Endometriosis
Tissue like the womb lining grows outside it, causing painful periods, pelvic pain, painful sex and fertility trouble. Period pain that stops you living is not normal. There are good options.
Diagnosis has changed. A specialised internal ultrasound or MRI can diagnose many cases without surgery, and treatment can start while tests are underway. A normal scan doesn’t rule it out.
The endometriosis ladder
Your GP can start the first few steps. Give each hormone option about 3 months before judging it.
- Step 1 · Self-careHeat, gentle movement and a pain diaryHeat packs, walking or stretching, and tracking pain against your cycle.
- Works
- Evidence weak but low risk: heat and exercise ease period pain in small trials; not tested well in endometriosis
- Cost
- About $10–30 for a heat pack
- How long
- Use on bad days; keep the diary for 2–3 cycles
- Watch for
- Burns from very hot packs: don’t sleep on them.
A pain diary is the best evidence you can bring to an appointment.
- Step 2 · PharmacyAnti-inflammatories (ibuprofen, naproxen)Taken regularly from the day before or the start of your period.
- Works
- For period pain, about 1 in 2 get good relief vs 1 in 5 on a dummy treatment; little endometriosis-specific evidence
- Cost
- About $5–15 a pack
- How long
- 2–3 days each cycle
- Watch for
- Reflux and stomach upset. Avoid with stomach ulcers, kidney problems or some types of asthma.
Take them on time and regularly, not as a last resort at 3 am.
- Step 3 · PrescriptionHormonal contraception: pill (often continuous), hormonal IUD or implantQuiets the cycle that feeds the pain.
- Works
- Period pain down about 2 points out of 10 vs a dummy treatment in small, low-quality trials; first-line in guidelines
- Cost
- PBS pills about $10–25 a script; newer private pills about $20–40 a month. Hormonal IUD: $25 on the PBS plus an insertion fee.
- How long
- 3 months to judge; can be used long term
- Watch for
- Spotting, nausea, mood changes. Combined pill: small clot risk; not with migraine with aura or smoking over 35.
Skipping periods on purpose is safe, and often the whole point.
- Step 4 · PrescriptionDienogest (progestogen tablet)A daily tablet made for endometriosis.
- Works
- Pain down about 27 vs 15 points out of 100 on a dummy treatment at 3 months; as good as stronger hormone medicines
- Cost
- $25 a month on the PBS ($7.70 concession)
- How long
- 3–6 months to judge; long term
- Watch for
- Irregular bleeding or spotting (often settles), headache, breast tenderness, low mood. It isn’t a contraceptive: use condoms if you need contraception.
Early spotting is the price of admission for many. It usually settles.
- Step 5 · Allied healthPelvic physio and psychologyHelp with pelvic floor tension, painful sex and living with ongoing pain.
- Works
- Small trials, mostly positive; evidence is growing and risk is low
- Cost
- Physio about $100–150 a session; psychology about $200–260. Medicare rebates with a GP plan.
- How long
- Several sessions over 2–3 months
- Watch for
- Look for a physio experienced in pelvic pain.
Pain changes the nervous system. Treating that is real treatment, not “it’s in your head”.
- Step 6 · SpecialistRelugolix combination tabletA daily tablet that switches off ovarian hormones, with added hormone to protect bones.
- Works
- About 3 in 4 had much less period pain, versus about 3 in 10 on a dummy treatment
- Cost
- $25 a month on the PBS ($7.70 concession) for eligible people, started by a specialist
- How long
- Long term, with bone checks
- Watch for
- Hot flushes, headache, irregular bleeding, bone thinning. Works as contraception only after the first month (use condoms until then); don’t take with the pill. Not in pregnancy.
Slow, steady and needs supervision. Worth it for the right person.
- Step 7 · ProcedureKeyhole surgery (laparoscopy)Finds and removes endometriosis; may help fertility.
- Works
- Many improve, but trials are too small to be sure it beats a look-only operation; pain returns in up to half within 5 years
- Cost
- Free as a public patient (waits vary); privately, median about $700 out of pocket
- How long
- Home in 1–2 days, 1–2 weeks to recover
- Watch for
- Surgical risks such as bleeding, infection or bowel or bladder injury (rare). Hormones are often continued afterwards.
Surgery isn’t a finish line. It works best as part of a plan.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- CA-125 blood testNot reliable for diagnosing endometriosis: often normal in people who have it and raised in plenty who don’t. Guidelines say don’t use it to diagnose.
- The ‘endo diet’No particular diet is proven to treat endometriosis; the studies are small and low quality. Eat well, but a cookbook isn’t a treatment plan.
- Supplements (vitamin D, turmeric, fish oil)Small studies, mixed results, no good proof they ease pain. Mostly expensive wee.
- AcupunctureSome small trials show a little less pain, but they’re low quality. May help a bit alongside treatment, not instead of it.
What you can do
- Keep a pain and period diary to bring to appointments.
- Heat packs and regular gentle exercise on the bad days.
- Tell your GP if you’re planning a pregnancy, as treatment choices change.
- Hysterectomy is not a first step: it doesn’t always fix pain and ends fertility.
See your GP if
- Period pain stops you going to work, school or activities
- Pain isn’t controlled by anti-inflammatories or the pill
- Pain with sex, bowel motions or passing urine around your period
- No pregnancy after 12 months of trying (6 months if you’re 35 or over)
Go to the emergency department for sudden severe pelvic pain, pain with fainting or fever, or pain with a positive pregnancy test.
Common questions
What are the symptoms of endometriosis?
Painful periods, ongoing pelvic pain, pain with sex or bowel motions, tiredness and trouble getting pregnant. Period pain that stops you doing normal things is not normal.
Do you need surgery to diagnose endometriosis?
Not always. A specialised internal ultrasound or MRI can diagnose many cases, and treatment can start while tests are underway. A normal scan doesn’t rule it out.
What is the treatment for endometriosis?
Anti-inflammatories and hormonal treatment come first: the pill taken continuously, a hormonal IUD, the implant or dienogest. Pelvic physio and psychology help ongoing pain. Specialist tablets and keyhole surgery are options if these aren’t enough.
Can endometriosis affect fertility?
It can make getting pregnant harder, and surgery may help fertility. See your GP if you’re not pregnant after 12 months of trying, or 6 months if you are 35 or over.
How common is endometriosis?
About 1 in 7 Australian women and people assigned female at birth have been diagnosed by their mid to late 40s. Many wait years for a diagnosis, often around 6 to 7 years from first symptoms.
Can endometriosis be cured?
There’s no cure yet, but it can be managed well. Hormone treatments reduce pain for many people, and surgery to remove endometriosis can ease pain, although symptoms come back for some people within a few years.
Is endometriosis genetic?
It tends to run in families. Having a mother or sister with endometriosis raises your chance of having it several times over, so mention family history to your doctor if you have painful periods.
Helpful resources
- Endometriosis AustraliaNational charity: education, peer support groups, a podcast and help finding clinicians with endo experience. Free, Australia.
- QENDO appFree symptom and period tracker built for endometriosis, adenomyosis, pelvic pain and infertility. Makes reports to bring to appointments.
- Endometriosis UK supportHelplines, local and online support groups, and a forum. Free, UK.
Evidence and more information
- Healthdirect: Endometriosis
- Jean Hailes: Endometriosis
- RANZCOG: Australian Living Evidence Guideline (2025)
- PBS: Dienogest for endometriosis
- Medicine Today: Relugolix combination for endometriosis (2025)
- TGA product information: Dienogest (Visanne)
- newsGP: Relugolix combination and contraception
- Cochrane: NSAIDs for period pain (2015)
- Cochrane: Oral contraceptives for endometriosis pain (2018)
- Cochrane: Laparoscopic surgery for endometriosis (2020)
maladywise.com/endometriosis/