Endometriosis Treatment Options: From Diagnosis to Care
Updated: Nov 3
In Australia, about 1 in 7 women and people assigned female at birth are diagnosed with endometriosis.
A long-term condition occurs when tissue similar to the lining of the uterus grows outside the uterus. It often grows in the pelvis. It can cause inflammation, scar tissue, and symptoms such as pelvic pain, period pain, heavy periods, pain during sex, bowel and bladder problems, and trouble getting pregnant. It can also affect mental health and quality of life. At the moment, there is no cure for endometriosis. But many treatments backed by research can help manage symptoms. The best plan is often a mix of care made for the person's needs and pain history. This article covers the main options used in Australian and international guidelines and research.
Pain relief medication
Guidelines suggest a short trial of pain medicines, anti-inflammatory drugs, or both as a first step for endometriosis pain. If these do not ease symptoms enough, you should consider other pain care and a specialist review. For nerve pain, medicine that works on the nervous system may also help as part of a wider plan.
Hormone therapy
Hormone therapy is a key part of endometriosis care.
It works by lowering or stopping the hormone shifts that help endometriosis tissue grow. That can ease pain and slow the disease.
It does not permanently change future fertility, and it can be started before surgery confirms the diagnosis.
Options include:
the combined oral contraceptive pill
progestogen-only medicine, such as tablets, injections, or the hormonal IUD
GnRH antagonists
Australian guidelines include these for people who have not improved with other treatment.
Surgery
Doctors consider surgery, including laparoscopic endometriosis surgery, when symptoms do not improve enough with other treatments.
It may also be used when a diagnosis needs to be confirmed or when problems such as cysts need treatment.
Laparoscopic surgery can remove or burn endometriosis lesions and scar tissue. Evidence shows it can reduce pain and, in some cases, improve fertility.
A laparoscopic hysterectomy is usually not the first choice for endometriosis, but it may be discussed if there are other uterine problems.
Some people use the term endometriose stage 4 to mean severe disease, but the best plan still depends on symptoms, scans, and goals.
Pelvic floor physio
Pelvic floor physio plays an important part in endometriosis pain.
A 2025 review found that physio helped ease endometriosis-linked pelvic pain more than non-physio care.
Treatment from a pelvic floor physio may include:
pain science education to show how the nervous system affects pelvic pain and how to calm it
bladder and bowel advice for symptoms such as urgency, frequency, and painful bowel movements
ways to manage flare-ups and get back to activity
checking the pelvic floor muscles and manual therapy
pelvic floor exercises
breathing and calm-down strategies to lower pelvic floor tension, muscle spasm, and sensitivity
exercise plans made for the person
Pelvic floor physio can also help before and after surgery for endometriosis.
Pain science education
Learning how pain works is a key part of endometriosis care.
Pain science education means learning about pain biology. It explains why pain can last, why pain level does not always match how much disease is there, and how the nervous system, stress, sleep, and mood all affect pain.
Research shows these are important ideas for people with ongoing pelvic pain, including endometriosis.
Pain science education can be provided by pelvic floor physios, pain specialists, psychologists, and GPs who work with chronic pain.
In a pelvic health physio setting, it is often part of treatment sessions along with other care. This can help people feel less afraid of movement and pain, and more involved in recovery.
For some people, understanding the science behind their pain can be empowering in daily life.
Psychological support
Endometriosis can affect mental health, relationships, and overall wellbeing.
Counselling, CBT, and sex therapy are evidence-based parts of care.
Guidelines recommend checking emotional and sexual health needs and building them into a plan made for the person.
Complementary approaches
Some people find complementary therapies helpful with medical treatment.
Evidence is still growing, but some research looks at supplements such as N-acetylcysteine for their possible role in easing pain and inflammation.
Talk with your healthcare team before starting any complementary therapy.
Getting the right treatment for you
Endometriosis is best managed by a team.
That team may include specialist doctors, pelvic floor physios, pain specialists, psychologists, and other health professionals working together around the person's needs and goals.
No single treatment works for everyone, and the plan may change over time.
If you need an endometriosis care plan or feel your current treatment is not helping enough, speak with your GP, pelvic floor physio, or specialist about reviewing your plan.
References
Endometriosis Australia. What is endometriosis? https://endometriosisaustralia.org/what-is-endometriosis/
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Australian Living Evidence Guideline: Endometriosis. 2025. https://ranzcog.edu.au/womens-health/endometriosis/
National Institute for Health and Care Excellence (NICE). Endometriosis: diagnosis and management. NICE Guideline NG73. Updated November 2024. https://www.nice.org.uk/guidance/ng73
PETAL Collaboration. Pain Education Team to Advance Learning. https://www.petalcollaboration.org/
Chalmers KJ, et al. Pain science education concepts for pelvic pain: an e-Delphi of expert clinicians. Frontiers in Pain Research. 2025. https://doi.org/10.3389/fpain.2025.1498996
Can MA, et al. Physiotherapy for endometriosis-associated pelvic pain: a systematic review and meta-evaluation. Pain Medicine. 2025. https://academic.oup.com/painmedicine/advance-article/doi/10.1093/pm/pnaf083/8211830
Healing Pelvic Pain by Peta Wright. 2023. Purchase here: Healing Pelvic Pain by Peta Wright
Q&A
Question: Is there a cure for endometriosis?
Short answer: No, there is no cure yet. But symptoms can often be managed with care backed by research. The best plan is usually a mix of options matched to the person.
Question: Can hormone therapy affect future fertility?
Short answer: No, not in a lasting way. According to the article, hormone therapy can ease pain, slow disease growth, and can be started before surgery confirms the diagnosis.
Question: When might surgery be considered for endometriosis?
Short answer: Surgery may be considered when symptoms have not improved enough with other treatment, when a diagnosis needs to be confirmed, or when problems such as cysts need care. Laparoscopic surgery can remove or burn endometriosis lesions and scar tissue, and it can often reduce pain.
Question: How can pelvic floor physio help with endometriosis-related pain?
Short answer: Pelvic floor physio can help with pelvic floor tension, pain sensitivity, bladder and bowel symptoms, flare-up management, and return to activity. A 2025 review found physio was more effective than non-physio care for easing endometriosis-linked pelvic pain.
Question: Why is a team approach recommended for endometriosis management?
Short answer: Endometriosis can affect pain, fertility, bladder and bowel function, mental health, relationships, and quality of life. A team approach brings different health professionals together so the care plan can match the person's needs and goals.
