Endometriosis

Endometriosis is a long-term, often painful condition where tissue similar to the endometrium (the lining of the uterus) grows outside the uterus. These endometrial-like cells can implant anywhere in the pelvis — including the ovaries, fallopian tubes, bladder, bowel, and the tissue lining the pelvis — and, in rare cases, beyond.

Despite being common, endometriosis is still widely misunderstood. It affects about one in seven people assigned female at birth, often beginning during the teenage years. Symptoms vary significantly between individuals. For some, it causes severe pain and infertility; for others, it may be silent or mildly symptomatic and found incidentally.

Symptoms

The most common symptoms of endometriosis include:

• Painful periods (dysmenorrhoea)
• Chronic pelvic pain
• Pain during or after sex (dyspareunia)
• Bowel or bladder issues, especially around menstruation
• Fatigue
• Difficulty conceiving or infertility

Endometriosis symptoms don’t always correlate with the extent of disease. Even minimal disease can cause severe symptoms, and extensive disease can be asymptomatic.

What causes endometriosis?

The exact cause is not fully understood. Several theories exist, including retrograde menstruation, immune dysfunction, and genetic and environmental factors. Regardless of the cause, we know that it is not your fault — it is a medical condition that deserves proper care and support.

Diagnosis

Diagnosis of endometriosis begins with a careful history and physical examination. However, imaging also plays a key role, particularly when symptoms suggest deep infiltrating endometriosis (DIE).

Endometriosis commonly affects multiple organs within the pelvis leading to inflammation and pain.

Imaging:

• Transvaginal ultrasound: When performed by a clinician trained in endometriosis scanning, this can identify features of deep disease (e.g. endometriomas, bowel nodules, and adhesions).
• MRI: Occasionally MRI is used for pre-operative planning in cases of extensive bowel involvement.

However, many people are told that their imaging is “normal” despite persistent pain. This can be distressing and invalidating. A normal scan doesn’t rule out endometriosis — particularly superficial disease, which isn’t always visible on imaging.

Laparoscopy

Laparoscopy — a keyhole surgical procedure where a camera is inserted into the abdomen to look directly at the pelvic organs - enables visual diagnosis. If disease is found, it can often be removed at the same time.

Endometriosis deposits on the uterosacral ligament behind the uterus.

Treatment

Management of endometriosis is highly individualised. There is no one-size-fits-all solution, and I work with you to tailor a plan based on your symptoms, goals, and preferences.

Treatment options include:

Medical management

• Hormonal contraception (combined pill, progestogens, IUDs) to suppress menstruation
• GnRH analogues and antagonists
• Pain relief: Anti-inflammatories, nerve pain agents, and more

Hormonal treatments don’t cure endometriosis, but they can help manage symptoms and reduce progression. For some, hormonal treatment is not suitable — either due to side effects, personal preference, or contraindications — and that’s okay. We’ll work with what’s right for you.

Surgical management

• Laparoscopic excision of peritoneal, ovarian, and deep endometriosis
• Adhesiolysis to free up pelvic organs that are stuck together
• Ovarian cystectomy for endometriomas
• Hysterectomy in select, carefully considered cases

Multidisciplinary care

Endometriosis is more than just a “gynae issue.” It affects every aspect of life — from relationships and work to mental health and fertility. That’s why care often involves more than surgery or medication.

I work closely with:

• Pelvic physiotherapists (for pelvic floor dysfunction and pain)
• Pain psychologists
• Colorectal and urology surgeons (for select cases)
• Fertility specialists

Fertility

Endometriosis is associated with infertility, though not everyone with endometriosis will have trouble conceiving. If you’re thinking about starting a family — now or in the future — we can talk about your options, including fertility preservation and when to involve a fertility clinic.

Living with endometriosis

Endometriosis can have a profound impact on quality of life. Many people have been dismissed or misdiagnosed multiple times before getting answers. If you’re reading this and feeling like no one has believed you — I see you. This is your body, and you deserve answers and care that respects your experience.

I aim to provide a space where you can speak openly, ask questions, and be part of every decision.

Dr Sam Holford

Struggling with endometriosis or pelvic pain?

I offer expert ultrasound and surgical diagnosis and personalised treatment plans to help you find relief.

Book an appointment

FAQs

Helpful resources

Here are some excellent, evidence-based New Zealand and Australian resources for learning more about endometriosis:

• Endometriosis NZ: Support, advocacy, education, and resources for New Zealanders.
• Pelvic Pain Foundation of Australia: Comprehensive information and updates.
• RANZCOG O&G Magazine: Endometriosis issue
• Health Navigator NZ – Endometriosis: Consumer-focused medical advice.
• Jean Hailes – Endometriosis: Australian women’s health resource with great patient explanations.

Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.