Mr Denis Tsepov, Consultant Gynaecologist and Laparoscopic Surgeon at The Endometriosis Centre at The Harley Street Clinic, part of HCA Healthcare UK - speaks to us about why endometriosis can be difficult to diagnose, the debilitating pain it can cause, and how his team are revolutionising the way it is treated in clinic.

When did you first realise that you wanted to be a gynaecologist?

It was inevitable that I was going to be involved in science or medicine when you look at my family. My father was a military psychiatrist, my mum was a dentist and my grandparents were both nuclear scientists, so science and medicine were always in my blood.

Understanding why I chose gynaecology is a different matter. I knew that women’s health would be a passion of mine when I first saw a woman give birth whilst I was working as a healthcare assistant in a maternity hospital whilst at medical school. It truly astounded me what a woman’s body could do and at that moment I knew that I wanted to care for women – something which remains an honour.

In 2014, four years after becoming an NHS consultant, I started work at HCA Healthcare UK, carrying out general gynaecology and gynaecological surgery work. As my clinical interests developed, I then moved to building my practice, and then my clinic, entirely around endometriosis and advanced endoscopic surgery.

What is endometriosis and why does it interest you?

Endometriosis is a chronic condition where tissue which is similar to the lining of the womb grows in other places, such as the ovaries, fallopian tubes, bowel or bladder and can affect women of any age, but mostly during reproductive years. In the UK, it takes an average of 7.5 years to diagnose due to its symptoms being considered very non-specific by many health professionals. Symptoms include painful periods, non-cyclical pelvic pain, pain during sex and pain when passing bowel movements together with many other symptoms including difficulty getting pregnant and constant fatigue.

Many patients who have dealt with these problems unsupported for years come to the clinic with so little faith in the medical profession. It’s our job to go back to the start and understand their medical history and the problems they’ve been facing so we can identify endometriosis, assess its severity and treat it. We will take into consideration a patient’s symptoms, age, fertility aspirations and look at where her quality of life is affected most.

What is particularly fascinating to me about endometriosis is that it’s unpredictable. One woman might have one or two spots of endometrial-like tissue on the lining of her pelvis, but be in excruciating pain, yet with another woman, her bowel lumen could be completely narrowed by the endometriotic tissue growth and yet be in barely any pain at all. Every patient is utterly unique and that is what makes my work so interesting.

What do you expect will be the biggest change in the diagnosis and treatment of endometriosis in the next five years?

At the moment, there are no biochemical or tissue markers to predict that one woman’s endometriosis is going to be extensive and fast growing, whilst another woman’s will be mild and stable. I can perform the same excisional surgery for deep endometriosis on two women – and the result for one woman could be that there is no recurrence of the disease, and yet the other woman it could recur incredibly fast.

I also think, as with many specialties, we will look to make endometriosis surgery as minimally invasive as possible and will likely turn fully to robotic surgery to help make that happen. For patients, this will mean smaller cuts, less time in surgery and quicker recovery times. We also will continue to promote the concept of ‘conservative radicality’ in excisional endometriosis surgery, which dictates being radical in removing the all disease, like in cancer surgery for example, but at the same sparing the pelvic nerves, minimising damage to the ovarian reserve and avoiding large ‘cancer type’ bowel resections.

I also hope that the understanding of this condition improves. If you’re experiencing painful periods, pain during sex or pain during bowel movements or you know a woman who is – this could be endometriosis and it’s important that it’s diagnosed and treated quickly as it can severely impact fertility and overall quality of life. I expect that its impact on fertility will be the subject of a lot of research over the next few years too.

Why choose The Harley Street Clinic Endometriosis Centre at HCA Healthcare UK?

Endometriosis is a complex condition and often requires the work of several specialists to effectively treat it. I am incredibly proud of the fact that at The Harley Street Clinic Endometriosis Centre, I’ve managed to bring together so many top expert clinicians in one place.

Our philosophy is:
  • Multidisciplinary team approach and constant support of our patients
  • Individualised treatment strategy and involvement of patients in decision making
  • Excisional, nerve-sparing endoscopic endometriosis surgery of any complexity
The Harley Street Endometriosis Centre is a coordinated, multidisciplinary network which offers a comprehensive and personalised approach to endometriosis. At our clinic, gynaecology endometriosis surgeons, specialist endometriosis nurses, colorectal (bowel) surgeons, urologists, anaesthetists, chronic pain specialists, gastroenterologists, and consultant radiologists, specialising in endometriosis, work together. At our clinic, which is fully accredited by The British Society Of Gynaecological Endoscopy (BSGE), our specialists discuss the treatment of each patient during multidisciplinary team (MDT) meetings to optimise and coordinate individual surgical strategy for each patient.

We believe in supporting patients in all aspects of endometriosis care before, during and after surgery. Apart from the core medical specialists, our patients will have access to a clinical psychologist, complimentary medicine specialist and psycho-sexual counsellor. We work in close partnership with the fertility team at The Lister Hospital in Chelsea for those patients who have difficulty getting pregnant with endometriosis. Our aim is to improve reproductive health of our patients and enhance their quality of life.
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