Endometriosis & Pelvic Pain Care in Castle Hill
Painful periods, ongoing pelvic pain or pain with sex are common reasons to see a gynaecologist, and they are not something you simply have to put up with. Dr Laarnie Pe Benito consults at Women’s Care in Castle Hill.
What is endometriosis?
Endometriosis is a condition in which tissue similar to the lining of the uterus (the endometrium) grows in places outside the uterus. It is most often found on the pelvic lining, the ovaries, the fallopian tubes and the ligaments supporting the uterus, and sometimes on the bowel or bladder. This tissue responds to hormonal changes through the menstrual cycle, which can cause inflammation, pain and scarring.
Endometriosis is common. Endometriosis Australia estimates that about 1 in 9 Australian women and people assigned female at birth are affected. It can be diagnosed in the teenage years and through to menopause.
Symptoms of endometriosis and chronic pelvic pain
Symptoms vary a great deal between women, and the amount of pain does not always reflect how much endometriosis is present. Common symptoms include:
- Period pain that is severe, worsening over time or not controlled by simple pain relief
- Pelvic pain at other times in the cycle, or pain that is ongoing
- Pain during or after sex
- Pain with bowel movements or passing urine, especially around a period
- Heavy or irregular bleeding
- Bloating, nausea or tiredness that follows a cyclical pattern
- Difficulty becoming pregnant
Pelvic pain can also have causes other than endometriosis, including adenomyosis (see heavy periods, fibroids and adenomyosis), ovarian cysts, pelvic floor muscle tension, bowel or bladder conditions and scarring from previous surgery. Working out what is contributing to your pain is an important part of the assessment.
When to see a gynaecologist
It is reasonable to ask your GP about a referral to a gynaecologist if:
- pain is interfering with work, study, relationships or daily activities
- pain relief or hormonal treatment prescribed by your GP has not helped enough, or is not suitable for you
- you have pain with sex or ongoing pelvic pain
- you are finding it hard to become pregnant and have pelvic pain or very painful periods
- an ultrasound has shown an ovarian cyst that may be related to endometriosis
Sudden, severe pelvic pain, particularly with fever, vomiting or fainting, needs urgent medical attention. Go to your nearest emergency department or call 000.
How endometriosis is assessed
Assessment usually starts with a detailed discussion of your symptoms, your cycle and what you have already tried, followed by an examination where appropriate. A pelvic ultrasound, and in some cases an MRI scan, may be used to look for ovarian endometriomas (cysts caused by endometriosis) or deeper disease. A normal scan does not rule endometriosis out, because superficial disease is often not visible on imaging.
Laparoscopy (keyhole surgery) allows the pelvis to be looked at directly, and tissue to be sampled to confirm the diagnosis. It is not always necessary to have surgery before starting treatment. Whether laparoscopy is helpful for you depends on your symptoms, your scan results, how you have responded to other treatment and your plans for pregnancy.
Treatment options
There is no single best approach, and treatment is chosen to suit your symptoms, your age and whether you wish to become pregnant. Options may include:
Non-surgical options
- Pain relief, including anti-inflammatory medicines
- Hormonal treatments that reduce or suppress periods, such as the combined oral contraceptive pill, progestogen-only options or a hormonal intrauterine device (IUD)
- Other hormonal medicines that may be considered in selected situations
- Pelvic floor physiotherapy, and input from a pain specialist or other health professionals where pain is persistent
Surgical options
Laparoscopic surgery may be recommended when symptoms continue despite other treatment, when there are endometriomas or deeper disease, or when the diagnosis is uncertain. During laparoscopy, endometriosis can be removed (excised) or treated where it is found, and adhesions (bands of scar tissue) can be released. Ovarian endometriomas can be removed by cystectomy. In some women with severe symptoms who have completed their families, hysterectomy, with or without removal of the ovaries, may be discussed.
Surgery does not suit everyone, and endometriosis symptoms can return after surgery. The potential benefits, risks and alternatives are discussed with you before any decision is made. See minimally invasive gynaecological surgery for more on laparoscopy.
If you are planning a pregnancy, tell your doctor early, as this affects which treatments are suitable. Where appropriate, referral to a fertility specialist can be arranged.
How Dr Pe Benito can help
Dr Pe Benito is a specialist gynaecologist and advanced laparoscopic surgeon whose clinical focus includes pelvic pain and endometriosis. At Women’s Care in Castle Hill she can assess your symptoms, arrange investigations, discuss medical and surgical options and, where surgery is appropriate, perform laparoscopic surgery including removal of endometriosis, ovarian cystectomy and adhesiolysis.
Consultations are available to women from Castle Hill, Baulkham Hills, Kellyville, Rouse Hill, Bella Vista, Cherrybrook, Glenhaven, Dural, Glenwood and surrounding suburbs of the Hills District and greater Sydney.
Common Questions
Do I need a scan before seeing a gynaecologist?
Not necessarily. If you have already had a pelvic ultrasound or other tests, please bring the reports. Otherwise, the need for tests can be discussed at your appointment.
Will I need surgery for endometriosis?
Not everyone does. Many women are managed with medicines and other supports. Surgery is considered when symptoms are not controlled, when there are endometriomas or deeper disease, or when diagnosis is unclear. This is discussed with you individually.
Does endometriosis affect fertility?
Endometriosis can make it harder for some women to become pregnant, but many women with endometriosis conceive. If you are planning a pregnancy, let your doctor know so that the right approach can be chosen.
Consultation Enquiries
Dr Pe Benito is a female gynaecologist consulting at Castle Hill Women’s Care. A GP referral is recommended for Medicare rebates on specialist consultations. Please contact the rooms to arrange an appointment.