Greenslopes Obstetrics & Gynaecology: Dr Ken Law - Endometriosis

ENDOMETRIOSIS Dr Ken Law

MBBS (Hons 1), FRANZCOG Obstetrician and Gynaecologist - Greenslopes Private Hospital Fertility Specialists - Care Fertility Senior Lecturer - The University of Queensland

Endometriosis Endometriosis is a condition where the innermost layer of the uterus, called the endometrium, grows in locations outside the uterus. The most common sites are in the pelvis and around the ovaries, but it has been found in more exotic locations such as the lung and brain and had even been found in men.

These deposits may cause adhesions on the uterus. The uterus can become stick to the ovaries, fallopian tubes and bowel. Although many patients experience extreme pain, some women with endometriosis do not experience any symptoms. Usually it causes pain around the time of your period but, for some women, the pain is almost constant.

Symptoms The symptoms of endometriosis vary widely from woman to woman and the severity of symptoms is not necessarily related to the severity of the endometriosis. Symptoms depend on the extent and location of the endometrial implants and the affected structures. While some women have few or no symptoms, others experience severe and incapacitating pain that recurs each month for many years.

• Period pain • Pain during sexual intercourse • Pelvic and abdominal pain outside of menstruation • Abnormal bleeding • Difficulty in getting pregnant • Painful urination and bowel disturbances

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

How is Endometriosis Diagnosed?

• • •

Clinical history and examination Ultrasound Laparoscopy (keyhole surgery)

Uterus

Fallopian Tube

Adhesions

Endometriosis

Treatment Treatment for endometriosis depends on a number of factors including: • • • •

The severity of symptoms The extent of the endometriosis The woman’s age Her outcome requirements and goals (e.g. reduction in pain, improved lifestyle and improved fertility).

Drugs used to treat endometriosis treatment include: • • •

The oral contraceptive pill Anti-inflammatory medications Hormonal treatments

Surgical options for endometriosis treatment include: • • •

Laparoscopic surgery - keyhole surgery Laparotomy - open surgery Hysterectomy

Any treatment needs to be individualised to each patient bearing in mind the severity of symptoms, extent of endometriosis and overall goals of treatment.

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Anatomy of the Female Pelvic Organs

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Anatomy of the Female Pelvic Floor

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P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Laparoscopy Consent Form The following will be performed: A tube is put into the abdomen and instruments passed down the tube to examine the inside of the abdomen and pelvis using a camera and video monitor. Sometimes, banks of fibrous tissue grow around the bowel or other organs. If so, the doctor many need to cute these. The doctor may also need to operate on the pelvis region.

Risk of • Infection can occur, requiring antibiotics and further treatment.

• Bleeding could occur and may require a return to the operating room. Bleeding is more common if you have been taking blood thinning drugs such as Warfarin, Aspirin, Clopidogrel (Plavix or Iscover) or Dipyridamole (persantin or Asasantin).

• Deep bleeding inside the abdomen. This may need fluid replacement, blood transfusion or further surgery. This may mean a longer than expected stay in hospital and longer recovery time.

• Damage to other organs, such as bladder or bowel, which may need further surgery. This may mean longer than expected stay in hospital and longer recovery time.

• Rarely the gas, which is passed into the abdomen, can cause heart and chest complications.

• Infections such as pus collections in the abdominal cavity. This may need surgical drainage and antibiotics.

• Adhesion (bands of scar tissue) may form and cause a bowel obstruction. This can be a short term or a longterm complication and may need further surgery.

• In some people, healing of the wound may be abnormal and the wound can be thickened and red and the scar may be painful.

• A weakness in the wound with the development of a hernia (rupture). This may need further surgery.

• Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.

• Very low possibility of fistula (a connecting passage between on area and another) developing.

• There is a possibility that the symptom(s)/ pain you have been experiencing and the reason for this operation, may not resolve or worsen as a complication of the procedure.

• The cause of pain/other symptoms sometimes cannot be found, if you are having a exploratory operation.

OTHER SPECIFICS TO BE DOCUMENTED BY YOUR DOCTOR: I acknowledge that the doctor has explained; ̹ my medical condition and the proposed procedure, including additional treatment if the doctor finds some thing unexpected. I understand the risks, including the risks that are specific to me. ̹ the anaesthetic required for this procedure. I understand the risks, including the risks that are specific to me. ̹ Other relevant procedure/treatment options and their associated risks. ̹ my prognosis and the risks of not having the procedure. ̹ the no guarantee has been made that the procedure will improve my condition even though it has been carried our with the due professional care. ̹ the procedure my include a blood transfusion. ̹ tissues and blood may be removed and could be used for diagnosis or management of my condition, stored and disposed of sensitively by the hospital. ̹ If immediate life-threatening events happen during the procedure, they will be treated based on my discussions with the doctor or my Acute Resuscitation Plan. ̹ I was able to ask questions and raise concerns with the doctor about my condition, the proposed procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction. ̹ I understand I have the right to change my mind at any time, including after I have singed this form but,

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Laparoscopy Consent Form ̹ Preferably following a discussion with my doctor. ̹ I understand that image/s or video footage may be recorded as part of and during my procedure and that these image/s or video/s will assist the doctor to provide appropriate treatment.

On the basis of the above statements, I request to have the procedure: Name of Patient ................................................................................................................................................

Signature .............................................................................. Date ..................................................................

I have explained to the patients all the above points and I am of the opinion that the patient understood the information.

Name of Doctor .................................................................................................................................................

Signature .............................................................................. Date ...................................................................

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Laparoscopy for Resection of Endometriosis Consent Form The following will be performed: A tube is put into the abdomen and instruments passed down the tube to examine the inside of the abdomen and pelvis using a camera and video monitor. Somethings, bands of fibrous tissue grow around the bowel or other organs. If so, the doctor may need to cute these. The doctor may also need to operation on the pelvic organs. Tissues suspicious of endometriosis, or it may show scarring or normal tissue. Endometriosis may be located close to important organs such as the ureters (the tubes draining urine from the kidneys to they bladder) or the bowel, and surgery may be required to dissect the endometriosis from these important organs.

Risks for surgery include: • Infection can occur, requiring antibiotics and further treatment.

• Bleeding could occur and may require a return to the operating room. Bleeding is more common if you have been taking blood thinning drugs such as Warafin, Aspirin, Clopidorgrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin).

• Deep bleeding inside the abdomen. This may need fluid replacement, blood transfusion or further surgery. This may mean a longer than expected stay in hospital and longer recovery time.

• Damage to other organs, such as bladder or bowel, which may need further surgery. This may require conversion to laparotomy (an open incision into your abdomen), and may mean a longer that expected stay in hospital and longer recovery time.

• If there is injury to the bowel, a segment of the bowel may need to be removed, and this bowel may need to be diverted to a bag on your abdominal wall to collect the bowel contents (colostomy). This is usually temporary, and you may need a subsequent operation to reconnect the bowel several weeks later.

• If there is injury to the ureters (the tubes draining urine from the kidneys to the bladder), then a stent may need to be inserted into the injured ureter, which needs to be removed at a subsequent procedure several weeks later.

• If there is injury to the bladder, this will be repaired by suturing, and you will need to have a catheter to drain the bladder for up to one week.

• The above injuries may not be able to be recongnised at the time of surgery, and you may require further surgery if problems arise in the post-operative period.

• Rarely the gas, which passed into the abdomen, can cause heart and chest complications.

• Infections such as pus collection in the abdominal cavity. This may need surgical drainage and antibiotics.

• Adhesions (bands of scar tissue) may form and cause a bowel obstruction. This can be short-term or long-term complication, and may need further surgery.

• In some people, healing of the wound may be abnormal and the wound can be thickened and red and the scar may be painful.

• A weakness in the wound with the development of a hernia (rupture). This may need further surgery.

• Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.

• Very low possibility of fistula ( a connecting passage between one area to another) developing.

• There is a possibility that the symptom (s)/pain you have been experiencing and the reason for this operation, may not resolve or worsen as a complication of the procedure.

• The cause of pain/other symptoms will improve after surgery, there may be no improvement, or the disease and associated symptoms may recur over time.

• Endometriosis may recur over time, and further treatment may be required in the future, including further surgical procedures.

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Laparoscopy for Resection of Endometriosis Consent Form OTHER SPECIFICS TO BE DOCUMENTED BY DOCTOR: I acknowledge that the doctor has explained; І my medical condition and the proposed procedure, including additional treatment if the doctor find something unexpected. I understand the risks, including the risks that are specific to me. І The anaestheric required for this procedure. I understand the risks, including the risks that are specific to me. І Other relevant procedure/treatment options and their associated risks. І my prognosis and the risks of not having the procedure. І that no guarantee has been made that the procedure will improve my condition even though it has been carried out with due professional care. І the procedure may include a blood transfusion. І tissues and blood may be removed and could be used for diagnosis or management of my condition, stored and disposed of sensitively by the hospital. І if immediate life-threatening events happen during the procedure, they will be treated based on my discussions with the doctor or my Acute Resuscitation Plan. І I was able to ask questions and raise concerns with the doctor about my condition, the proposed procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction. І I understand I have the right to change my mind at any time, including after I have signed this form, but preferably following a discussion with my doctor. І I understand that Image(s) or video footage may be recorded as part of and during my procedure and that these image(s) or video(s) will assist the doctor to provide appropriate treatment.

On the basis of the above statements, I request to have the procedure.

Name of Patient ................................................................................................................................................

Signature .............................................................................. Date ..................................................................

I have explained to the patients all the above points and I am of the opinion that the patient understood the information.

Name of Doctor .................................................................................................................................................

Signature .............................................................................. Date ...................................................................

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Hysteroscopy Dilation and Curettage +/- Removal of Abnormal Tissues (e.g. Polyps, Fibroids) Consent Form The following will be performed: Under an anaesthetic, the cervix is carefully widened until there is enough room to pass a telescope into the womb. The womb is then filled with fluid, which gives a better view of the inside. A telescope is used to see if there is anything abnormal inside the womb. The fluid is then drained out. The lining of the womb is usually scraped to collect cells. The lining of the uterus and any other tissue that looks abnormal inside the uterus is then removed and may be sent to pathology for tests. This may include polyps or fibroids inside the uterus.

Risks of • Infection can occur, requiring antibiotics and further treatment.

• Bleeding could occur and may require a return to the operating room. Bleeding is more common if you have been taking blood thinning drugs such as Warfarin, Aspirin, Clopudigreal (Plavic or Iscover) or Dipyridamole (Persantin or Asasantin).

• Bleeding that can be so heave that a blood transfusion may be needed. It may also need further surgery.

• Damage may occur to the uterus with rupture or perforation. This may require a laparoscopy and/or laparotomy, and/or longer stay in hospital than expected. In the event of uterine perforation, there is a risk of damage to other organs, such as the bowel or bladder, which may require further corrective surgery.

• Rarely, the procedure may not be able to be completed, due to narrowing of the inside of the cervix. If the condition continues, further surgery will be necessary.

• Infection in the uterus. This can cause heavy bleeding or discharge, worsening cramps or high fevers. The infection may affect the tubes and cause problems with getting pregnant in the future. Antibiotics are used to treat the infection.

I acknowledge that the doctor has explained; І my medical condition and the proposed procedure, including additional treatment if the doctor finds something unexpected. I understand the risks, including the risks that are specific to me. І the anaestheric required for this procedure. I understand the risks, including the risks that are specific to me. І Other relevant procedure/treatment options and their associated risks. І my prognosis and the risks of not having this procedure/ І that no guarantee has been made that the procedure will improve my condition even though it has been carried out with due professional care. І the procedure may include a blood transfusion. І tissues and blood may be removed and could be used for diagnosis or management of my condition, stored and disposed of sensitively by the hospital. І if immediate life-threatening events happen during the procedure, they will be treated based on my discussions with the doctor or my Acute Resuscitation Plan. І I was able to ask questions and raise concerns with the doctor about my condition, the proposed procedure and its risks and my treatment options. My questions and concerns have been discussed and answered to my satisfaction. І I understand I have the right to change my mind at any time, including after I have signed this form but, preferably following a discussion with my doctor. І I understand that the image(s) or videos footage may be recorded as part of and during my procedure and that these image(s) or video(s) will assist the doctor to provide appropriate treatment.

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Mirena Insertion Consent Form The following will be performed: A progesterone releasing intra-uterine device will be put inside the uterus through the vagina. This will provide birth control for up to 5 years.

Risks of Infection can occur, requiring antibiotics and further treatment; ̹ Bleeding could occur and may require further surgical treatment. ̹ Infection can be passed into the uterus and spread into the pelvis. This may need treatment with antibiotics, and can cause infertility (unable to get pregnant). ̹ Abnormal bleeding in the first three months. This usually settles. If not, the device may have to be removed. ̹ Puncture of the wall of the uterus when intrauterine device is put inside. The device will not work, so pregnancy is possible. There may be infection , which will need antibiotics. The device may need to be removed and laparoscopy may be necessary to do this. ̹ The uterus may push out the intra-uterine device in 1 in 20 women. If this happens, pregnancy is a possibility. ̹ Pain may be felt during and shortly after insertion. ̹ Ovarian cysts in 1 in 8 women, which may cause pain and painful sex. They usually disappear in 2-3 months. If they persist, further monitoring is required. ̹ The intra-uterine device may not provide complete relief from the symptoms for which it is being used. ̹ Pregnancy in 1 in 600 women. A third of these will have ectopic (tubal) pregnancy. In which case, surgery will be required to remove the fetus and possibly the tube to prevent the tube from rupturing. If the tube ruptures, it can be life threatening and emergency surgery will be required.

I acknowledge that the doctor has explained; ̹ my medical condition and the proposed procedure, including additional treatment if the doctor finds something unexpected. I understand the risks, including the risks that are specific to me. ̹ Other relevant procedure/treatment options and their associated risks. ̹ my prognosis and the risks of not having the procedure. ̹ that no guarantee has been made that the procedure will improve my condition even thought it has been carried out with due professional care. ̹ the procedure may include a blood transfusion. ̹ tissues and blood may be removed and could be used for diagnosis or management of my condition, stored and disposed of sensitively by the hospital. ̹ I was able to ask questions and raise concerns with the doctor about my condition, the proposed procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction. ̹ I understand I have the right to change my mind at any time, including after I have signed this form but, preferably following a discussion with my doctor.

On the basis of the above statements, I request to have the procedure.

Name of Patient ................................................................................................................................................

Signature .............................................................................. Date ..................................................................

I have explained to the patients all the above points and I am of the opinion that the patient understood the information.

Name of Doctor .................................................................................................................................................

Signature .............................................................................. Date ...................................................................

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Laparoscopy Post-Operative Advice Before leaving hospital make sure you have: • Prescriptions if required • Our contact details to make follow-up appointments If you require a medical certificate: • Please call 07 3188 5000, and the medical certificate will be emailed to you What to expect when you go home: • Overall recovery should take one to two weeks - you should be mobile within 24 to 48 hours though • Pain/discomfort at the wound sites may persist for 7 to 10 days • Shoulder pain may persist for up to 48 hours - this is from residual gas under the diaphragm • Nausea may be present for the first 24 to 48 hours Help you bowels move as soon as possible post-op, and avoid constipation: • Ensure adequate hydration • Use a combination of aperients, such as Movicol, Lactulose, Coloxyl, Benefibre The key-hole surgery incisions: • Have been closed with absorbable sutures, and should completely dissolve by 4-6 weeks • Have been covered with skin glue, which will gradually was away after 2-3 weeks Be aware of signs of infection • Hot flushes / high temperatures / sweats • Progressively worsening pain • Red, weeping wounds In the first 24 hours: • Get adequate rest - no heavy lifting, housework etc.

• Gently ease back to normal activities • Do not drink alcohol • Do not operate machinery • Do not sign legal documents You should not drive until you can put you foot on the brakes without any pain. Generally, this may take 2-4 weeks.

In the next 2 weeks: • Avoid heavy lifting or straining • Avoid intercourse • Use pads not tampons • Avoid spa baths If at any point you have concerns, please contact me immediately.

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au

Informed Financial Consent Consultation & Outpatient Procedure Fees Patients have the right to know how much their private health care will cost. At Greenslopes Obstetrics & Gynaecology, we will always strive to provide full and transparent financial disclosure. Below is a list of our basic consultation fees for Gynaecology services. This list does not include all services provided by our practice and does not include inpatient surgical procedures. Any patient requiring an inpatient surgical procedure will be provided with a full Estimate of Surgical Fees following consultation and assessment with one of our doctors.

Gynaecology

FEE

MEDICARE REBATE

OUT OF POCKET

Gynaecology Consultation with New Referral

$295

$78.05

$216.95

Follow-up Gynaecology Consultation

$135

$39.25

$95.75

Fertility

FEE

MEDICARE REBATE

OUT OF POCKET

Initial Fertility Consultation

$295

$78.05

$216.95

Follow-up Fertility Consultation

$135

$39.25

$95.75

Associated Medical Procedures

FEE

MEDICARE REBATE

OUT OF POCKET

Insertion of IUD (Mirena, Kyleena, Cooper)

$230

$72.05

$157.95

Removal of IUD (Mirena, Kyleena, Cooper)

$80

-

$80

Endometrial Biopsy

$176

$47.95

$128.05

Colposcopy/Vulvoscopy

$230

$57.40

$172.60

Cervical Biopsy in conjunction with Colposcopy

$321

$86.20

$234.80

Cervical/Vaginal Polyp Removal

$182

$57.50

$124.50

Vulval Biopsy in conjunction with Vulvoscopy

$355

$91.95

$263.05

Vulval Biopsy

$250

$46.95

$203.05

Implanon Insertion

$130

$32.05

$97.95

Implanon Removal

$180

$54.60

$125.40

Insertion of Zoladex Implant

$84

$32.05

$51.95

Vaginal Pessary for Prolapse

$67.50

-

$67.50

Pudendal Nerve Block

$298

$90.65

$207.35

Penthrox (‘Green Whistle’)

$80

-

$80

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Not all in-office procedures available are listed above.

Fees for Suite 7.101, Levelabove 7, Nicholson Street Specialist any additional services not listed (e.g. ultrasounds) will beCentre 83 Nicholson St, Greenslopes Qld 4120 advised at time of consultation by your specialist. gsog.com.au

Informed Financial Consent Fertility Management & Procedure Fees The fees outlined below are payable at Greenslopes Obstetrics and Gynaecology. It is separate from the fees payable at Care Fertility, which are outlined in the Fee Schedule from Care Fertility.

IVF

FEE

MEDICARE REBATE

OUT OF POCKET

Planning & Management of IVF or ICSI Cycle (13029)

$360

$76.15

$283.85

Follow-up Consultation After Completion of IVF Cycle

$135

$39.25

$95.75

Egg Pickup & Embryo Transfer

FEE

MEDICARE REBATE

KNOWN GAP (IF INSURED)

Egg Pickup (13212)

$1080

$318.50

$500

Embryo Transfer (13215)

$340

$99.90

$130

Intrauterine Insemination

FEE

MEDICARE REBATE

OUT OF POCKET

Planning & Management of IUI Cycle (13209)

$360

$76.15

$283.85

IUI Cycle Global Fee (13203) (Includes scans/bloods during the cycle, and the insemination procedure)

$1485

$437.40

$1047.60

Once you reach the Extended Medical Safety Net threshold in a calendar year, you may receive a higher Medicare rebate for Outpatient Services.

P 07 3188 5000 | F 07 3188 5050 info@gsog.com.au Suite 7.101, Level 7, Nicholson Street Specialist Centre 83 Nicholson St, Greenslopes Qld 4120 gsog.com.au