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Endometriosis and Pelvic Pain GP Clinic
In 2023, funding was provided by the Australian Government for the establishment of targeted Endometriosis and Pelvic Pain GP Clinics (GP clinics) in primary care settings to provide enhanced services for the treatment and management of endometriosis and pelvic pain. The key program objectives were to support clinics to provide multi-disciplinary care with a focus on improving diagnostic delay and to promote early access to intervention, care and treatment options for endometriosis and pelvic pain.
CHN, ACT’s PHN, commissioned Sexual Health and Family Planning ACT (SHFPACT) to deliver the Endometriosis and Pelvic Pain GP Clinic. The clinic is delivered using a multipronged approach, designed to improve quality of life outcomes for patients. Through individualised interventions and treatment plans, training and capacity building for GPs and Allied Health clinicians, and improved interconnection, networks and ongoing supports for the sector through the ACT Pelvic Pain Network.
Since service delivery commenced in September 2023, 86 patients have been supported through individualised assessment and treatment during the 9-month period. Patients had an initial appointment with a Pelvic Pain Nurse, focussing on securing patient history and gathering of data, to maximise the value of the time spent in the subsequent session with the Pelvic Pain-trained doctor. Doctor appointments have focussed on education and exploration of pain management strategies, and outcomes have been measured by quality-of-life indicators and pain levels.
Many patients have reported that the treatment and support they received has been ‘life changing’ and they ‘wish they had come to SHFPACT years ago.’ The clinic runs approximately one day per week, staffed by both Nurse and Doctor. Since opening there has been approximately 81 clinic hours patient contact with the Nurse, with 126 hours of doctor-led clinic, Since the Pelvic Pain Nurse was employed in January 2024, approximately 115 hours of Pelvic Pain Nurse-led clinic hours have been held.
Testimonial
“Women who have been waiting for a diagnosis or treatment for years, such as surgery, are continuing to have a high level of pain. I believe we need to be doing something in primary care to try to minimise the pain and subsequent affects. At the ACT Pelvic Pain and Endometriosis Clinic, we first focus on validating women’s symptoms and educating them about their conditions. It isn’t normal or okay to have this pain. There are very achievable things we can do within any general practice setting. The earlier we start; the better control we get, as we can avoid the potential development of secondary consequences to their bodies,” said Dr Tara Frommer, GP at SHFPACT and Clinical Lead of the ACT Pelvic Pain and Endometriosis Clinic.
Client Story
Ayla* (not her real name) wanted to fall pregnant. She had a background of long-standing painful periods and persistent pelvic pain, with multiple ED presentations. Ayla also had issues with bladder and bowel symptoms, and experienced pain with sex. A private Gynaecologist diagnosed suspected endometriosis, after a specialised ultrasound scan. However, Ayla then had a phone consult with a public hospital endometriosis clinic and was told that she “likely did not have endometriosis”. Ayla felt invalidated, unsupported and did not attend that endometriosis clinic again. During her many GP visits, Ayla felt undervalued and had little confidence in medical supports for her condition.
Following the initial Nurse appointment at the Endometriosis and Pelvic Pain GP Clinic, Ayla received education at the initial Doctor appointment around pelvic pain, how it interacts with common comorbid conditions such as painful sex, bladder symptoms and bowel symptoms. S stated that no-one had ever taken the time to educate her on her symptoms like this and she felt validated by the process. The clinician provided an overview of a holistic management plan, including pharmacotherapy, a referral to a pelvic floor Physiotherapist and pain science education (through an online program), and evidence-based management options for her irritable bowel syndrome.
Ayla engaged with a pelvic floor Physiotherapist and attended pain science education programs. An additional evidence-based treatment for her symptoms was Clinician supervised online gut directed hypnotherapy. After 3 months, Ayla reported that her symptoms were the best they had ever been. This included a significant reduction in her pelvic pain, resolution of her bladder symptoms, reduced pain during sex, and ongoing improvements to her irritable bowel syndrome symptoms. A plan was formulated, and it specifically looked at how to manage her symptoms. Ayla described feeling supported and confident in having her IUD removed to move forward with her plans to start a family.
Ayla represents the common pelvic pain patient with multiple comorbid conditions requiring care coordination, individualised patient-centered care and education, which empowers the patient to engage and have agency in their health care journey. Her initial presentation is a demonstration of the fragmentation of care that is common in pelvic pain. These patients often receive segmented care from individual providers, often receive conflicting information from providers and social media, and often disengage from the health care system as a result. She is a good example of why having a primary care service, with providers who are accustomed to providing care coordination, is so important in addressing pelvic pain.
