Uterine Fibroids, Endometriosis & Chronic Pelvic Pain Management

Uterine fibroids (benign smooth-muscle tumours of the uterus) and endometriosis (the presence of endometrial-like tissue outside the uterine cavity) are among the most common causes of severe menstrual pain (dysmenorrhoea), heavy prolonged bleeding (menorrhagia), deep pain during intercourse (dyspareunia), pelvic pressure, and subfertility in South African women.

Accurate treatment begins with precise anatomical mapping. During your consultation, Dr Tebo Rasenyai classifies uterine fibroids according to the international FIGO system — distinguishing submucosal fibroids (which protrude into the uterine cavity and affect implantation and bleeding), intramural fibroids (within the muscular wall), and subserosal fibroids (on the outer surface) — while screening for ovarian endometriomas and adenomyosis.

• Submucosal Fibroids (FIGO Types 0–2): Frequently cause heavy menstrual flooding, blood clots, anaemia, and delayed conception; often amenable to incision-free hysteroscopic resection.
• Intramural & Subserosal Fibroids (FIGO Types 3–7): May cause pelvic bulk symptoms, bladder frequency, lower back ache, and uterine enlargement.
• Endometriosis & Adenomyosis: Characterised by cyclical or chronic pelvic pain, bowel or bladder pain during menstruation, and painful intercourse requiring targeted hormonal or laparoscopic intervention.

Not every fibroid or ovarian cyst requires surgery. Treatment is tailored to your symptom severity, fibroid location, haemoglobin level, age, and whether you wish to conceive now or in the future.

Medical management options include non-hormonal antifibrinolytic therapy (tranexamic acid), targeted anti-inflammatory regimens, combined hormonal suppression, progestogen therapy, levonorgestrel intrauterine systems (Mirena), and GnRH analogues. When surgical intervention is required, fertility-sparing myomectomy or laparoscopic endometriosis excision is carefully planned to restore normal pelvic anatomy.

To help Dr Rasenyai obtain the clearest ultrasound images during your visit to Suite D, Room 2, please note our bladder preparation protocol: if a transabdominal scan is needed (particularly for large fibroids extending toward the umbilicus or for patients who cannot undergo an internal scan), arrive with a full bladder by drinking 3 to 4 glasses of water an hour beforehand.

If a high-resolution transvaginal ultrasound is performed to evaluate the endometrium, ovaries, or deep endometriosis nodules, you will be asked to empty your bladder right before the examination.

Chronic pelvic pain and heavy menstrual bleeding should never be dismissed as 'normal period pain'. Left untreated, chronic blood loss frequently leads to severe iron-deficiency anaemia, chronic fatigue, missed workdays, and emotional distress.

Our practice pairs definitive gynaecological treatment with rapid correction of iron deficiency (including oral or intravenous iron replenishment where indicated) and structured long-term follow-up to prevent symptom recurrence.