On arrival you will be asked to complete a symptom questionnaire.

You will then see a member of the team to discuss these symptoms. You may be asked specific questions about your periods and sex life. The consultation will cover previous investigations and treatments you may have tried, and the effect of your symptoms on your day-to-day life.

Your gynaecologist may ask to examine your abdomen and pelvic area (this involves an internal examination), with the support of a nurse chaperone. There is always privacy to undress and dress. An ultrasound may be recommended; this is often completed transvaginally, via a thin probe inserted into the vagina.

The effect of endometriosis varies hugely between women. Individualised recommendations will then be discussed with you including the risks and benefits of each approach. You will have the opportunity to ask questions.

Below are examples of possible plans of care. One or more may take place in sequence or in parallel.

Further investigations may be suggested. This could include blood tests, vaginal swabs to look for infection, biopsies from the womb lining or an MRI (Magnetic Resonance Imaging) scan. More specialist tests may be necessary involving the bladder (e.g. cystoscopy) and/or bowel (e.g. sigmoidoscopy), meaning additional appointments having to be arranged.

Medical treatments for endometriosis may be offered. This can involve taking extra hormones or treatments that result in lower hormone levels.

Surgical investigation and treatment may be offered.

Mild to moderate endometriosis can sometimes be treated if discovered at the time of surgery.

Surgery for moderate and severe endometriosis may require a longer operation time, additional surgical support and different pre operative planning, in which case the endometriosis is often treated at a second procedure. This usually involves an overnight stay on our Cotswold ward.

When factors make endometriosis surgery complex or high risk, we discuss cases at our Endometriosis MDM. This is a full review of your history, examination findings and the results of any investigations (or previous surgery) with the whole team. We use this to ensure we are recommending the best plan of care and to discuss surgery if proposed.

This meeting also helps us review and guide improvements to our service.

Some women find it helpful to bring a family member, friend or partner along with them for support. You may find it useful to write down your symptoms or any questions you may have beforehand and take your notes along to the appointment with you.

Endometriosis is a chronic inflammatory condition driven by the hormones oestrogen and progesterone.

In women with endometriosis, cells similar to those of the womb lining (the endometrium) are found in other parts of the body, most commonly in the pelvis (e.g. on the lining of the wall of the pelvis, in the ovaries, fallopian tubes, bladder, bowel or ligaments supporting the womb). 

These cells undergo cyclical changes (related to the menstrual cycle), where patches of endometriosis thicken and shed but with no way for them to leave the body. This causes inflammation and scar tissue to form, which can lead to pain and discomfort.

Endometriosis is not an infection and it is not contagious. Endometriosis is not cancer.

Endometriosis affects as many as one in ten women of reproductive age, many of whom will have no symptoms. This is an estimated two million women in the UK. It can affect women from every social group and ethnicity.

• Pelvic pain which is cyclical (related to the menstrual cycle) or non-cyclical (unrelated)
• Excessive pain before/during/after periods
• Pain during sex
• Fertility problems
• Persistent tiredness
• Pain when urinating
• Abnormal bleeding
• Pain with bowel movements

Endometriosis can vary in severity. Some women experience few or no symptoms; other women suffer with many effects. It can affect many aspects of a woman’s life including her general physical health, emotional wellbeing and daily routine.

There are three types of endometriosis:

1. Ovarian endometriosis: This causes ovarian cysts called endometrioma. The cyst is filled with old blood and because of the colour, the cysts are often referred to as ‘chocolate cysts’.

2. Deep endometriosis: The nodules of endometriosis implant at least 5mm below the peritoneum. Structures affected can include the uterosacral ligaments (ligaments supporting the womb), bowel, bladder and ureters.

3. Superficial peritoneal endometriosis: The lesions involve the peritoneum, which is a thin film that cloaks the inner surfaces of the pelvis. The lesions are flat and shallow and do not invade into the spaces underlying the peritoneum.

Some patients have more than one type of disease present in their pelvis.

Endometriosis can be diagnosed by having a diagnostic laparoscopy (key hole surgery). This involves passing a thin telescope through a small cut in your umbilicus (navel). It is connected to a video camera and television so that the inside of the pelvis can be examined. This procedure requires a general anaesthetic.

Some types of endometriosis can be diagnosed through ultrasound or other imaging such as an MRI scan.

Endometriosis is treated by medical or surgical methods.

Medical therapies include:

1. Painkillers (paracetamol, ibuprofen)
2. Hormones such as the oral conceptive pill, Depo-Provera ™ injection, Nexplanon™ implant and Mirena™ coil or types that cause a temporary and false menopause state (Zoladex™)

Surgery involves removing the deposits. This is mostly completed laparoscopically

Bristol Genetics Laboratory (BGL) and Exeter Genetics Laboratory (EGL) are UKAS accredited medical laboratories numbers 9307 and 8092. UKAS assesses against the International Standard for medical laboratories, BS EN ISO15189:2012. Further information on accreditation is available via the UKAS website.

Details of activities that are currently provided under the scope of accreditation can be found at:

1. BGL Schedule of Accreditation
2. EGL Schedule of Accreditation - link to follow

In certain circumstances laboratory tests will be performed outside the scope of accreditation. This may arise when new services are introduced, for which UKAS accreditation is yet to be awarded. Application for extension to the laboratory scope will be submitted, however, whilst accreditation is pending the test continues to be performed to the same rigorous internal quality control standards and protocols as accredited tests. It should be noted that elements of the Whole Genome Sequencing service are undertaken by an external provider and are, therefore, provided outside the laboratory’s UKAS scope of accreditation.Methods that are currently pending accreditation are as follows:

The SWGLH participates in a comprehensive range EQA schemes provided by the following:

UKNEQAS / GenQA

EMQN

Where a formal EQA scheme is not available, arrangements for an informal sample swap testing scheme are made with another accredited laboratory.

The SWGLH is working towards 90% compliance with national reporting time guidelines stated in the table below:

Below are the turnaround times (TAT) for the Cancer Genomic Services at the South West Genomic Laboratory Hub (SWGLH).  Cancer Genomic Services for the SW GLH are delivered from the Bristol Genetics Laboratory. Unless otherwise stated TAT is measured in calendar days from the date of sample receipt at Bristol Genetics to the point at which a result is returned to the requestor.

Further information on requesting a test can be found at SWGLH Sample and Test Information. 

Solid Tumour Genomics

Please contact SWGLHcancer@nbt.nhs.uk for further information. 

Haematological Malignancy Genomics

Please contact Haem Duty Scientist SWGLHhaemonc@nbt.nhs.uk for further information.

As the SWGLH , we strive to fulfil the requirements of all our service users and conduct regular user surveys. We are always happy to receive comments and feedback from our service users, please use the contact details below . This drives continual improvement and ensures that our service meets the needs of both referrers and patients.

If you would like to provide feedback please email us mailto: SWGLHenquiries@nbt.nhs.uk

We would like to assure our service users that complaints are taken very seriously and are fully investigated. The SWGLH laboratories respond to complaints in line with their respective Trust complaints policies and procedures. Further information can be found via the links below:

NBT Complaints Procedure

EGL Complaints Procedure

The SWGLH workforce development strategy is underpinned by a set of guiding principles:

• It is aimed at the multi-professional workforce and not limited to professional groups
• It is cross-organisational and not is bound to existing institutional boundaries
• It is focussed on ensuring a genomically knowledgeable workforce aligned to deliver equity of testing to the local population

The SWGLH education and training plan defines the portfolio of Genomic education and training activities required to deliver the workforce development strategy. 

There will be several different modes of delivery to underpin the plan's guiding principles:

• Accessible to all - where possible based on individual learning needs
• Various modes and formats to support different styles of learning
  • Following current guidelines in line with social distancing - using remote delivery methodology
• Using evaluation and improvement science methodology to continuously drive for quality education and training that is fit for its intended purpose

• The Education strategy and plan is led by the SWGLH Education and Training Lead.  Contact details above
• The lead facilitates activity from teams and individuals across the regions’ key stakeholder groups including expertise from Scientists, Clinicians and Educationalists

This area of the website has content pages associated with:

• Information on future educational events
• Resources from past events
• Signposting to both national genomics educational packages and locally developed resources
• Link to a genomics glossary.

The SWGLH participates in many research projects working with both University and Commercial partners. Please contact the service if you wish to discuss any research projects you are involved with and how we may help to support you.

National Institute for Health and Care Research (NIHR) and The Academy of Medical Royal Colleges (AoMRC) Clinician Researcher Credentials Framework.

• Are you a healthcare practitioner who aspires to be a Co-Investigator or Principal Investigator
• Could you help to mentor colleagues to develop research delivery leaders of the future?
• Are you an employer looking for new ways to develop the next generation of Research Delivery Leads?

Visit NIHR & AoMRC Clinician Researcher Credentials Framework

About the course

This course is designed so participants can work at their own pace for a few hours over a couple of weeks. The course looks at why it is important to work with people and communities, how we can successfully involve marginalised communities, and some of the challenges to working with people and communities that health and care professionals can face and how they can be overcome. The course also explores how to create better health outcomes through working with people, and can support you to think about what it means to be really heard – and what difference that can make. 

Who is the course for?

The course is mainly for NHS and social care professionals including clinicians, receptionists and clinical students.

How do I sign-up?

You can sign up on the FutureLearn website here

Is the course funded?

If you work within the NHS, your upgrade is fully-funded through a partnership between the NHS and FutureLearn. You will be able to get a certificate for completing the course and will keep access to the sessions.  Details on how to do this, along with eligibility criteria, are available here.