McMaster Endometriosis Clinic Multidisciplinary Model
The McMaster Endometriosis Clinic delivers coordinated, evidence-informed care for patients in Hamilton, Ontario and the surrounding region. Care emphasizes precise surgical excision, fertility preservation when requested, multimodal pain control, and rehabilitation delivered by a team drawn from McMaster University and affiliated hospitals within Hamilton Health Sciences and St. Joseph’s Healthcare Hamilton. Services operate within Ontario’s publicly funded system while offering streamlined referral and shared decision-making pathways.
Clinic architecture, team roles, and coordination
Multidisciplinary care is organized around collaborative decision-making, timely diagnostics, and patient-centered rehabilitation. Core membership includes gynecologic surgeons with advanced laparoscopic excision expertise, reproductive endocrinologists, pain medicine specialists and anesthesiologists, pelvic floor physiotherapists, gastroenterologists, urologists, radiologists with specialized pelvic protocols, pathologists, nurses and clinical navigators, mental health clinicians, and allied health staff. Administrative coordination is led by clinical nurse coordinators and care navigators who manage referrals, preoperative optimization, and follow-up scheduling.
Key operational principles:
- Prioritize complete excision for deep infiltrating disease while preserving fertility when indicated.
- Combine medical and non-medical pain strategies, integrating interventional options only after multidisciplinary review.
- Use advanced imaging to guide surgical mapping and minimize repeat procedures.
- Implement standardized outcome measures for pain, quality of life, and reproductive outcomes.
The following matrix summarizes typical roles, responsibilities, and expected access timelines for patients entering care in Hamilton. This appears mid-document as a central resource for referring clinicians and patients.
| Team role | Primary responsibilities | Typical initial access (triaged) | Key metrics tracked |
|---|---|---|---|
| Gynecologic surgeon (laparoscopic excision) | Operative mapping and complete excision of endometriotic lesions, bowel/bladder resection coordination | 8–16 weeks for urgent fertility/pain; 4–6 months routine | Surgical completeness, complication rate, symptom reduction |
| Reproductive endocrinologist | Fertility assessment, ovarian reserve testing, IVF coordination, fertility preservation | 4–12 weeks | Pregnancy rate, time to treatment |
| Pain medicine / anesthesiology | Multimodal pharmacologic management, nerve blocks, pudendal or superior hypogastric plexus interventions | 2–8 weeks | Pain scores, opioid reduction |
| Pelvic physiotherapy | Pelvic floor retraining, bladder/bowel coordination, graded exposure | 2–6 weeks | Function scores, pelvic pain scales |
| Gastroenterology | Assessment of bowel involvement, colonoscopy/CT enterography as needed, medical or surgical bowel management | 4–12 weeks | Bowel symptom index, need for bowel resection |
| Urology | Cystoscopy, ureteric assessment, management of bladder endometriosis | 4–12 weeks | Urinary symptom scores, voiding function |
| Radiology | Transvaginal ultrasound with bowel protocol, pelvic MRI with dedicated endometriosis reporting | 1–3 weeks | Imaging concordance with operative findings |
| Pathology | Histologic confirmation of excised lesions, standardized reporting | Postoperative | Lesion type, margins |
| Nursing / care navigation | Triage, preop optimization, education, follow-up coordination | Immediate on referral | Wait times, patient satisfaction |
| Mental health / social work | Psychological therapies, coping strategies, social supports, disability counseling | 2–8 weeks | Mental health inventories, functional status |
Referral, intake, and diagnostic pathways
Referrals originate from primary care providers, emergency departments, and specialists. Triage criteria prioritize suspected deep infiltrating disease with organ involvement, chronic severe pain refractory to first-line therapies, or infertility where endometriosis is suspected. Ontario Health pathways and local eReferral mechanisms are used to track wait times and referral completeness. Initial intake comprises a structured history, surgical history, prior imaging and pathology review, and baseline instruments for pain and quality of life. Imaging protocols use transvaginal ultrasound performed by experienced sonographers and pelvic MRI when bowel, bladder, or ureteric involvement is suspected. Radiology reporting follows structured templates aligned with international reporting recommendations.
Diagnostic workup algorithms combine clinical exam, imaging, and selective endoscopic evaluation. Preoperative planning includes bowel and urology pre-assessment when indicated. Multidisciplinary case conferences are held weekly to review complex cases, align on surgical strategy, and identify need for multispecialty operating teams. Shared decision-making meetings involve patients, family when desired, and the multidisciplinary team to review risks, expected outcomes, and fertility implications.
Treatment strategy, surgical planning, and long-term care
Surgical planning emphasizes timing that balances symptom burden, fertility goals, and comorbidity optimization. Multispecialty operating lists include gynecologic surgeons with advanced laparoscopic skills, colorectal surgeons for segmental bowel resection when required, and urologists for bladder or ureteric repair. Postoperative pathways specify early mobilization, graded physiotherapy, thromboprophylaxis per provincial guidelines, and pain tapering plans. Medical management options include combined hormonal contraceptives, progestins, levonorgestrel intrauterine systems, and GnRH analogues when indicated. Analgesic regimens integrate acetaminophen, NSAIDs, neuropathic agents, and careful opioid stewardship. Interventional pain procedures are reserved for refractory cases following multidisciplinary review.
Fertility preservation counseling is offered according to ovarian reserve testing; options include oocyte cryopreservation and IVF coordination. Postoperative rehabilitation includes pelvic floor physiotherapy initiated within weeks, dietary and bowel retraining with gastroenterology input when necessary, and targeted mental health interventions for chronic pain adjustment. Long-term monitoring uses standardized patient-reported outcome measures at set intervals to guide modifications in therapy.
Education, research, equity, and system performance
Patient education resources include condition-specific workshops, self-management toolkits, and peer-led support networks. Virtual care options extend clinic access for follow-up and symptom management; remote monitoring uses validated pain and function instruments. The clinic participates in provincial registries and collaborates on translational research with McMaster’s research institutes, contributing to outcomes research and trainee education. Continuous quality improvement focuses on wait-time reduction, surgical complication tracking, and equitable access initiatives that address language, cultural needs, and disability accommodations for Hamilton’s diverse population. Training opportunities support resident and allied health involvement under structured supervision, ensuring skill transfer and sustained regional capacity.
