Endometriosis is a condition where tissue similar to the lining of your uterus (womb) is found in places outside of your uterus, such as on your ovaries, bladder or even bowel. It affects 1 in 10 New Zealand cis females and transgender people.
Meet our multi-disciplinary for Endometriosis
Symptoms
Pain with periods (dysmenorrhoea).
Painful sex (dysparaeunia)
Random pelvic pain (non-cyclical pain)
Fatigue
Infertility
Bladder and Bowel troubles (bloating, pain with bowel movements, pain with urination)
Diagnosis
A “clinical” diagnosis can be made based on symptoms patients experience and/or evidence of deep endometriosis (scarring) felt during a gynaecological exam or seen on ultrasound/ MRI.
A “surgical” diagnosis is made after endometriosis is excised and sent for lab diagnosis. Under the microscope endometriosis shows up as inflammation and glandular tissue. This type of tissue should not be found in the pelvis normally.
Stages of Endometriosis
Many people talk about endometriosis as stage 1 to 4 (minimal to severe) (ASRM). This staging system tries to encapsulate how widespread the endometriosis is. Whether it affects ovaries, fallopian tubes, or other organs in the pelvis (bowel, bladder). Newer staging systems focus on the level of invasion of pelvic organs (ENZIAN). A clinical exam, ultrasound and/or MRI are used to establish the level of disease.
Treatment
Treatment should involve a multi-disciplinary approach. What this means is there is more than just an endometriosis doctor is involved in a patient’s care. Other key health professionals include physiotherapists, nurses, dieticians, psychologists. Treatment should take into account a patient’s age, severity of symptoms, fertility desire and a patient’s preference.
Conservative and Medical treatment
This can include counselling and education on triggers of symptoms. Particular foods can trigger pain in many people. Mental health and management of fatigue is important. Women’s physiotherapists help with tailored treatment of tense pelvic floor muscles that can seize up due to endometriosis pain (see link- easy stretches to relax the pelvis)
Medication can be used at times of need and a GP or gynaecologist can speak with you about the best approach for you. Some medications are prescribed daily whereas others can be used only when pain is present.
Hormonal medication is used in endometriosis to stop the flares that glandular endometriosis tissue creates in your body. Hormones work for many but not for all and many type and preparations exist.
Surgical management
Surgical management is recommended as the “gold standard” for diagnosis and treatment. Not only will it confirm or exclude endometriosis in people but excising it will remove the endometriosis. In many people this leads to a significant improvement in pain and fertility success. Surgery is reserved as a option when conservative and medical management has failed or if endometriosis is particularly advanced.
Endometriosis can invade other pelvic organs such as the bowel, bladder and ureters (drainage system for the kidneys). Excision of deep endometriosis around these organs is challenging and has risks. It should only be performed by and AGES accredited level 6 surgeon.
Meet our multi-disciplinary team for endometriosis
Mr Andrew Herd
Colorectal surgeon and Endoscopist
BSc, MBChB 2004 (Otago), FRACS 2013 (General Surgery), MCCSANZ 2017 (Colorectal)
Andrew is my assisting colorectal surgeon for endometriosis cases requiring rectal disc excision and bowel resections.
Mr. Andrew Herd is a New Zealand trained General and Colorectal Surgeon and Endoscopist. After completion of his General Surgical training, he completed a two-year post-fellowship training program as part of the Australasian Colorectal Society, with one year spent in the prestigious Goligher unit in Leeds (UK) and one year at Royal Prince Alfred Hospital (Sydney, Australia).
Dr Jash Agraval
Radiologist - Auckland Radiology Group
BHB, MBChB, FRANZCR
My referrals for dynamic ultrasound and MRI are through Dr Jash Agraval at ARG. We work together publicly at North Shore hospital in addition to private. We will look at scans together to make a tailored approach for each endometriosis patient.
Dr Jash Agraval graduated from the University of Auckland Medical School in 2007 and completed his radiology training in Auckland. He then undertook subspecialty fellowship training in Oncologic and Molecular imaging at the Memorial Sloan Kettering Cancer Centre in New York, returning to Auckland in 2016. He is currently the Clinical Director of Radiology at North Shore and Waitakere Hospitals, as well as the clinical lead for the Health NZ Transforming Diagnostic Imaging (TDI) project.
Jash has subspecialty interests in gynaecologic and prostate imaging.
Dietitian and Nutritionist
BSc (Bachelor of Science), MDiet (Master of Dietetics), NZRD (New Zealand Registered Dietitian)
Teresa Gudex
Teresa works out of Auckland Gynaecology group with me and is a close friend and colleague. She is achieving great results for many of my endometriosis patients and will be able to give people a good starting point for dietary modification.
Since finishing her training at Otago University in 2014 Teresa has worked in hospitals in Hawkes Bay, Auckland and Ireland in a range of positions with adults and children. Her main area of interest is the critical importance of nutrition in the peri conception period and with pelvic pain. She aims to make dietary changes that are backed up by science and achieve results with the least amount of restriction possible.
Caroline Couldwell
Physiotherapist
BHSc (Bachelor of Health Science – Physiotherapy), Postgraduate Certificate in Health Science (Acupuncture), Postgraduate Certificate in Health Science (Rehabilitation), Credentialed Pelvic Health Physiotherapist, MPNZ (Member of Physiotherapy New Zealand)
Caroline provides onsite physiotherapy services to AGG clients. She is a passionate and empathetic clinician who thrives on working directly with her patients alongside a wider multi-disciplinary team to assist them in achieving their rehabilitation goals.
Caroline graduated from AUT in 2008 and has worked in private practice in New Zealand, Australia and the United Kingdom. Having a keen interest in pelvic health, she became a credentialed pelvic health Physiotherapist and has developed her niche in assessing and treating pelvic health conditions. Her treatment approach comes with a holistic lens as with her strong background in musculoskeletal physiotherapy and pain management, she understands how the various systems are inter-related and how symptoms can be influenced by many different factors.
Helen Nicholson
Counsellor
BSW (Bachelor of Social Work), MANZICA, MANZASW, Registered Social Worker
Lani Eagle
Counsellor
BSW (Bachelor of Social Work)