Endometriosis: diagnosis and treatment
Endometriosis is in the public awareness, and mainstream media, more than ever before. The 2026 Four Corners production 'Scarred', reported by Louise Milligan and produced by Mary Fallon, has ultimately helped shine a spotlight on this common and often debilitating disease.
Although the production presents a harrowing account of mistreatment and breach of trust of many women, it has potentially helped provide Australian women with a guide as to the quality of care they should expect, if not demand, from their gynaecological care providers. A level of compassionate, evidence-based, multidisciplinary care that should be the minimum standard, not the rare exception, for women who experience pelvic pain.
How is endometriosis diagnosed?
Endometriosis is a complex, multi-system inflammatory disorder. Diagnosis, therefore, involves a combination of symptom assessment, history-taking, physical examination, and detailed imaging.
Historically, laparoscopic surgery was the only way to achieve a diagnosis of endometriosis. Thankfully, updated Australian RANZCOG guidelines are now focusing on combining symptoms, examination, and imaging to guide the diagnosis and management of endometriosis.
This means that women can often begin treatment without requiring immediate surgery.
The pattern of your pain can provide important clues as to the cause—such as pain linked to the cycle, pain during sex, or pain with bowel or bladder function. It is worthwhile keeping a pain/symptom diary to share with your doctor.
Ultrasound and MRI
Specialised pelvic ultrasound is now considered a first-line investigation in many cases, particularly when performed by specialist sonographers.
At Belle Women's Health, this can be arranged as part of your ongoing care, with imaging performed in-house by our experienced gynaecological sonographer Tammy. This allows your symptoms, assessment, and imaging to be considered together.
MRI may be recommended in certain situations, for example when deep infiltrating endometriosis is suspected or if further detail is required to guide your treatment plan.
However, imaging does not detect all types of endometriosis, particularly superficial/peritoneal disease. A normal ultrasound or MRI does not necessarily mean there is no endometriosis present—it simply means no obvious disease was seen.
What does treatment involve?
There is no single treatment that works for every woman. Endometriosis management should be individualised, based on your symptoms, preferences, and goals (e.g. fertility or pain management).
Treatment of endometriosis, or pelvic pain, falls into three main areas:
1. Medical management
Medications are usually the first step in management. These may include:
- Hormonal treatments (e.g. 'the pill' or hormonal IUD) to suppress menstruation and/or ovulation and reduce symptoms
- Anti-inflammatories to help manage discomfort
- Medications to calm the nervous system and inhibit pain pathways
Hormonal treatments can be effective for many women; they can control symptoms and can also suppress progression and recurrence of endometriosis.
Non-medication options include the use of TENS, pelvic floor stretches, heat packs, and supplements.
2. Surgical options
Laparoscopic surgery may be considered where symptoms are persistent, severe, or not responding to medical management. Some women may choose this option if they do not want or cannot tolerate hormonal management.
A laparoscopy can confirm the diagnosis and also treat/excise endometriosis at the same time.
For some women, surgery may play a role in improved fertility, reduced pain, or simply by validating their pain with a diagnosis.
Whilst many women may have improvement in their pain with laparoscopy and excision of endometriosis lesions, there are some women for whom surgery does not improve pain. This is why it is key to treat the 'whole patient' and the 'whole problem'—with the aim of improving pain and function with multiple treatment modalities. Never surgery alone, and ideally never surgery as first-line management.
It is also important to acknowledge that a normal laparoscopy can be difficult for some women to process and in no way does it mean their severe pelvic pain is not real. There are multiple causes of persistent pelvic pain, and endometriosis is only one of them.
3. Multidisciplinary care
Endometriosis is not just about the pelvis and lesions—it requires a broad and supportive management approach. This should be tailored to individualised symptom management.
Management should include some, or all, of the following:
- Pelvic floor physiotherapy – with a pain-informed, specialised pelvic floor physio
- Pain management strategies – e.g. CBT, breath work, yoga, or pain specialist input
- Support for mental health and wellbeing
- Lifestyle and nutritional support
The evidence supports a coordinated, multidisciplinary approach. This approach can make a meaningful difference to pain and function.
A level of compassionate, evidence-based, multidisciplinary care that should be the minimum standard, not the rare exception.
Why early assessment matters
Endometriosis can take years to diagnose, and many women experience delays along the way. Endometriosis is a progressive disease, and late diagnosis can, in some cases, lead to more advanced disease.
Seeking care early can help reduce the impact of symptoms, improve quality of life, and sometimes reduce the potential impact on fertility.
Taking the next step
If you are experiencing symptoms that may indicate endometriosis, including pelvic pain, the best initial step is a conversation with your GP. Your GP may initiate treatment or further investigation. At some point in your treatment journey, they may refer you to a Gynaecologist experienced in the management of pelvic pain and endometriosis.
Personalised endometriosis care in Brisbane
At Belle Women's Health, Spring Hill, Brisbane, Dr Rebecca Ryder supports women through the investigation and management of endometriosis, with a focus on thoughtful, personalised care and clear guidance at each stage.
Book an appointmentNB: This is general information only and is not a replacement for individualised medical advice.