Endometriosis Centre

Endometriosis is a chronic condition affecting 10% of women of reproductive age.

It is associated with pelvic pain and painful periods, which can be debilitating, and fertility problems. Our centre aims to provide patients with the best possible treatment for their symptoms, and support them through every step of their treatment journey. We offer a range of medical and surgical treatments, and work closely with other specialties to provide multidisciplinary care. At every stage, the emphasis is on patient-centred care; offering the appropriate treatment for that patient at that time in her life.

What we offer

Our multidisciplinary team provides high quality, evidence-based care to assess and treat women with all grades of endometriosis, ranging from mild disease to the most severe form involving the bladder and bowel. We work closely with our colleagues in pain management. Patients with endometriosis seeking fertility can be managed jointly with the fertility service.

We are accredited by the British Society of Gynaecology Endoscopy (BSGE) as a specialist centre for the treatment of severe endometriosis, including safe surgical treatment of the most complex cases.

We are incredibly proud of our performance which includes:

  • Nearly all cases of endometriosis managed by laparoscopy (keyhole surgery), providing a shorter hospital stay, quick recovery, less infection, fewer wound complications and less scarring
  • Using laser to treat endometriosis which is proven to be safe and effective in treatment of Endometriosis
  • Our patients report an improvement in their quality of life following treatment that exceeds the national average

How to prepare for your visit

It may be helpful to keep a record of your symptoms in the few months before your appointment (2-3 months if possible) – especially days when your pain is bad, and their relationship to your periods.

At the first appointment, you will be given the BSGE pelvic pain questionnaire to help us understand your problems and to find the most appropriate treatments. It may also help you to formulate your thoughts on your symptoms and the way in which they can affect your quality of life.

Then a detailed history will be taken by the specialist doctor about your symptoms and the extent to which your lifestyle is being affected. This will help to build the basis upon which the treatment will be planned. 

A detailed treatment plan will be made at this visit; information will be given about endometriosis and available treatment options. At this appointment you will have the opportunity to discuss your treatment and any concerns.

Any necessary investigations will be arranged (ultrasound scan, blood tests, other imaging including MRI or CT in some cases) and a laparoscopy (looking inside the abdomen) or hysteroscopy (looking inside the womb) will be arranged.

Where appropriate a further appointment will be made to discuss the results of the investigations and plan the treatment.

Referring a patient

We accept referrals from GPs and from other gynaecologists.

 

GPs are advised to refer patients with known or suspected endometriosis with any of the following:

  • Suspected deep infiltrating disease (involving the bladder / bowel)
  • With symptoms that have returned after previous surgery
  • With symptoms that have not improved with medical treatments
  • With ultrasound evidence of endometriosis

Symptoms may include painful periods severe enough to cause an impact on work, home or family life (dysmenorrhea); pain in the pelvis (lower tummy) throughout the month; pain during sex (dyspareunia) or pain on passing urine or opening the bowels, that may worsen during the period.

Endometriosis can be associated with infertility problems. In these cases, patients should be referred via the fertility pathway – their endometriosis treatment will be managed in parallel with their fertility treatment.

Meet our team

  • Mr Parveen Verasingam – consultant gynaecologist, Endometriosis Centre lead
  • Afeeza Illahibuccus – endometriosis specialist nurse
  • Mr Lee Dvorkin – consultant colorectal surgeon
  • Mr Gopal Nair- consultant urologist
  • Dr Alice Man – pain management specialist

Contact us

T: 0208 887 3117

Generic email: northmid.fertility@nhs.net

Female incontinence and pelvic floor dysfunction clinic

What we offer

Following initial clinic appointment, we offer a combined urology, colorectal and gynaecology input for pelvic floor dysfunction and female incontinence (both urinary and faecal). Assessments of female incontinence including cystometry, flow rate, post void residual volume and pad tests performed by experienced nurse specialists.

Our unit offers conservative, surgical and outpatient management such as biofeedback (specialized pelvic physiotherapy), bladder retraining, percutaneous tibial nerve stimulation (PTNS), Botox and periurethral bulking agents. We are currently the largest PTNS centre in the UK for the treatment of overactive bladder and have published research on this treatment in international journals.

We also perform complex non-mesh prolapse surgery and specialize in same day discharge hysterectomy through the vagina (no cuts).

We manage and treat childbirth injuries from vaginal births (third and fourth degree perineal tears) and also offer anorectal physiology tests to investigate faecal incontinence.

Sister Joadel Mafuta runs a weekly ring pessary clinic on Monday afternoons and gives expert advise on conservative measures for vaginal prolapse.

In conjunction with Sister Rosemary Dadswell (from Urology Suite), we also manage painful bladder syndrome and urinary retention problems.

We hold regional multidisciplinary team discussions with our colleagues from other North London sector hospitals.

How to prepare for your visit

  • Bladder diary for 3 days
  • MSSU specimen
  • History of previous surgery/treatment
  • List of medication

Meet our team

  • Medical: Wai Yoong, Adewale Adeyemo
  • Nursing: Joadel Mafuta (ring pessary clinic), Rosemary Dadswell (Urology Suite), Roda Owusu (pelvic physiotherapy)

Useful websites

NICE Guidance NG123. Urinary Incontinence and Pelvic Organ Prolapse in Women (2019).

The Independent Medicines and Medical Devices Review on Vaginal Meshes (2020).

Research work from our unit

1: O'Neill AT, Hockey J, O'Brien P, Williams A, Morris TP, Khan T, Hardwick E, Yoong W. Knowledge of pelvic floor problems: a study of third trimester, primiparous women. Int Urogynecol J. 2017

2: Zhou D, Seraphim A, Yoong W. Tibial sensory neuropathy as a rare complication of percutaneous tibial nerve stimulation. Int Urogynecol J. 2015

3: Newbold P, Vithayathil M, Fatania K, Yoong W. Is vaginal hysterectomy is equally safe for the enlarged and normally sized non-prolapse uterus? A cohort study assessing outcomes. Eur J Obstet Gynecol Reprod Biol. 2015

4: Aref-Adib M, Lamb BW, Lee HB, Akinnawo E, Raza MM, Hughes A, Mehta VS, Odonde RI, Yoong W. Stem cell therapy for stress urinary incontinence: a systematic review in human subjects. Arch Gynecol Obstet. 2013

5: Ridout AE, Yoong W. Tibial nerve stimulation for overactive bladder syndrome unresponsive to medical therapy. J Obstet Gynaecol. 2010

6: Yoong W, Sivashanmugarajan V, Relph S, Bell A, Fajemirokun E, Davies T, Munro K, Chigwidden K, Evan F, Lodhi W; Enhanced Recovery After Surgery (ERAS) Team for Gynaecology and Anaesthesia. Can enhanced recovery pathways improve outcomes of vaginal hysterectomy? Cohort control study. J Minim Invasive Gynecol. 2014

7: Relph S, Bell A, Sivashanmugarajan V, Munro K, Chigwidden K, Lloyd S, Fakokunde A, Yoong W. Cost effectiveness of enhanced recovery after surgery programme for vaginal hysterectomy: a comparison of pre and post-implementation expenditures. Int J Health Plann Manage. 2014

8: Yoong W, Shah P, Dadswell R, Green L. Sustained effectiveness of percutaneous tibial nerve stimulation for overactive bladder syndrome: 2-year follow-up of positive responders. Int Urogynecol J. 2013

9: Yoong W, Ridout AE, Damodaram M, Dadswell R. Neuromodulative treatment with percutaneous tibial nerve stimulation for intractable detrusor instability: outcomes following a shortened 6-week protocol. BJU Int. 2010

Hysteroscopy

Outpatient hysteroscopy is a procedure carried out in the outpatient clinic that involves examination of the inside of the uterus (womb) with a thin telescope called a hysteroscope which has a tiny camera on its tip. This is inserted through your vagina and the neck of your womb (cervix). It enables your health care professional to examine inside of your womb and see pictures of it on a screen to identify whether there are any problems inside your uterus that may need further investigations or treatment. 

What we offer

Outpatient hysteroscopy is indicated primarily in the assessment of women with abnormal uterine bleeding, but is also employed in the diagnostic work-up of reproductive problems. Our facility also provides operative hysteroscopic procedures in an outpatient setting with or without the use of local anaesthesia. Common procedures include endometrial polypectomy, removal of small submucous fibroids, endometrial ablation and removal of lost intrauterine devices.

Hysteroscopy

Novasure Endometrial Ablation

How to prepare for your visit

You should eat and drink normally. You do not need to fast before your appointment.

It is recommended that you take pain relief (400mg of ibuprofen or 1 gram of paracetamol or whatever pain relief you find useful for period pain) at least 1 hour before your appointment.

Bring a list of any medications that you are taking with you.

You may wish to have a friend or family member accompanying you. You will be able to go home shortly after the procedure. The whole visit to clinic should take 45 minutes to 1 hour.

Meet our team

Meet the team
Consultants Nurses Admin
Mr. W Lodhi Joadel Mafuta Unique Henry
Mr A Woonacott Melinda Austin     Carmen Stephens
Miss A Al-Habib Colleen Mitchell Shania David
Mr A Adeyemo Yaarty Peenith  Wendy Smith
Miss V Sivashanmugurajan Lenitsa Mastakouli Salman Hassan

Miss S Rouabhi

    

Miss V Sampson

    

Contact us

Phone: 0208 887 4215

 

 

Uterine fibroids service

Women with fibroids represent 20 to 30% of patients presenting at the gynaecological unit at the North Middlesex University Hospital. This is not unexpected as a result of our diverse population in Enfield and Haringey community. Fibroids

In essence over the years we have designed a comprehensive service on the management of the condition in our unit.

All the consultant staffs are versed in looking after women presenting with uterine fibroids related complaints. Those with more complicated fibroids are looked after by colleagues with special interest in complex fibroids management. We have special clinics to review patients with complex fibroid related problem.

What we offer

  • Medical management of fibroid
  • Surgical management: Hysteroscopy, laparoscopy, open surgery
  • Uterine fibroid embolization
  • Information about MyoSure

How to prepare for your visit

At your appointment, questions will be asked about your symptoms. Remember to keep a record of your menstrual cycle and bleeding patterns. Following history taking, physical examination will be done. This will include general examination, abdominal examination followed by Pelvic examination.

Pelvic examination may include introducing a speculum to the vagina to check the neck of the womb (cervix) and sometimes a sample from the lining of the womb may be needed. This will be discussed with you prior to your examination.

Following speculum examination – digital examination may be needed to check for the womb size.

After the initial consultation a plan will be made for more investigations depending on findings.

Investigations include – abdominal-pelvic ultrasound, MRI and routine blood test to check for evidence of anaemia. Outpatient hysteroscopy may be booked as well

Review of investigation is done afterwards in subsequent clinics.

Referring a patient

GPs are advised to refer patients with menstrual irregularity or pressure symptoms associated with uterine fibroids either on scan or abdominal examination.

Fibroids rarely cause pain so best to exclude other causes of abdominal pain prior to referring to a Gynaecological clinic for review.

Subfertility may be associated with uterine fibroids thus if patients essential problem is achieving pregnancy then a referral to fertility clinic should be prioritized over the fibroids

Meet our team

Mr Fakokunde – Consultant Lead for fibroid services. GOPD mainly fibroid patients and runs once a month clinic jointly with Mr Nakhosteen (Consultant Radiologist and specialist nurses) for patients being considered for fibroid embolization.

Mr Verasingam/Miss Al-Habib Ansam - fibroids with subfertility issues or in association with endometriosis.

All consultants clinics do see fibroid patients in routine GOPD, and subsequent referral as may be needed are done to be seen in the above 2 clinics.

Patients coming to the fibroid embolization clinic will be requested to have MRI prior to the referral.

Lead nurse: Joadel Mafuta

Lead radiology nurse – Hedye Joti