Endometriosis – painful or painless?


Period pain – what’s all the fuss about? I must first confess that I have never really had major issues with my periods. When I was young having them was a nuisance on sports day, but other than the social inconvenience, they never amounted to much. After I completed my family I was keen to avoid them, and a Mirena IUD has been my solution – though not necessarily the right solution for everyone.

For many women however, including some of my closest friends, periods have defined, redefined and even destroyed their lives at times.

As a obstetrics & gynaecology trainee my interest in period pain arose from my love of laparoscopic surgery. From this interest I spent 18 months training in advanced laparoscopic surgery at the Royal Women’s Hospital in the Pelvic Pain/Endometriosis unit. After my training I took a specialist role and continued to work in the Unit as a gynaecologist and surgeon. Women from all over Victoria and beyond came with pelvic pain looking to us for answers and solutions for their pain.

Many things can cause pelvic pain

Endometriosis is one of the diseases that can cause pelvic pain. Defined as 'ectopic endometrial tissue' – meaning tissue that's normal found only in the lining of the uterus, shedding once a month to give you your period, is instead also found outside the uterus elsewhere in the pelvis. Endometriosis can be associated with debilitating and life-destroying pain.

Painful periods, pain when you have sex, pain when you open your bowels, pain mid-cycle or all-cycle, spotting before your period, bloating and infertility are just some of the common symptoms that you might experience with endometriosis.

Endometriosis diagnosis & treatment

Diagnosis and treatment of endometriosis is most effectively done with surgery, although we generally start first with simpler interventions.

Ultrasound has improved dramatically over the last few decades, and can now identify endometriosis cysts (endometriomas), and in specialised ultrasound facilities (such as Women’s Imaging in Hobart for Tassie Women) can also find deeply invasive endometriosis.

However because only 5% of  those with with endometriosis will have either endometriomas or deeply invasive endometriosis, many women even with strongly-suggestive symptoms can still have a normal ultrasound. For these women laparoscopic surgery may be required to find answers.

Adding to the myriad of symptoms that women with endometriosis often experience, unfortunately even surgery to remove areas of endometriosis doesn’t always result in complete relief from symptoms or improvement in fertility.

While surgery to excise, rather than simply cauterise, areas of endometriosis is often very effective, we also know that for many women endometriosis will recur in the future, requiring more surgery and the potential risks that that brings.

Endometriosis – an often ignored women's health issue

For many women I’ve met and cared for with endometriosis, their stories of being told ‘you're a woman, it's normal to have painful periods’, ‘just take a panadol’, or ‘it's all in your head’ are sadly all too frequent.

Women with endometriosis are often challenged daily with pain. Their pain is real and often profound. It often impacts every part of their lives. What they need first is acknowledgement and understanding of their condition.

At TasOGS we believe endometriosis is all too often one of the unheard women’s health issues. Considering it effects up to 1 in 10 women, it’s likely that you know someone who is affected but who may have never spoken about it.

If you have symptoms that you think might be related to endometriosis, make sure you talk to your GP. There are many treatments, including both medications and surgery, than can be useful in managing the often debilitating symptoms of endometriosis.

There are also many great websites with more information about endometriosis, including Endometriosis Australia and the Pelvic Pain Foundation of Australia.

The Journey of Infertility


If it was not for assisted reproduction treatment (ART) options, such as IVF (In Vitro Fertilisation), I would not have my two amazing daughters. For that I am extremely thankful. IVF is a challenging journey. If I could have chosen another option, I would have. However, like for many women, it was my only option for pregnancy.

During my IVF journey I felt moody, exhausted, disappointed, teary, bloated, nauseated, frustrated, hopeful and overwhelmed – and that could sometimes all be on the same day!

I managed giving myself injections everyday. I endured the multiple vaginal scans by different specialists. I tolerated the egg pick-up process. It was however always the embryo transfer that I found the I remain hopeful or do I maintain a face of resilience, doubt and realistic pessimism...?

Nonetheless, my IVF journey ended with a good result – even if the process was difficult.

Just as with spontaneous pregnancies, sadly not every IVF journey ends the way we hope. Ongoing infertility, pregnancy losses, pregnancy complications and perinatal loss can happen whichever way we conceive.

For some of us, the pregnancy journey is just tough.

Everyone’s journey with fertility is different. IVF is not necessarily better or worse than for those who conceive spontaneously (the old fashion way), but there are some important differences and added challenges.

IVF brings with it significant extra cost; pregnancy rates are not as high; the physical and emotional swings often greater, adding personal and relationship stress; and the pregnancy that follows can be associated with higher risks.

Pregnancies from IVF can have up to a 2-fold greater risk of preterm birth and low birth weight babies. There are associated increased rates of placenta praevia (placenta covering the cervix), placental abruption (the placenta separating too early in a pregnancy), gestational diabetes, pre-eclampsia (blood pressure and protein in a pregnancy after 20 weeks) and higher rates of caesarean section.

For these reasons, we manage your pregnancy closely and carefully, being mindful of these higher risks. Because of this, your pregnancy care with an IVF baby should involve a specialist obstetrician for at least one planning consultation, even if your pregnancy is primarily managed by another healthcare provider.

At TasOGS our obstetricians have significant experience managing high-risk pregnancies, including those from IVF. We are happy to provide single consultations or to care for you and your family throughout your pregnancy journey.