Endometriosis

Tissue similar to the lining of the womb grows outside it, usually in the pelvis. It can cause painful periods, ongoing pelvic pain, pain with sex or bowel motions, tiredness and trouble getting pregnant. It can start in the teenage years. Period pain that stops you doing normal things is not normal.

Diagnosis has changed. A specialised internal ultrasound, or MRI, can now diagnose many cases without surgery, and treatment can start while tests are underway. A normal scan doesn’t rule it out.

Treatment options

Ratings show how strong the research is.

• Strong evidenceHormonal treatmentThe main medicine option: the combined pill (often taken continuously to skip periods), progestogen tablets such as dienogest, a hormonal IUD or the implant. Reduces pain while used, and your GP can start it.
• Strong evidenceSpecialist hormone medicinesFor severe pain: GnRH medicines (injections, or newer tablets combined with add-back hormones), via a gynaecologist.
• Moderate evidenceAnti-inflammatoriesSuch as ibuprofen or naproxen, started a day before or at the first sign of a period. Check with your pharmacist.
• Moderate evidenceKeyhole surgeryRemoving endometriosis can reduce pain and may help fertility. Symptoms return in some people, so hormones are often continued afterwards.
• Limited evidencePelvic physio and psychologyA pelvic floor physiotherapist and psychological support can help ongoing pain and painful sex.
• Limited evidenceDiet changes and supplementsLimited evidence. A food diary may help if you have bowel symptoms.
• Not recommendedHysterectomy as a first stepDoesn’t always relieve pain and ends fertility. Only considered after other options.

What you can do

• Keep a pain and period diary to bring to appointments.
• Heat packs and regular gentle exercise can ease pain.
• Tell your GP if you’re planning a pregnancy, as treatment choices differ.

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 are 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.

Evidence and more information

• Healthdirect: Endometriosis
• Jean Hailes: Endometriosis
• RANZCOG: Australian Living Evidence Guideline (2025)

Reviewed October 2026. General education, not personal medical advice. Treatment depends on your situation, so talk to your GP or pharmacist.

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