Endometriosis - a multidisciplinary approach
Evidence shows the best management for endometriosis comes in the form of a multi-disciplinary approach. The purpose of this resource is to outline complementary therapies available to people with endometriosis, and to provide a directory of local clinicians working in this space.
The goals of endometriosis treatment should involve the following three key elements:
Reduction of PROGRESSION
Prevention of RECURRENCE
SURGERY is the most effective method for removing endometriosis. However on its own it may not completely eliminate pain and cannot prevent recurrence. Surgery is therefore used as part of a more comprehensive treatment plan.
MEDICAL or hormone treatment is considered the mainstay of endometriosis management because it aims to achieve a reduction in pain, progression and recurrence. There are numerous types of hormone therapies available. Your doctor will discuss these with you.
Where to next after hormonal and surgical treatment?
While there is a lack of good quality evidence for the efficacy of complementary therapies, experts acknowledge that for some people, complementary involvement can improve quality of life. There are advantages and disadvantages to all complementary treatments, it is not a one size fits all. It is important to consider potential benefits, potential risks and cost when assessing if a complementary therapy is right for you. Dr Anju Agarwal and her nurse are happy to discuss this with you in more detail.
Little research has investigated the link between diet and endometriosis symptoms however many people with endometriosis find that particular foods trigger or relieve their symptoms. There are various theories surrounding this relationship, most of which focus on inflammation and the effects of diet on oestrogen levels. Below is a link to some general advice relating to diet and endometriosis. A certified nutritionist may be able to help you to alter your diet, with the aim of reducing symptoms.
Exercise is thought to help people live with endometriosis in multiple ways. It may act as an analgesic (through the release of ‘feel good chemicals’), reduce inflammation, improve mobility and reduce cramping. It can also improve mental well-being by reducing ‘brain fog’ and fatigue, improving mood and by reducing stress. The best place to start is by choosing a physical activity you enjoy. If exercise causes flare ups or pain, consider speaking to a pelvic physiotherapist or exercise physiologist who can modify and adjust your exercise accordingly.
Endometriosis can cause weight gain by increasing bloating, reducing the ability to exercise due to pain, increasing exposure to oestrogen and as a side effect from some hormone treatment regimes. Weight gain can affect energy levels, increase pain and cause poor body image as well as cause a range of other health concerns. Improving diet and increasing exercise are effective ways to lose weight. If you need assistance with weight loss, a nutritionist, exercise physiologist or weight loss clinician may be able to provide strategies to achieve your goals.
Pelvic pain management
Pelvic pain caused by endometriosis varies in severity and the level of endometriosis does not necessarily correspond with the level of pain. For some people, their pain is strong, persistent and debilitating. People with endometriosis often contract the pelvic muscles as a response to pain, which in turn can contribute to further, persistent pain. Pelvic physiotherapy may be helpful in decreasing pain by reducing sensitivity and over activity in your pelvis through a range of exercises. For others, a pain specialist or ‘pain team’ may be required to develop a comprehensive pain management plan, which may involve the use of analgesia, physiotherapy, occupational therapy, psychological support and follow up.
People with endometriosis are at an increased risk of anxiety and depression, caused by persistent pain, hormonal imbalance, infertility, changes to body image and other challenges associated with this chronic condition. Support for your mental health can come in many forms, such as from family and friends, support groups, or a professional psychologist or counsellor. If you would like to see a counsellor or psychologist, start by speaking to a GP who can provide you with a referral. Many psychological services offer Medicare rebates.
Acupuncture and Chinese medicine
While the scientific evidence for acupuncture and Chinese medicine in reducing the burden of endometriosis difficult to measure and confirm, some people find these therapies helpful in managing their symptoms, including the reduction of fatigue, pain, inflammation and stress, and the improvement of energy levels. Accupuncture is said to work by activating the central nervous system and triggering the release of natural pain relieving chemcicals and endorphins. It is also said to work by regualting the HPA axis and balance the central nervous system, which is often overstimulated when pain is present. The risks associated with acupuncture are low (if it is administered by a certified acupuncturist) and therefore we support this as an option for our patients. It is important to speak to a doctor before taking Chinese medicines including herbs, vitamins and minerals, particularly if you are on hormone therapy or trying to conceive, as they can interact with other medications and body processes.
Directory of local clinicians**
Acupuncture and Chinese Medicine
Dr Suzi Craig
55 Garsed street
Bendigo VIC 3550
Bendigo Chinese Medicine
69 Mitchell Street
Bendigo VIC 3550
Flora Accupuncture and Herbal Medicine
Shop 1/56 Harley Street
Strathdale VIC 3550
103 Williamson St
Bendigo, VIC 3550
Melanie Hale - Dietician
Health Hub @ UFS Pharmacy
Bendigo VIC 3550
Bendigo Pain Therapy
69 Garsed Street
Bendigo VIC 3550
Pain Rehabilitation Clinic, Bendigo Health
Dr Kim Hattingh and team Women’s Clinic
Pain specialist and anaesthetist Dr Suran Dhanapala
Vic Pain Management
707 Mair Street Ballarat
Precision Health - Brain, Spine and Pain
Dr Symon McCallum
Various locations across Melbourne
Physiotherapy Centre Bendigo
Cheryl Ludwig & Kara Normington
59 McIvor Roa
Bendigo VIC 3550
White Hills Physio
496 Napier Street
White Hills VIC 3550
Pelvic Health Physio
Echuca Moama Physiotherapy
72 Meninya Street
Moama NSW 2731
Shop 2, 40 Forest Street
Weight Loss Clinician
Central Victoria Integrated Clinic
Bendigo VIC & Echuca
Dr Kirby White
Bendigo Surgical Services
**This list is not intended to promote specific clinicians. Rather, it is a starting point for seeking out allied-health support in Bendigo and surrounding areas. There are many skilled clinicians working in these areas, and we encourage you to do your own research.
Australian and New Zealand Women with Endometriosis Support Group https://www.facebook.com/groups/425058554296380/
List of support groups - Endometriosis Australia - https://www.endometriosisaustralia.org/support-groups
Credible internet resources
Endometriosis Australia webinar series - https://www.endometriosisaustralia.org/webinars
Endometriosis Australia - https://www.endometriosisaustralia.org/
ESHRE; European Society or Human Reproduction and Embryology: Patient information on Endometriosis https://www.dranjuagarwal.com.au/_files/ugd/31ff8d_aaf899f5493741739d25530a83b5c679.pdf
Jean Hailes - Endometriosis - https://www.jeanhailes.org.au/health-a-z/endometriosis