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10.32 pm

The Parliamentary Under-Secretary of State for Health (Yvette Cooper): I congratulate my hon. Friend the Member for Hayes and Harlington (Mr. McDonnell) on securing this debate on endometriosis services. This is a subject in which I know he has a great personal interest

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and to which he is devoting considerable time and energy, and I welcome that. I am particularly pleased to have the opportunity to reply to the debate because this is a complex and often ill-understood disease that affects many thousands of women in this country.

Endometriosis is the second most common gynaecological condition in this country, and it affects up to about 2 million women. It is estimated that between 3 and 10 per cent. of women aged between 15 and 45 have endometriosis. In women who have difficulty conceiving, the rate rises to between 25 and 35 per cent.

My hon. Friend has ably described endometriosis and its effects. It is a condition that remains with a woman intermittently throughout the reproductive years of her life. For many women, the continuing recurrent pain and other symptoms make life difficult or even intolerable. The condition can have lasting effects on a woman's self-image, sexuality and fertility. The widespread effects are felt not only by the woman herself but by family and friends trying to cope with the problems that can result. We should not underestimate the importance of endometriosis and the effects that it has on so many people.

Outdated ideas about who is likely to have endometriosis are unfortunately still common. There remains a belief in some quarters that it is the illness of goal-oriented career women over the age of 30. That misconception has now been well and truly disproved. Women in their 20s are increasingly coming forward with endometrial symptoms, and the condition is being diagnosed and treatment offered. The sooner the condition is diagnosed and treated, the better, because that can prevent women from experiencing unnecessary suffering and developing more complex problems that will need more radical treatment.

Endometriosis is not always easy to diagnose because it can mimic or even accompany other causes of abdominal pain. That leads to many women facing uncomfortable, difficult and frustrating delays in diagnosis. Laparoscopy is the only sure way of diagnosing endometriosis. Often in the past, and even today, the pain experienced by sufferers has been dismissed as psychological, while the damage to the pelvic organs continues from the condition.

It is important that at all stages of treatment, medical practitioners discuss the disease and possible treatments fully with the patient. It is vital that each woman understands the options for treatment and understands and agrees with the way in which the condition is handled.

Treatment options can include management of symptoms, medical management of the disease, conservative surgery and radical surgery. Most drug treatments for endometriosis are based on suppressing ovarian activity and hormone release, which abolishes a woman's normal cycle. Generally, such treatments can only suppress endometriosis. I know that many women have found some improvement in their symptoms through using complementary therapies.

For more limited surgery, minimally invasive surgical techniques are increasingly used, allowing a woman to be up and about much sooner following the operation. The radical treatment for endometriosis is a hysterectomy. However, that is appropriate only for women who have completed their families or in cases in which the disease is showing itself in a particularly severe form.

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With hysterectomy, it is vital that a woman feels psychologically prepared for the impact of such a radical move.

The Royal College of Obstetricians and Gynaecologists has produced guidelines on the investigation and management of endometriosis. The guidelines bring together the latest knowledge and best practice, based on clinical evidence of the diagnosis and treatment of endometriosis. They also examine options for treatment in the light of presenting symptoms and associated infertility. The guidelines have been distributed to all the royal college's fellows and members, and I welcome that piece of work.

My hon. Friend has raised a series of concerns, issues and proposals. I will be happy to discuss them with him and with any delegation that he chooses to bring. There are many areas in which we could have a positive and constructive discussion about some of his proposals.

My hon. Friend referred to increasing awareness among women about endometriosis. Work on that is already done through the National Endometriosis Society. The Department of Health funds the society by giving it a grant to help with its core costs, and a further grant for employing an information officer. The NES is a long-standing, effective organisation that can target information about endometriosis at relevant audiences. We look forward to continuing the close working relationship with the society over the range of its activities, including raising awareness of this serious condition.

There may be other areas that we can explore. There are, for example, new ways of making information available. A section on endometriosis is now included on the NHS website and there may be other ways, particularly using new technology, that could help to raise awareness. However, I recognise that as we use new technology to raise awareness, we must also be conscious of the limitations that it can have in reaching all parts of society. We must ensure that our means of communication do not perpetuate inequalities.

My hon. Friend mentioned improving the awareness and training of general practitioners. I should certainly be interested to discuss that issue further with him. Options in that respect may include taking advantage of the new technologies, such as the electronic health library. This may be an area in which more work can be done. My hon. Friend will be aware that the NHS plan sets out proposals to expand continuing support and training for doctors and general practitioners across the board. This is certainly an aspect that we would be interested in considering further.

The National Institute for Clinical Excellence is undertaking the referral practice project on advice to GPs about referring common conditions. Endometriosis is not included in the project, but the results of the project may give us a guide on an effective way of offering referral

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guidance to GPs on a range of common conditions including endometriosis. That may be another area to explore.

My hon. Friend raised issues about increased specialisation, especially as regards centres of excellence. When we meet, I should be interested to hear further from him on that subject, although I express a note of caution: given that endometriosis is so prevalent, managing and treating it should be part of the routine work of every gynaecology department. We want every area to use the evidence-based approach, to ensure that gynaecologists are following the guidelines issued by their governing body, the Royal College of Obstetricians and Gynaecologists.

My hon. Friend referred to the importance of a patient-centred approach. That is crucial. Right across the board, patients, rightly, expect to receive more information about their health. The NHS must provide that; it must respond to that expectation. It is not enough to leave the provision of information about medical conditions to voluntary organisations and support groups. It is essential that the NHS--whether through consultants, GPs or specialist nurses--can provide patients with the support and information that they need about their condition.

Individual patients need proper discussion of the problems from which they are suffering and of the options that are available. That patient-centred approach and self-management are very much part of the new NHS plan and the work going on at present. Endometriosis is a good example of a condition where that approach can work effectively to the patient's benefit. There are a variety of options for treatment of the condition, but the right treatment will be that which suits a particular woman's own condition and needs. That will be achieved only by the woman discussing her needs fully with her doctor.

There may be further work on self-management which could be pursued. Work is continuing on expert patients groups--supporting patients to help them to manage their own conditions. That may be another aspect that could be developed to provide support for women who suffer from endometriosis.

I welcome the points made by my hon. Friend. I look forward to discussing them further with him and with any delegation that he chooses to bring. More can be done. The RCOG guidelines and the work already under way have improved matters for women suffering from endometriosis. Decades ago, the condition was often less recognised and sufferers experienced many difficulties in having their condition taken seriously; there has certainly been an improvement since then, but I am sure that there is more we can do. When I discuss the matter with my hon. Friend, I hope that we can come up with a constructive way forward.

Question put and agreed to.

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