Endometriosis Care

Endometriosis is a chronic inflammatory, hormonal and immune-mediated condition where tissue similar to endometrium grows outside the uterus. It can infiltrate the pelvis, ovaries, bowel, bladder, nerves, and beyond. It affects quality of life, fertility, pelvic function, emotional wellbeing and long-term health.

Dr Rebecca Mackenzie-Proctor provides contemporary, whole-person endometriosis care combining expert diagnosis, modern hormonal therapies, surgical precision and fertility-focused management.

Understanding Endometriosis

Endometriosis involves:

• Inflammation and cytokine activation

• Progesterone resistance and oestrogen dominance at lesion level

• Altered immune response

• Pelvic nerve involvement contributing to chronic pain

• Adhesion formation and organ distortion

It commonly presents with:

• Severe period pain

• Pain with sex

• Bowel/bladder symptoms

• Chronic pelvic pain

• Heavy periods

• Fatigue

• Infertility or difficulty conceiving

Symptom severity does not always correlate with disease stage—this is why careful assessment is essential.

Comprehensive Diagnostic Approach

Diagnosis includes:

• Full menstrual and symptom mapping

• Pain phenotype assessment

• Endometriosis-focused pelvic ultrasound (transvaginal preferred)

• Evaluation for adenomyosis

• Preoperative fertility evaluation if appropriate

• Ovarian reserve testing when clinically indicated (e.g., endometriomas)

Where deep infiltrating disease is suspected, collaboration with colorectal and urological surgical teams may be initiated.

Medical Management

Medical therapy aims to reduce pain, inflammation and hormonal stimulation of lesions. Options include:

• Hormonal therapies - not appropriate for fertility

• Combined oral contraceptive pill (cyclical or continuous)

• Progesterone-only pill

• Levonorgestrel IUD

• Dienogest (in appropriate patients)

• Short-term GnRH analogues with add-back therapy

These treatments do not remove endometriosis, but can significantly improve symptoms.

• Adjunct therapies 

• Pelvic floor physiotherapy (gold standard for pain + dyspareunia)

• Diet modifications (anti-inflammatory, low FODMAP when indicated)

• Psychological and pain management tools

• Acupuncture (supportive evidence for pain reduction)

• Nutrition support for bowel involvement, energy, iron, and mood

Advanced Laparoscopic Surgery

Surgical excision remains the most effective method of removing endometriosis.

Dr Mackenzie-Proctor performs:

• Precision excision of superficial + deep disease

• Ovarian endometrioma cystectomy with ovarian tissue sparing

• Adhesiolysis

• Correction of pelvic anatomy

My surgical goals:

• Remove disease safely

• Restore anatomy

• Preserve fertility

• Minimise adhesions

• Integrate postoperative medical therapy where beneficial

Endometriosis & Fertility

Endometriosis can impact fertility through:

• Inflammation impairing egg quality

• Altered endometrial receptivity

• Tubal distortion or blockage

• Ovarian reserve reduction in severe disease

• Adhesions disrupting anatomy

Fertility strategies include:

• Timed natural conception with ovulation optimisation

• Laparoscopic excision - may improve outcomes for those with early stage endometriosis

• Ovulation induction - limited evidence

• IUI or IVF with personalised ovarian stimulation

• Pre- and postoperative fertility counselling and support. 

Dr Rebecca Mackenzie-Proctor takes a holistic, team-based approach to care, working closely with pain specialists, physiotherapists, and psychologists to support every aspect of your health and wellbeing. Some patients may benefit from surgery prior to IVF - for example, large endometriomas or significant deep disease-but this is always tailored.