cases, the pain is located in the lower abdomen zone and radiates to the dorsal region.
  • Adenomyosis manifests as a dull chronic pain.
  • Symptoms such as transit and urinary disorders.

Adenomyosis is more often diagnosed in patients between 30-45 years of age although there are quite a lot of cases of adenomyosis in very young patients of 20 to 25 years of age.

Treatment of Adenomyosis

  1. Non-surgical treatment options: there are a variety of prescription drugs that can alleviate symptoms such as reducing pain and heavy bleeding. Oral contraceptives, various progesterone preparation and the use of slow-release uterine progesterone devices can be used as well.
  2. Surgical option: What can be done in young women who desire fertility (since the ideal case is to remove the uterus for an effective treatment) is to section and/or coagulate some of the ligaments where some nerves go that cause pain in the uterus, this will preserve fertility. It produces no consequences for the patient and you may have less pain.
  3. Surgical option: Hysterectomy is considered a radical intervention and is indicated as the last option in patients with diffuse adenomyosis. This should not be done in patients with both endometriosis and adenomyosis.

Preparing for Your Endometriosis Journey Abroad

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.

Preoperative consultation and tests

The patients need to arrive 2-3 days before the surgery. If an MRI is necessary, it will be performed either the day before the surgery or two days before the surgery. On the day prior to the surgery date you will need to perform pre-operative tests, you will meet the anesthesiologist for a consultation. You will meet your surgeon for a clinical exam on the same day. You will also do the pre-operative tests and you will be offered information about how to prepare for surgery.

Diagnostic MRI

The MRI will be done within the hospital. The written report of the MRI will be sent to the patient by email, after the examination. At the end of the MRI examination based on what was seen, your surgeon will have a discussion with you. A mini enema (bowel prep) will need to be performed. You will receive all the information regarding the preparation together with the appointment confirmation.

One method of finding out more information about the extent of the disease and the organs affected is the MRI for endometriosis. This specific MRI consists in vaginal and rectal gel insertion, which have the role of distending the cavities to allow a better view of the organs. In addition to this, it’s also important that the MRI be done by a radiologist familiar with how endometriosis looks like.

Hospital Admission and Surgery

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.

Step-by-Step Guide for Post-Endometriosis Surgery Follow-Up:

  1. Follow Your Surgeon’s Instructions: After your endometriosis surgery, carefully follow the instructions provided by your surgeon. These instructions may include specific guidelines for wound care, medication management, and activity restrictions.
  2. Attend Follow-Up Appointments: Attend all scheduled follow-up appointments with your surgeon. These appointments are essential for monitoring your recovery progress, addressing any concerns or complications, and making adjustments to your treatment plan if necessary.
  3. Manage Pain and Discomfort: Take any prescribed pain medications as directed by your surgeon to manage post-operative pain and discomfort. If you experience severe or persistent pain, contact your healthcare provider for guidance.
  4. Rest and Recovery: Allow yourself time to rest and recover following surgery. Avoid strenuous activities and heavy lifting during the initial recovery period to prevent strain on your body and promote healing.
  5. Gradually Resume Activities: As you start to feel better, gradually resume your normal activities and daily routines. Listen to your body and avoid pushing yourself too hard, but also aim to stay active to prevent stiffness and promote circulation.
  6. Incorporate Gentle Exercise: Incorporate gentle exercises recommended by your healthcare provider to improve flexibility, strength, and overall well-being. Examples may include walking, gentle stretching, and low-impact activities such as swimming or yoga.
  7. Monitor for Signs of Complications: Keep an eye out for any signs of complications such as excessive bleeding, infection, fever, or worsening pain. If you experience any concerning symptoms, contact your surgeon or seek medical attention promptly.
  8. Maintain Open Communication: Maintain open communication with your healthcare team throughout the recovery process. Don’t hesitate to ask questions, share any concerns or changes in symptoms, and seek guidance as needed.
  9. Follow Dietary Recommendations: Follow any dietary recommendations provided by your surgeon or dietitian to support your recovery and promote overall health. Eating a balanced diet rich in nutrients can aid in healing and boost your immune system.
  10. Practice Self-Care: Take care of yourself mentally and emotionally during the recovery period. Engage in activities that help you relax and de-stress, such as meditation, reading, or spending time with loved ones.
  11. Be Patient and Persistent: Remember that recovery from endometriosis surgery takes time, and it’s normal to experience ups and downs along the way. Be patient with yourself, stay positive, and trust in the healing process.
  • Sorcha Baliczki

    Sorcha Baliczki

    • Endometriosis and Adenomyosis
    • 14/03/2024

    "Everything was amazing and from the minute I woke up I knew the pain was gone,” said Sorcha Baliczki from Bettystown, Co. Meath. “Everything was brilliant right through to my recovery. The hotel and Healthcare Abroad staff made it seem more like a holiday than surgery recovery".

    Read Their Story
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