What we know
Endometriosis involves inflammation and responds to hormones. It can run in families. Its biology involves several interacting processes, and it affects people differently.
GYNAECOLOGY & PELVIC FLOOR CARE
Endometriosis
Living with suspected or confirmed endometriosis can be exhausting, especially when you have already tried treatment or struggled to get answers. I start by understanding your experience, reviewing what has been tried and working with you on a clear plan for what comes next.
YOUR CARE
What we work through together.
Your experience
What pain stops you doing, your priorities and previous treatment—including side effects or care that has been difficult.
The whole picture
Relevant findings alongside pelvic-floor, bladder and bowel symptoms. My work in gynaecology and urogynaecology helps bring these concerns into the same assessment.
A clear next step
A suitable treatment plan, any useful colleague input and when to review progress. Goals may include better sleep, work, movement or intimacy.
UNDERSTANDING THE CONDITION
What is endometriosis?
Endometriosis is a long-term condition in which tissue similar to the womb lining grows outside the womb. It can involve the pelvic lining, ovaries or deeper tissues near organs such as the bowel and bladder.
Symptoms include painful periods, pain between periods or with sex, painful bowel movements or urination, fatigue and sometimes difficulty conceiving. Symptoms can overlap with other conditions.
An endometrioma is an ovarian cyst related to endometriosis. Adenomyosis affects the womb muscle; it is different, although both conditions can coexist.
Why does endometriosis happen?
What we are still learning
The exact cause remains uncertain. Research explores genetic, immune and hormonal pathways. Backward menstrual flow is one proposed contributor, but does not explain every case.
Having endometriosis is not a personal failure. We do not need every answer about its origins to assess your symptoms and discuss useful treatment.
YOUR ASSESSMENT
Building a diagnosis and a plan.
A clinical diagnosis can guide initial treatment while investigations continue. An operation is not always needed before care begins.
History, examination and imaging
Your symptoms and previous results guide assessment. A vaginal ultrasound may be recommended, with alternatives discussed if unsuitable or declined. Specialist ultrasound or MRI can help map suspected deep disease.
A normal scan does not exclude all endometriosis, particularly superficial disease.
When laparoscopy adds value
Laparoscopy can inspect the pelvis and, when agreed, obtain a biopsy or treat disease. It may help when symptoms persist, findings need clarification or surgery is being considered.
We discuss how the findings could change your treatment.
Tell me about previous difficult examinations or worries. We explain any proposed examination and ask for your consent; you can ask to pause or stop. An internal examination is not automatically needed for every patient, including teenagers.
TREATMENT CHOICES
Options with a clear purpose.
Your symptoms, health, preferences, side effects and pregnancy plans guide the choice. Treatments can be combined and adjusted over time.
SURGICAL CARE AT LIFE KINGSBURY HOSPITAL
Planning advanced laparoscopic care.
Prepare for the right operation
I offer advanced laparoscopy as part of broader endometriosis care. We review imaging and previous operations, the intended treatment and alternatives. Suspected deep disease may need specialist imaging and additional surgical expertise, including colorectal input for bowel involvement.
Understand the benefits and limits
Excision removes lesions; ablation treats them with energy. The choice depends on the disease and its location. We discuss risks, symptoms that may remain and follow-up. Surgery can help, but does not guarantee a cure or remove every contributor to pain.
Before surgery on an endometrioma, we discuss ovarian reserve and previous ovarian surgery. Your pregnancy plans are part of that decision.
LOOKING AT ALL THE CONTRIBUTORS
Why pain can have more than one contributor.
The amount of visible disease does not reliably measure how much pain you feel. Pelvic muscles can become tense and tender, bladder or bowel conditions can coexist, and pain pathways can become more sensitive.
These are real, physical contributors. A normal scan or pain after surgery does not by itself tell us which is present. Coexisting adenomyosis may also need attention.
Physiotherapy, selected pain care or psychological and psychosexual support can help address different parts of the experience. This does not mean your pain is imagined or replace assessment of endometriosis.
Endometriosis
Pelvic
muscles
Bladder
& bowel
Pain
sensitivity
Your symptoms
Working with the right colleagues.
I work with other clinicians when their expertise can help, and review how their recommendations fit your overall care.
- Physiotherapists
- Targeted assessment and care for relevant pelvic muscle and movement difficulties.
- Colorectal surgeons
- Input when suspected bowel involvement or complex surgical planning requires their expertise.
- Fertility specialists
- Advice when pregnancy priorities or fertility treatment affect the next decision.
Additional pain, psychosexual, dietetic or urology input can be discussed where useful. We consider the purpose of a referral and your preferences.
PREGNANCY PLANS
Endometriosis and pregnancy plans.
Trying now or thinking ahead
Endometriosis does not mean everyone will struggle to conceive. Tell me whether you hope to conceive now, in the future, or do not want a pregnancy. Hormonal suppression treats symptoms; it does not improve pregnancy chances while trying to conceive.
Choose the next step together
Assessment may consider age, ovarian reserve, tubes and other fertility factors. I work with fertility specialists when needed. Removing an endometrioma before IVF is not routinely recommended solely to improve live-birth rates; other reasons for surgery may apply.
IF YOU HAVE ALREADY HAD TREATMENT
Still in pain after treatment or surgery?
Ongoing pain deserves a fresh assessment. We review what was found, what was treated, what improved and what has changed. This helps us consider persistent or recurrent disease alongside other contributors.
We agree when to review, what progress would look like and a plan for symptom flares. If pregnancy is not an immediate goal, hormonal treatment after surgery may help reduce recurrence.
New or changing symptoms need reassessment. Do not assume every episode is caused by established endometriosis.
OPTIONAL SYMPTOM DIARY
Preparing for your appointment.
Bring a medicine list and previous scan, operation and histology reports if available. The optional diary helps record symptoms, what helps and your priorities; it includes an appointment summary.
Use only the pages you find helpful. You can book without a confirmed diagnosis, complete records or a full cycle of diary entries.
Endometriosis & menstrual symptom diary
Printable PDF · 8 pages · 41 KB
COMMON QUESTIONS
Questions about endometriosis care
Does a normal scan rule out endometriosis?
No. Some forms, particularly superficial endometriosis, may not be seen. We consider the scan alongside your symptoms and discuss whether further assessment would help. A normal result does not automatically make surgery the next step.
What if I do not want hormones or have had side effects?
Your experience and preferences matter. We review what you tried and discuss suitable alternatives, further investigation or a surgical assessment, including their likely benefits and limits.
Why discuss physiotherapy or psychological support?
Pelvic muscle pain and the effects of persistent pain can need their own care alongside endometriosis treatment. Support with pain, sleep, distress or intimacy does not mean the pain is imagined.
Will hysterectomy cure endometriosis?
Removing the womb does not necessarily remove disease elsewhere or resolve every source of pain. It may help in selected circumstances, including coexisting womb-related problems. Removing the ovaries is a separate decision with consequences to discuss carefully.
Is endometriosis ablation the same as endometrial ablation?
No. Endometriosis ablation treats lesions outside the womb. Endometrial ablation treats the lining inside the womb to reduce heavy bleeding. They are different procedures.
YOUR NEXT STEP
Discuss a plan for your endometriosis care.
Consultations in Claremont, with additional appointments in Simon’s Town on selected Mondays. Reception will confirm your date, time and venue.
General information to support your consultation. Your assessment and treatment plan are individual.
Page updated: .
Sources & further reading: WHO: overview and causes · NHS: endometriosis · ACOG: diagnosis update, 2026 · NICE: diagnosis and management · ESHRE: guideline and patient information · RANZCOG: living guideline · EAU: overlapping pelvic pain · Genetic research, 2026