A curated hub of gynaecology resources for New Zealand GPs: endometriosis ultrasound, pelvic pain interventions and toolkits, abnormal uterine and postmenopausal bleeding guidance, plus patient explainers worth handing out
Endometriosis ultrasound
This section complements my practice education session on endometriosis ultrasound.
The single most useful thing to know: a “normal” pelvic ultrasound does not exclude endometriosis. A standard pelvic scan is not looking for superficial disease, uterosacral nodules, or complex adhesions. If you want that information, the request has to ask for it, and the scan has to be done by someone trained to look.
On the request form:
- State the clinical question — “dysmenorrhoea, dyspareunia, ? endometriosis” — rather than just “pelvic pain”
- Request a dedicated endometriosis or IDEA protocol pelvic ultrasound
- Note any bowel or bladder cyclical symptoms, since they change where the sonographer looks
See what endometriosis looks like:
EndoSonography101 Free. Structured lectures plus 101 annotated live video cases, ordered from normal through severe disease to subtle lesions — each shown silently first, then narrated. The best free resource in this space, and the one I recommend to anyone who scans. Created by Dr Sofie Piessens and colleagues.
Sonos for Sonos – Endometriosis Sonographer-facing collection of endometriosis imaging resources, protocols, and technique videos.
ISUOG Advanced Training Curriculum – Ultrasound findings of endometriosis Structured curriculum with lectures and assessment for those wanting a formal pathway.
The underlying papers and guidelines:
IDEA consensus (Guerriero et al, 2016) The systematic four-step approach to sonographic assessment of the pelvis in suspected endometriosis, with agreed terms and definitions. This is what “IDEA protocol” on a request form means.
International Consensus Statement on non-invasive imaging and classification systems (2024) Open access. Where imaging, #Enzian and the other classification systems currently sit.
RANZCOG Endometriosis Clinical Practice Guideline Australasian guidance, useful for referral thresholds and expectation-setting.
Pelvic pain: interventions and toolkits
Persistent pelvic pain rarely resolves with a single intervention, and most of the work happens in primary care between specialist appointments. These are the tools I use and the ones I point patients toward.
Toolkits to work through with a patient:
My Pelvic Pain Toolkit My own guide, written for patients — pacing, flare planning, sleep, movement, and how the medications fit together. Written for New Zealand patients and free to share or print.
Managing Chronic Pelvic Pain in Girls and Women A concise, practical clinician-facing summary from the Pelvic Pain Foundation of Australia.
Medications for pelvic pain Plain-language explanations of the analgesic, hormonal and neuromodulator options, including what to expect and how long to trial each.
Resources and useful links Handouts worth printing: tips to reduce period and pelvic pain, an introduction to pelvic pain, stretches, bladder diaries, and translated versions in 17 languages.
Pain neuroscience, for the explaining part:
Tame the Beast A five-minute video by Prof Lorimer Moseley that does more for a patient’s understanding of persistent pain than most consultations can. Play it in the room.
Retrain Pain Foundation Free, short, visual lessons on pain physiology in dozens of languages.
Live Well with Pain – Ten Footsteps Built for primary care teams: structured self-management resources, consultation tools, and clinician guides.
Pain Toolkit (Pete Moore) The twelve-tool self-management framework, with a dedicated professionals’ section.
Better Pain Management (ANZCA Faculty of Pain Medicine) Online CPD modules on assessing and managing persistent pain. Paid, but genuinely good.
Interventions I offer, and when they help:
Pelvic floor botulinum toxin For pelvic floor myalgia and high-tone dysfunction that has not settled with physiotherapy alone.
Laparoscopic resection of endometriosis Excision rather than ablation, with the caveat that surgery is one part of a plan rather than the plan.
Persistent pelvic pain assessment What I cover at a first appointment, so you can prepare the patient for it.
Pelvic floor physiotherapy is worth arranging early rather than as a last resort. If you are not sure who to send to locally, contact me and I will point you to a recommended local pelvic floor physiotherapist.
Abnormal uterine bleeding
The national picture changed recently — Pipelle biopsy and Mirena insertion are moving into primary care, with funding and pathways to match.
Start here:
Assessment and management of AUB in non-pregnant women of reproductive age The current national guideline from Health New Zealand | Te Whatu Ora (February 2026). Covers risk stratification for endometrial hyperplasia and cancer, and when Pipelle biopsy is first-line rather than imaging. This is the one to read if you only read one.
National women’s health clinical guidelines index Where the AUB guideline lives, alongside the NZGCG guidance on atypical endometrial hyperplasia and fertility-preserving management of early endometrial cancer.
For Auckland practices:
POAC – Abnormal Uterine Bleeding The funded Auckland pathway: claiming, provider lists, competence declarations, and how to get pipelle and LARC training in your own clinic.
Ko Awatea LEARN Free online training module on AUB and Pipelle biopsy.
Community HealthPathways – Abnormal Uterine Bleeding Regional pathway (requires HealthPathways login).
My abnormal bleeding page What happens after referral, in patient-friendly language.
Postmenopausal bleeding
Any bleeding after 12 months of amenorrhoea warrants investigation, however light and however brief. Most causes are benign; the point of the pathway is speed, not alarm.
Community HealthPathways – Postmenopausal Bleeding The regional pathway, including thresholds and referral routes (requires HealthPathways login).
POAC – Abnormal Uterine Bleeding Also covers PMB in the Auckland funded pathway, including primary care Pipelle.
ACOG updated guidance on evaluation of postmenopausal bleeding (2026) A significant shift: ACOG now recommends transvaginal ultrasound and endometrial tissue sampling at initial evaluation for most patients, rather than relying on endometrial thickness alone. Worth knowing where the international consensus is heading.
Te Aho o Te Kahu – Cancer Control Agency Faster cancer treatment timeframes and referral expectations.
My postmenopausal bleeding page For patients who want to understand why you are investigating.
Patient explainers
- Healthify NZ — the NZ default; plain language, te reo Māori options, reliable
- Jean Hailes for Women’s Health — the best all-round Australasian patient library
- Endometriosis New Zealand — support, education and advocacy; also runs schools programmes
- Pelvic Pain Foundation of Australia — period pain, endometriosis, and persistent pelvic pain
- AskPCOS — evidence-based PMOS/PCOS information and app from Jean Hailes and Monash
- Australasian Menopause Society fact sheets — concise, printable, and updated
- Just the Facts — NZ sexual health and STI information
- National Cervical Screening Programme — HPV self-testing information for patients
- My full patient resources page — organised by symptom and condition
- My surgical recovery toolkit — what to expect after gynaecological surgery, week by week
Staying current
For the GP who has fifteen minutes, not fifteen hours.
- RANZCOG resources and statements — Australasian position statements across gynaecology
- RCOG Green-top Guidelines — thorough, referenced, and freely available
- FSRH — the reference standard for contraception, including the UKMEC criteria
- Australasian Menopause Society — MHT guidance for prescribers
- NICE guidance — for when you want the evidence tables
Free education for your practice
I run free professional development sessions for GP practices — at your clinic or virtually, at a time that suits, on whatever topic your team wants. Endometriosis ultrasound, abnormal bleeding, pelvic pain, fibroids, cervical screening, or a general update.
Want a session at your practice?
Get in touch and we'll find a time. I'm also happy to take an email or phone call about any case you're unsure about.
Make an appointment