Our Services

Living with chronic pain can be physically and emotionally exhausting, often affecting daily activities, sleep, mood, and overall quality of life. Unlike acute pain, which signals short-term injury, chronic pain can persist for months or years and may not have a clear cause. Conditions such as pelvic pain, endometriosis, fibromyalgia, or musculoskeletal pain can all contribute to long-term discomfort, but with the right support, it’s possible to improve function and reduce the impact of pain on your life.

One of the most effective strategies in chronic pain management is staying active. Gentle, consistent movement helps to retrain the nervous system, build strength and flexibility, reduce stiffness, and improve confidence in your body. However, this can feel challenging without the right guidance.

An Accredited Exercise Physiologist (AEP) is specially trained to help people manage chronic pain through safe, personalised movement programs. They work closely with your individual symptoms, limitations, and goals to help you move comfortably and gradually return to meaningful activities.

You may also access your exercise physiologist as part of a multidisciplinary team (MDT), which may include your GP, women’s health physiotherapist, and gynaecologist. Working together, this team approach ensures your care is connected, consistent, and tailored to your unique needs.

Reasons to seek support include:

• Persistent or worsening pain impacting daily life
• Fear of movement or re-injury
• Pain interfering with sleep, work, or relationships
• A new diagnosis such as endometriosis or pelvic floor dysfunction

What can be offered:

• Thorough assessment and understanding of your pain history
• Education about pain science to reduce fear and increase control
• Graded exercise programs designed to reduce pain sensitivity and build resilience
• Support for pacing activities, flare-up planning, and goal setting
• Collaboration with other healthcare providers for a well-rounded approach

Chronic pain is complex, but you don’t have to manage it alone. With the right support, movement can become a powerful tool for healing, empowerment, and reclaiming your quality of life.

If you’ve been trying to conceive for 12 months (or 6 months if over 35) without success, it may be time to explore fertility support. Infertility services offer compassionate and personalised care to help identify possible causes and guide you through the next steps. This may include detailed health and menstrual history, blood tests to assess hormone levels and ovulation, fertility-focused pelvic ultrasound, and investigations into lifestyle or medical factors affecting fertility. For couples, both partners may be involved in the assessment process to gain a complete picture.

Working closely with your regular GP, gynaecological surgeon, or fertility specialist, our team ensures your care is well-coordinated and evidence-based. We aim to provide clarity, reduce stress, and empower you with knowledge and options. Whether you're just beginning your fertility journey or preparing for assisted reproductive treatments like IUI or IVF, our services are here to support you every step of the way with understanding, respect, and clinical expertise.

Myomas (fibroids) are incredibly common with some studies estimating that 70-80% of women will have a fibroid at some stage of their lives. A fibroid is a benign (non-cancerous) growth of muscle that is found in or around the uterus. It may be any size and shape. We do not know why women get fibroids, though it is likely that a combination of factors contribute, such as genetics, hormones such as oestrogen and progesterone and the number of children you have had.

Often fibroids do not cause any symptoms and may only be found when undergoing investigations for other reasons. When fibroids do cause symptoms, they may cause abnormal or heavy vaginal bleeding, pain at the time of periods, problems with fertility, or pressure effects on surrounding organs like bladder and bowel which may cause pain or trouble with toileting.

When a fibroid is very large it may occur across a number of locations. That is, it may be both in the muscle wall and the inside of the uterus. The location fibroids may have more of an effect on your symptoms that the actual size. For example, a small 1cm fibroid completely inside the uterus may cause heavy bleeding while a 5cm fibroid on the outside may cause no symptoms at all. The size, location, and your symptoms will help determine the most appropriate treatment options.

Treatment for fibroids will depend on the number, size and location of the fibroids. Treatment is divided into three groups:

• Medical (using medications)
• Radiological (uterine artery embolisation)
• Surgical (surgical removal of fibroids or the uterus)

Whilst all of our doctors can discuss medical and radiological approaches to fibroids, Dr Budden has also undergone extensive training in the surgical management of fibroids and is particularly adept at laparoscopic and hysteroscopic removal {link}. He can discuss your options with you and create a plan for your care.

Medical treatments are aimed at managing symptoms such as heavy bleeding. They include both hormonal and non-hormonal treatments which are designed to reduce the heaviness of your periods. These treatments do not treat the fibroids themselves, rather they manage the symptoms. Each medical option has pros and cons and may not be appropriate for all women. For example, women who are trying to become pregnant should not use hormonal treatment.

Uterine artery embolization (UAE) is a radiological treatment where a small tube is passed through the main artery in the leg and directed towards the arteries in the pelvis that supply the uterus and fibroid. Small pieces of foam are injected to block the blood supply to the fibroid. This can reduce the volume of the fibroid by up to 50%. The fibroid is not removed but the reduction in size may reduce symptoms such as heavy bleeding or pressure. Currently this procedure is not recommended for women who are planning to fall pregnant in the future.

Surgery is the only way to completely remove them, although the advantages should be balanced against the invasive nature of the procedure. It will not prevent new fibroids occurring.  The most appropriate surgical approach for your fibroids will depend on their size, number and location. Hysteroscopic removal is best for fibroids inside the uterus (submucosal) while fibroids in the muscle wall (intermural) or outside the uterus (subserosal) require abdominal surgery, either laparoscopically or by laparotomy. Dr Budden can remove most intramural and subserosal fibroids laparoscopically, recommending a robotic approach over 7cm, and would only recommend open surgery if your fibroids are exceptionally large (greater than 14cm) or there are multiple fibroids to be removed (more than 5).

Fibroids may contribute to infertility in a number of different ways:

• Acting like an intra-uterine device (IUD)
• Changing the blood flow pattern in the uterine cavity
• Taking space within the uterine cavity
• Altering the endometrium (lining of the uterus), making it harder for an embryo to implant

Submucosal fibroids are the most likely to be associated with fertility problems. It is recommended to remove them before trying to become pregnant. For intramural and subserosal fibroids routine removal is not recommended. If you have experienced difficulty with a pregnancy, such as premature labour or growth restriction of the baby, then Dr Budden may discuss removing the fibroid before trying for another pregnancy. If you have a pedunculated fibroid (one on a stalk), then removing it may prevent complications of pregnancy such as the fibroid twisting (called torsion) or outgrowing its blood supply and causing pain or possibly premature labour.

Your pelvic organs include your bladder, uterus (womb) and rectum. These organs are held in place by strong tissues (fascia) and ligaments. The fascia and ligaments hold your pelvic organs inside the pelvis along with help from the pelvic floor muscles but may stretch over time or may tear as a result of childbirth. The pelvic floor muscles can compensate for this stretching or tearing but if they become weak then the pelvic organs may not be held in their correct place and will bulge into the vagina.

Pelvic organ prolapse is the term used to describe any bulge although it may be divided further into cystocele (bladder prolapse), rectocele (rectal prolapse) or uterine prolapse.

Female pelvic organ prolapse is a common occurrence.  It won’t go away by itself but there is help available. An early prolapse may be unnoticeable but as it becomes larger you may notice symptoms such as:

• A heavy or dragging sensation in the vagina
• A sense of something “coming down” or a lump in the vagina
• A bulge felt vaginally especially when showering
• Loss of sensation with intercourse for either partner
• Your bladder might not empty as it should or you may suffer recurrent urinary tract infections
• Dragging or back pain especially towards the end of the day
• Need to push inside the vagina to pass urine or stool

Causes of Prolapse

The main cause of prolapse is pregnancy and vaginal birth although other common causes include chronic coughing, heavy lifting and constipation. Prolapse may also run in the family. It is more likely to occur after menopause or if you are overweight, but it can happen to young women, particularly if they have recently had a baby.

Treatment

Like many things, prevention is often best. As prolapse can present with prolonged weakness of the pelvic floor muscles, all women should keep their pelvic floor muscles strong and do daily exercises throughout their life. If the pelvic floor muscles are already weak, they can be strengthened with the help of a pelvic floor physiotherapist {link to staff}.

The first step to treatment is to identify the type of prolapse and the symptoms that are bothering you. Our doctors at Saige can assess the pelvic floor to determine where the problem lies but the symptoms you are suffering from and your current activities will guide what treatments would be beneficial and if referral to prolapse surgeon is recommended.

Once the type of prolapse is identified and we have outlined your symptoms and goals for improvement, treatment can follow one or all of the following:

• Conservative and lifestyle measures such as pelvic floor muscle training, changes in lifestyle and being aware of good bowel and bladder habits are always discussed. For some women this is all that is required to improve their symptoms.
• Vaginal pessary use - There are a number of shapes and sizes of pessary. Your physiotherapist will discuss why a pessary may be beneficial to you before discussing the type that may be best for you. Over time you may need to change sizes or shapes of pessary if the prolapse continues to worsen.
• Surgery - The aim of surgery is to repair torn or stretched supporting tissues. The surgery can be done vaginally or abdominally (as an open procedure or laparoscopic). The aim of the surgery is to make the vaginal wall stronger, however one in three women will have a recurrence of prolapse after surgery. Dr Budden will discuss the reasons why you may or may not be a good candidate for surgery, the risks of recurrence and what factors may help reduce your risk of recurrence. Some of the reasons why surgery may not be the best option for you include if you plan to become pregnant in the future, your age and general health, work or family commitments that require heavy lifting and the nature of the prolapse.

While it may be caused by non-serious conditions, it should always be investigated, as it can sometimes be a sign of something more serious. Common causes include vaginal atrophy (thinning of the vaginal walls due to low estrogen), polyps, hormone replacement therapy (HRT), blood thinners (like aspirin) or endometrial (uterine) hyperplasia. In a small percentage of cases, it may be a symptom of endometrial cancer, which is why prompt assessment is important and an ultrasound is necessary.

Symptoms can vary but usually involve light spotting, heavier bleeding, or pink or brown discharge. Treatment depends on the underlying cause. For example, vaginal estrogen may be prescribed for atrophy, polyps may be removed, and hyperplasia may be treated with hormones or surgery. If cancer is diagnosed, treatment may include surgery, radiation, or other therapies. If you experience any bleeding after menopause, it’s important to see your healthcare provider for evaluation.

Ovarian cysts are solid or fluid-filled sacs that form on or inside the ovaries and are very common, especially in women of reproductive age. Most ovarian cysts are harmless, cause no symptoms, and often resolve on their own. However, some may lead to symptoms such as pelvic pain or pressure, bloating, irregular periods, pain during sex or bowel movements, or a feeling of fullness in the abdomen. In rare cases, a cyst may rupture or twist (a condition called ovarian torsion), which can cause sudden, severe abdominal pain and requires urgent medical attention.

Ovarian cysts can develop for various reasons, including normal ovulation (functional cysts), hormonal imbalances, endometriosis, polycystic ovary syndrome (PCOS), or, less commonly, benign or malignant growths.

Treatment depends on the type, size, and symptoms of the cyst. Often, no treatment is needed other than monitoring with ultrasound. Hormonal medications, such as the contraceptive pill, may be used to prevent new cysts from forming. If the cyst is large, painful, or appears abnormal, surgical removal {link} may be recommended. Most ovarian cysts are not cancerous, and many women will have them at some point without serious complications.

Polycystic ovary syndrome (PCOS) is the most common reproductive and endocrine disorder affecting reproductive aged women with one in every 6 to 7 women affected. It has classically been associated with irregular periods although it is possible to have a regular menstrual cycle with PCOS. At least two of the following features must be present before a diagnosis of PCOS can be made:

• Irregular (more than 35 days apart) or absent periods.
• Clinical signs of increased androgens such as hair growth in places like the face, chest and back, acne OR evidence of increased androgens on a blood test.
• Polycystic ovaries on ultrasound (more than 18 follicles per ovary or volume of the ovary more than 10 mL).

The clinical features of PCOS can be grouped into three areas:

• Reproductive – Irregular periods, poor fertility, excessive hair growth
• Metabolic – Insulin resistance and diabetes, obesity, and increased risks of heart disease
• Psychological – Increased risks of depression and anxiety, eating disorders and negative body image

The exact cause of PCOS remains unknown however it is known that women with PCOS express a genetic predisposition and lifestyle choices (diet and exercise) can worsen or improve their symptoms  Many women with PCOS are diagnosed during their early reproductive life and report feeling isolated, depressed and anxious.

Management options

For some women no immediate treatment is required. Our doctors will discuss how the results of any test results have provided a diagnosis of PCOS and any interventions that are required immediately or may be required in the future.

Management of PCOS is centred around:

• Lifestyle interventions (for example diet and exercise)
• Hormonal and non-hormonal medication to manage high levels of androgens and irregular periods
• Fertility treatments if needed.
• Pre-pregnancy assessments and maximising health prior to conception

Heavy menstrual bleeding (HMB), or menorrhagia, is when your periods are heavier or last longer than normal. It can affect your quality of life and may lead to symptoms like fatigue or iron deficiency.

Symptoms that suggest your period is heavier than normal include

• Soaking through a pad or tampon every 1–2 hours
• Needing to use double protection (e.g. pad and tampon together)
• Passing large blood clots more than a grape in size
• Periods lasting longer than 7 days
• Feeling tired, dizzy, or short of breath (due to low iron levels)

Heavy bleeding can be due to a number of reasons, including hormonal imbalance, irregular length of cycle, uterine fibroids, adenomyosis, bleeding disorders such as Von Willebrand disease, thyroid problems, and some medications.

Treatments are targeted at the underlying cause, severity, and your preferences, including whether you're trying to become pregnant. Medication therapies including Iron replacement, anti-inflammatories and Tranexamic acid to reduce bleeding, hormonal options like the contraceptive pill {link}, progesterone only tablets {link}, or Mirena {link}. Surgical options may include removal of fibroids {link to procedures}, endometrial ablation, and hysterectomy.

You should consider seeing a doctor if your bleeding causes anxiety of affects your daily activities, you need to change protection very frequently, or you feel weak or dizzy.

Nestled within your pelvis are important organs like your ovaries, fallopian tubes, uterus (womb), bowel and bladder.  Pelvic pain can affect any or a combination of these organs due to a number of common and not so common conditions. Pelvic pain symptoms can also vary greatly from one person to another but may include:

• Sudden sharp, stabbing pain
• Slow but steady pain
• Heavy ache or feeling of pressure
• Painful pelvic cramps
• Twisted or knotted feeling
• Pain felt during sex or exercise.

Getting the right diagnosis and comprehensive, evidence-based care can help to reduce pelvic pain and improve your quality of life.

Assessment of Pelvic Pain

The cause of your pelvic pain may relate to your bowel, bladder, reproductive organs or muscles, a comprehensive medical assessment is important to identify the underlying cause of your pelvic pain and the best approach to treatment.

What is endometriosis?

Endometriosis is a common cause of pelvic pain and fertility difficulties, affecting about 1 in 7 females and those assigned female at birth. Each month, the endometrium (lining of the womb) thickens to prepare for a pregnancy. If you don’t get pregnant, this tissue is shed, forming your period. If you have endometriosis, tissue similar to that which lines your womb forms elsewhere in your pelvis. It thickens each month too but there is nowhere for the blood to go.

That causes pain.

Signs of Endometriosis

Severe period pain may be the first symptom of endometriosis. You may be experiencing a significant period paid if you need:

• Strong painkillers during your period
• Time off work or school each month.

Endometriosis pain varies from woman to woman but can include pain:

• During your period
• When peeing or pooing
• During sex
• Between periods
• Bloating
• Fatigue

Endometriosis is also linked to [increased rates of depression, anxiety and fatigue](https://www.ox.ac.uk/news/2023-03-14-global-study-shows-experience-endometriosis-rooted-genetics#:~:text=Treatment is limited to repeated,women but not in others.).

Endometriosis diagnosis

Diagnosing endometriosis is a little like completing a jigsaw puzzle. Currently, the definitive diagnosis is looking at it under microscopy after being removed at surgery. But surgery is not always the best or most appropriate choice. Suspicion of the disease remains key and your story matters the most in establishing a diagnosis. Together with family history, clinical examination, and specialist gynaecological ultrasound {link to DIE page} a diagnosis may be made without surgery. Dr Budden will discuss whether diagnosis by laparoscopy is recommended in your case or not. It depends on factors like your clinical symptoms and whether you plan to become pregnant soon.

Endometriosis treatment

Dr Budden has spoken at countless events with a consistent message. There are many ways to approach management of endometriosis and it requires lots of different health professionals all working to find the best options for you. This may include some or all of:

• Medication
• Surgery
• Physiotherapy
• Psychology
• Natural therapies
• Nutrition

Treatment Outcomes

Whichever treatment (or combination of treatments) you have, the goal is to reduce symptoms and improve your daily life. Most treatments can lessen pain but not get rid of it completely.

How can the team at Saige help?

Finding someone who understands endometriosis and pelvic pain is not always easy. Indeed, many women have lived with endometriosis symptoms for 6-8 years before it is finally diagnosed. From our GPs, specialists, sonographers, physiotherapist, to reception staff there is extensive personal and professional experience in assessing and managing pelvic pain.