Endometriosis

Adelaide Endometriosis Research Group

Led by Prof Louise Hull, the Adelaide Endometriosis Research Group is committed to improving awareness of endometriosis, providing evidence-based information and facilitating accessible diagnosis of endometriosis, to women, their families and health providers.

Established in 2006 the group is currently supported by Commonwealth Government Funding, through the Medical Research Future Fund Primary Health Care Research Data Infrastructure Program and the Public Health and Chronic Disease Program, as well as through Endometriosis Australia.

Endometriosis team

L-R: Nicola Mathews, Dr Nimantha Abeygunasekara, Prof Gustavo Carneiro, Dr Hu Wang, A/Prof Louise Hull, Dr Jodie Avery, Dr Beck O’Hara, Aisha Sirop, Kate Chadwick, Yuan Zhang

  • What is endometriosis?

    Endometriosis is a common, chronic, inflammatory disease, causing period pain for 1 in 9 women and those assigned female at birth. It is where tissue similar to the endometrium grows outside the uterus. Endometriosis is usually underdiagnosed with an average of 6.4 years from first symptoms to diagnosis.

    Reproductive hormonal changes each month drive an excruciating cycle of endometriosis breakdown and remodelling. If undiagnosed, chronic pelvic pain, sexual pain, fatigue, anxiety, and depression may result. Endometriosis is associated with an increased risk of infertility, autoimmune conditions, cancer, and heart disease.

  • Research Team

    Prof Louise Hull Robinson Research Institute, Group Lead and Chief Investigator

    Louise has worked in fertility services since she graduated as a doctor in 1991. During this time she has been delighted to help many couples conceive, as well as promote the development of improved fertility treatments through research and education. She works at the Robinson Research Institute, University of Adelaide, Women’s and Children’s Hospital, Adelaide and in private practice at Embrace Fertility.

    Louise became an Obstetrician and Gynaecologist (FRANZCOG) after gaining clinical experience working in IVF units in Christchurch, New Zealand, Cambridge, UK and Adelaide, Australia, including Bourn Hall, the fertility centre where the first IVF baby was born. She was awarded the Certificate in Reproductive Endocrinology and Infertility (CREI) sub speciality qualification by RANZCOG in 2006.

    Louise completed a PhD s in Endometriosis at the University of Cambridge, UK in 2006. She was appointed to the University of Adelaide in 2006 where she established and led the Endometriosis Group at the Robinson Research Institute. Her research focuses on the basic science of endometriosis, developing new diagnostics for endometriosis and conducting Phase 3 and 4 pharmaceutical trials.

    She is an international ambassador for the World Endometriosis Society, a Medical Advisory Board member for Endometriosis Australia and EndoNZ and participated in the National Action Plan round Table for Endometriosis by invitation from the Minister of Health. She has several national and international collaborations and has been awarded considerable grant money over the last 2 years to further endometriosis research in Australasia.

    More recently, Louise has conducted research exploring the immunology and biology of implantation and has participated in biotechnology and pharmacology sponsored clinical trials in the IVF industry. She is the Deputy Clinical Leader of the Fertility and Conception Theme at the Robinson Research Institute, the co-chair of the Special Interest Group for Implantation of ASPIRE and has funding for several research projects exploring recurrent implantation failure and miscarriage. 

    Louise publishes widely, presents at international conferences, supervises PhD students and teaches reproductive medicine to medical students, registrars and reproductive medicine fellows. Additionally, Louise has been an associate editor for Human Reproduction, chaired several grant committees, sits on the Jean Hailes Governance Committee for the endometriosis national action plan and has been on the board of 3 IVF and software companies and 2 pharmaceutical medical advisory boards.

    Lastly, Louise has founded 2 IVF units and in her roles as Scientific Director and New Developments Director, has been integral in introducing novel treatments, laboratory methods and models of care to the IVF industry. She is currently the Written Exam Chair for the Certificate in Reproductive Endocrinology and Infertility (CREI) subspeciality for RANZCOG and the treasurer of the ANZCREI society.

    Dr Jodie Avery, Robinson Research Institute, Senior Research Fellow and Imagendo Program Lead

    Dr Jodie Avery BA, BAppSc, MPH, PhD is a social researcher with advanced skills in quantitative and qualitative research methodologies, with a background in radiology. Currently Senior Research Fellow with the Robinson Research Institute, University of Adelaide, and Program Manager of the $1.9M MRFF Funded IMAGENDO Endometriosis Imaging Study, developing a cost-effective, accessible, and accurate method to non-invasively diagnose endometriosis. Artificial intelligence using ultrasound and MRI images will develop diagnostic algorithms that estimate the likelihood that an individual has endometriosis. Images uploaded by in-built software in imaging machines, will be analysed by this algorithm in real time on a cloud-based digital platform.

    As a chronic disease epidemiologist, Jodie’s research concerns the intersection of chronic reproductive health conditions with psychosocial factors that may influence other awareness, diagnosis and lead to other associated comorbidities. This includes investigating psychosocial and mental health aspects of chronic conditions such as Endometriosis, Polycystic Ovary Syndrome (PCOS), and Incontinence throughout the life course. Jodie hopes to increase awareness and develop new diagnostic techniques for timelier diagnosis, as well as appropriate care suitable for individual needs.

    Jodie was awarded a 2021 Emerging Leader Development Award and a 2019 Women’s Research Excellence Award from the University of Adelaide, a 2018 Robinson Research Institute Career Development Fellowship, and a 2018 Australian Federation of University Women SA Trust Postdoctoral Award. In 2017 she undertook a Career Development Fellowship from the NHMRC Centre for Research Excellence in PCOS. An experienced lecturer and tutor, she has taught widely and supervised students across Health Sciences, Psychology and Medicine programs over the past 15 years.

    Dr Beck O’Hara, Robinson Research Institute, Grant Funded Researcher, EndoZone Project Coordinator

    Dr Beck O’Hara, BBUS(hons), P.G Cert (Health Promotion), PhD is a psychosocial and digital health researcher with experience in both qualitative and quantitative research methods. Dr O’Hara’s current research focuses on integrating digital health technologies to support endometriosis diagnosis and management. She coordinates the EndoZone project a co-created digital health platform with the endometriosis community, that empowers and supports people affected by the disease. It addresses community driven priorities such as improving doctor and patient communication, addressing pain normalisation and pain management. She is also a CI on the Imagendo project which uses machine learning (AI) to develop an algorithm to diagnose endometriosis from MRI and Transvaginal Ultrasound Images.

    Dr O’Hara completed her PhD at Monash University in 2019, where she conducted a mixed-methods study examining women’s experiences of managing endometriosis in Australia and the role of self-management in this disease. Prior to this, she established a 10-year research career in chronic disease, health policy and health promotion, working for state and local government, non-profit organisations and universities. She has conducted research in regional and remote areas and has contributed to projects investigating experiences of complex conditions like diabetes and with vulnerable population groups including women from Aboriginal and Torres Strait Islander and culturally and linguistically diverse communities.

    The EndoZone team were awarded the Robinson Research Institute Community Engagement Award. Beck was awarded a Graduate Women Victoria Special Award (2018 & 2019 and a Australian Research Training Program Scholarship (2016-2019).

    Dr Hu Wang, Australian Institute of Machine Learning, Post doctoral Researcher

    Hu Wang is currently a research fellow at Australian Institute for Machine Learning (AIML), the University of Adelaide, under the supervision of Prof. Gustavo Carneiro. He received a PhD degree in Computer Science from the University of Adelaide in 2021. His research is across multiple domains: Medical Image Processing, Multimodal Learning and Machine Learning Theory. He has published multiple papers on top-tier conferences, including ECCV, IJCAI, ACM multimedia and MICCAI . Recently, he is conducting a medical image processing project --- Imagendo. The aim is to detect endometriosis disease with Machine Learning techniques and thus can help promote the intelligent diagnosis of endo medical imaging in Australia. His personal website is https://huwang01.github.io/.

    Prof Gustavo Carneiro, Australian Institute of Machine Learning, Chief Investigator

    Prof Gustavo Carneiro, PhD is a computer scientist with extensive experience in medical image analysis, computer vision and machine learning. He is the recipient of two ARC discovery projects (as lead CI) in the areas above and he is also a CI of the Centre of Excellence in Robotic Vision, where he is the leader of the machine learning group. Prof. Carneiro is the recipient of prestigious international fellowships, such as the Marie Curie International Incoming Fellowship and the Humboldt Fellowship. He also has valuable industry experience at the Siemens Corporate Research Laboratory (Princeton, USA), where he developed several systems and was granted 6 patents. He has more than 150 publications in peer reviewed journals and conferences, cited more than 6500 times, with h-index 39.

    Ms Yuan Zhang, Australian Institute of Machine Learning

    Ms Yuan Zhang is a Ph.D. student at the University of Adelaide. Her main research interest is to apply deep learning and computer vision technologies to the field of medical science. Yuan received her master's degree in Data Science from the University of Adelaide in 2021, where her research focused on developing an AI-assisted colonoscopy diagnosis system. Before shifting her career towards AI, Yuan obtained a master's degree in Chemical Engineering in 2017 and a bachelor's degree in Bioengineering in 2014.

    Ms Alison Deslandes

    Alison is a specialist obstetric and gynaecological sonographer and researcher. Her clinical ultrasound experience covers public hospitals, private hospitals, private radiology practice and specialist suites. Whilst she has had exposure to all areas of sonography, obstetrics and gynaecology is her passion and primary area of both clinical practice and research. She has a particular interest in imaging of endometriosis and complex gynaecological pathologies.

    She has completed a Masters by Research focusing on the accuracy of transvaginal ultrasound in the diagnosis of endometriosis when performed by sonographers.

    She is heavily involved in the field of medical ultrasound and is the current president of the Australasian Society for Ultrasound in Medicine.

    Dr Nimantha Abeygunasekara

    Dr Nimantha Abeygunasekara is currently, undertaking an internship at the Central Adelaide Local Health Network (CALHN) in 2022. Nim is a dedicated, hard-working and motivated individual with a passion for learning and self-development. She has a keen interest in women’s health, as well as research in the field of Obstetrics and Gynecology, assisting in an update of a Cochrane review “Imaging modalities for the non-invasive diagnosis of endometriosis”. Nim is currently undertaking a Masters of Philosophy looking at General Practitioners Perspectives on the Diagnostic Delay of Endometriosis

    Dr Diksha Sirohi

    Dr Diksha Sirohi is a PhD student at the University of Adelaide. Her PhD project contributed to the co-creation and evaluation of EndoZone – an evidence-based digital health platform for endometriosis. Dr Sirohi completed her medical training in complementary medicine and holds a Bachelor of Homoeopathic Medicine and Surgery from Goa University, India. She has clinical experience of 8 years with a special interest in the holistic management of women's health conditions such as PCOS, endometriosis, uterine fibroids and other gynaecological disorders. She holds a Master of Public Health from the University of Queensland. Her research interest lies in the holistic management of endometriosis and improving the healthcare delivery for endometriosis.

    For General Enquires please contact endostudy@adelaide.edu.au.

  • The Imagendo Endometriosis Research Study

    Endometriosis is a common condition. By the age of 44, one in nine Australian women are diagnosed with endometriosis, a disease that caused 34,200 hospitalisations in 2016/17. Diagnosis of endometriosis is often delayed, with an average of 6.4 years between onset of symptoms and diagnosis.

    Until recently, the only reliable way of diagnosing endometriosis was to perform keyhole surgery and visualise the endometrial deposits inside the abdomen, ideally verified by microscopic examination of the tissue. This method was considered the gold standard for the diagnosis of endometriosis but surgery can be problematic, can be difficult to access, and is associated with delays. Now ESHRE 2022 guidelines recommend imaging for diagnosing endometriosis, providing negative findings do not exclude disease.

    IMAGENDO, led by the University of Adelaide aims to remove this surgical diagnostic barrier by developing a novel, accessible, cost-effective, non-invasive diagnostic tool for endometriosis.

    An Artificial Intelligence (AI) algorithm, combining the diagnostic capacity of specialist endometriosis TVUS (eTVUS) and endometriosis MRI (eMRI) scans, will:

    1. Reduce diagnostic delay
    2. Instigate prevention for infertility and chronic pain
    3. Reduce hospital admissions and laparoscopic surgery
    4. Improve mental health by validating patient’s pain experience.
    5. Promote development of timely, targeted, effective treatments.

    Please see our study webpage www.imagendo.org.au

  • EndoZone: Endometriosis Digital Platform

    EndoZone is an evidence-based platform co-created with people affected by endometriosis. It is funded by the Australian Government Department of Health and Jean Hailes for Women’s Health. The Design Thinking Framework guided the co-creation process. It has been developed by people affected by endometriosis, along with Australian Endometriosis Associations, General Practitioners, Allied Health Professionals, Nurse Practitioners, Gynaecologists, Researchers, Health Informaticians and Pain Specialists.

    People affected by endometriosis were asked what they needed most from EndoZone. Better communication with doctors about endometriosis and pelvic pain was the top priority among the 347 community members that responded to the survey. More information about period symptoms and what is normal was the next priority, followed by providing methods to help people manage pain better.

    EndoZone was designed to address these priorities. It features an interactive symptom checker and a health report that users can take to their doctor which captures information about diagnosis, symptoms, and treatments. There are self-management strategies to help people manage their endometriosis and pelvic pain symptoms.

    EndoZone also has pages for clinicians. Health professionals can rapidly access the latest ideas about how endometriosis symptoms develop, the best ways of diagnosing endometriosis and the latest treatments, including when to refer for surgery. A section is devoted to the latest research by Australian research groups, which includes ways the community can get involved in research projects to improve diagnostics and treatments for future generations.

  • Endometriosis Clinical Trials Group

    Dr Tran Nguyen

    Dr Sally Reid

    Dr Rituparna Dutta

  • Conferences, Presentations and Workshops
    • 2022 GP Partners CPD workshops – Adelaide, Port Lincoln, Lyndoch, Mount Gambier      
      Making diagnosis more timely and accessible for people with endometriosis
    • 2022: Royal College of Gynaecologists / British Society for Gynaecological Imaging Meeting 
      IMAGENDO: Combining ultrasound and magnetic resonance imaging using artificial intelligence to reduce diagnostic delay.
    • 2022 European Conference on Computer Vision 2022
      Uncertainty-aware Multi-modal Learning via Cross-modal Random Network Prediction 
    • 2022 ASUM deep dive endo day Imagendo® 
      Non-Invasive diagnosis of endometriosis using machine learning 
    • 2022 PELVIC PAIN Conference
      Do we need laparoscopy to diagnose Endometriosis?
    • 2022 RANZCOG  Using non-invasive imaging to diagnose Endometriosis
    • 2022 SEED Symposium
      It’s time to diagnose endometriosis before ART’
    • 2022 Fertility Nurse Association Workshop
      'Screening for Endometriosis and Improving Outcomes'
    • 2022: Queensland Women’s Health Forum & Health Translation SA
      An evidence-based platform co-created with people affected by endometriosis.
    • 2021 ISUOG 2021
    • 2021: World Congress on Endometriosis (WCE). 
      • Artificial Intelligence for Sliding Sign Detection to Diagnose Endometriosis
      • Engaging the Australian endometriosis community in the design of a digital health platform
      • The role of self-management among women with endometriosis
      • Challenges of managing endometriosis: the patients’ perspective
      • WHISE. Managing endometriosis in Australia, March 2021
      • Endometriosis Support SA, Endometriosis research update, March 2021
      • Adelaide Pelvic Pain Network. Endometriosis Research Update (clinicians), May 2021

  • Publications

     

    1. Shetty A, Delanerolle G, Zeng Y, Qing Shi J, Ebrahim R, Pang J, Hapangama, D, Sillem, M, Shetty S, Shetty B, Hirsch M, Raymont V, Majumder K, Chongm S, Goodison W, O’Hara R, Hull L, Pluchino N, Shetty N, Elneil S, Fernandez T, Phiri P, Brownstone R (2022) A Systematic Review and Meta-Analysis of Digital Application use in Clinical Research in Pain Medicine, Frontiers in Digital Health (4), doi: https://doi.org/10.3389/fdgth.2022.850601
    2. Armour, M., Avery, J., Leonardi, M., Van Niekerk, L., Druitt, M. L., Parker, M. A., Girling, J. E., McKinnon, B., Mikocka-Walus, A., Ng, C. H. M., O’Hara, R., Ciccia, D., Stanley, K., & Evans, S. (2022). Lessons from implementing the Australian National Action Plan for Endometriosis, Reproduction and Fertility, 3(3), C29-C39. Retrieved Aug 2, 2022, from https://raf.bioscientifica.com/view/journals/raf/3/3/RAF-22-0003.xml
    3. Evans, S., Villegas, V., Dowding, C., Druitt, M., O'Hara, R. and Mikocka-Walus, A. (2021), Treatment use and satisfaction in Australian women with endometriosis: A mixed-methods study. Intern Med J.       
    4. Delanerolle, G. et al. O’Hara, R. Hull, M.L, Majumder, K, Shi, JQ & Raymont, V (2021) A systematic review and meta-analysis of the Endometriosis and Mental-Health Sequelae; The ELEMI Project. Women’s Health.
    5. Maicas G, Leonardi M, Avery J, Pannucio C, Caniero G, Hull ML, Condous G. Deep learning to diagnose pouch of Douglas obliteration with the sliding sign on transvaginal ultrasound: a prospective study. Fertility and Reproduction. 2021 (In press)
    6. O'Hara, R., Rowe, H., & Fisher, J. (2021). Self-management factors associated with quality of life among women with endometriosis: a cross-sectional Australian survey. Human Reproduction.
    7. O’Hara, R., Rowe, H., & Fisher, J. (2020). Managing endometriosis: a cross-sectional survey of women in Australia. Journal of Psychosomatic Obstetrics & Gynecology. 
    8. O’Hara, R. Rowe, H., Roufeil, L. & Fisher, J. 2019 ‘Self-management in condition-specific health: a systematic review of the evidence among women diagnosed with endometriosis’, BMC Women’s Health.
    9. O’Hara, R. Rowe, H., Roufeil, L. & Fisher, J. 2018 ‘Should endometriosis be managed within a chronic disease framework? An analysis of national policy documents’, Australian Health Review  Book chapter
    10. Leonardi M, Avery J, Hull ML. “Novel diagnostic strategies for Endometriosis” in “Immunology of Endometriosis Pathogenesis and Management” Koga K (ed). Elsevier Press ISBN: 9780128209059

  • Media
    1. The Conversation: From sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms
      Rebecca O’Hara & Louise Hull, November 2022
    2. The University of Adelaide: Faster methods for diagnosing endometriosis, December 2021
    3. The University of Adelaide, The Discovery Pod: Fertile Ground, September 2021
    4. Facebook Live: Your Fertility – Women’s Chronic Conditions, August 2021
    5. Cosmos Magazine: An AI that can diagnose endometriosis?, July 2021
    6. ABC Sunshine Coast: Lack of endometriosis specialists in regional Queensland prolong pain for sufferers, January 2021
    7. The Guardian: Australian women with endometriosis face six-year wait for diagnosis, study finds, October 2020
    8. Health Times: Women with endometriosis suffer "terrible" 6 year wait for diagnosis, October 2020

  • Funding

    Current funding for the Imagendo Project

    • 2022: ASUM Australasian Society of Ultrasound in Medicine Research Grant: “Rectal deep endometriosis identification using Artificial Intelligence.” George Condous, Cansu Usuner, Jodie Avery, Catrina Panuccio, Gustavo Carneiro, Louise Hull ($19,966)
    • 2021: Robinson Research Institute Engaging Opportunities: General Practitioners Perspectives on the Diagnostic Delay of Endometriosis. ($14,439)
    • 2021: Medical Research Future Fund’s Primary Health Care Research Data Infrastructure Grant “IMAGENDO Diagnosing endometriosis with imaging and artificial intelligence” ($1,990,998)
    • 2021: Emerging Leader Development Award, Faculty of Health and Medical Science UofA ($40,000) Dr J Avery
    • 2020: Endometriosis Australia Endometriosis Research Grant: “Non-invasive endometriosis diagnosis using machine learning” ($30,000)
    • 2019: Australian Gynaecological Endoscopy Society ($9750)
    • 2019: Lions Club of Gawler ($1000)

     

    Current funding for EndoZone

    • 2020 – 2022: Australian Government Department of Health – Public Health and Chronic Disease Program ($1.06m)
    • 2019: Jean Hailes for Women’s Health ($150K)