Ms Ilanna Darcy:

I am not aware of difficulty accessing the clinics. The complication arises because, as I mentioned, endometriosis is linked to oestrogen dominance. The general course of treatment through menopause is with HRT. A lot of the initial symptoms and perimenopause are largely dealt with through oestrogen. Obviously increasing the oestrogen in a patient who has endometriosis can worsen the symptoms in some regards. People who present with heavy bleeding and so on may, for instance, be fitted with a Mirena coil. It is then deemed that because the coil is there, they do not need any more progesterone. There are many cases of women who have endometriosis, fibroids and adenomyosis, like me, where we have the coil but there is not sufficient progesterone. It is only taking care of the uterus, whereas there are progesterone receptors all over the body and endometriosis is outside the womb, so progesterone can still provide much relief.

As I mentioned, once women have had hysterectomies, maybe as a result of endometriosis, adenomyosis or fibroids, the medical guidelines are that if they do not have a womb, they do not need progesterone, but if they do not have a womb and they have endometriosis, they still have endometriosis even if they had a hysterectomy, and progesterone can still be valuable. The guidelines are set such that they do not really encompass the endometriosis patients as well as they could. It is beginning to change but there are no formal guidelines on prescribing progesterone if people do not have a womb.