Endometriosis treatment: What are your options?

Updated August 2023 | 6 min read
Expert contributors Professor Luk Rombauts, Head of Reproductive Medicine at Monash Health, Southern Health; Dr Erin Nesbitt-Hawes, obstetrician, gynaecologist and laparoscopic surgeon; Elisabeth Gasparini, Head of Nutrition and Dietetics at Melbourne’s Royal Women’s Hospital; Alexandra Diggles, physiotherapist; Ruth Schubert, physiotherapist; Tracey Gaibisso, naturopath
Words by Carolyn Tate

Finding the right endometriosis treatment and reducing the often-painful symptoms is a journey, say these experts.

Endometriosis is a condition that affects one in nine Aussie women and girls. While there's no cure, there are several endometriosis treatments available that can help improve quality of life for those living with it.

The main goals of any endometriosis treatment are to help alleviate the symptoms and chronic pain associated with the condition, and to improve fertility.

Many women choose to use more than one type of treatment at a time, but it’s important to discuss an endometriosis treatment plan that suits individual needs with a doctor before starting any medication.

Symptoms of endometriosis

Fertility expert, Professor Luk Rombauts, recommends that women rank their symptoms for their doctor – from most problematic to least – to inform decision-making.

“That will help the specialist determine what the priorities are, and the treatments that best fit the management of the condition,” he says. “The therapeutic approach for fertility issues will be different than for pain, and these priorities, and the treatments, may change over time.”

The symptoms of endometriosis vary and can range from mild to moderate to severe. While pelvic pain, particularly during your period, is the most common symptom of endometriosis, the severity of the pain does not indicate the degree or stage of endometriosis. You could have a severe form of endometriosis, but only experience mild symptoms, or no symptoms at all. Or you could have a mild form of endometriosis but experience severe pain that impacts your quality of life.

Endometriosis symptoms include:

• painful, heavy periods
• bleeding between periods
• pelvic and/or lower back pain
• discomfort with bowel movements
• pain during sex
• fertility issues.

Diagnosing endometriosis

Endometriosis can only be diagnosed definitively via surgery when doctors see the endometrial-like tissue growing outside of the uterus. This is done by laparoscopic surgery, under general anaesthetic, where a camera and light are inserted via a narrow tube through an incision near your navel.

If endometriosis is detected, it may be removed during surgery, sometimes offering immediate relief. However, surgery and removal of tissue is not a cure, and endometrial-like tissue can continue to grow, and may require further treatment.

Medical treatments for mild endometriosis

Mild endometriosis pain can be treated with over-the-counter pain relief medications, like paracetamol or non-steroidal anti-inflammatories. This may be enough for some women to live more comfortably with their condition.

A doctor may also prescribe a hormonal treatment – like the combined oral contraceptive pill, or a progesterone treatment like the Mirena IUD. Contraceptives can help by suppressing menstrual periods, which may slow endometriosis growth.

Reducing the menstrual cycle as an endometriosis treatment option isn’t ideal for everyone, says Prof Rombauts.

“A significant proportion of women will not tolerate the hormonal side effects which vary from treatment to treatment,” he says. “The contraceptive pill and progestogens can be associated, for example, with abnormal bleeding patterns, mood swings and some weight gain.”

Surgical treatments for endometriosis

Surgery for endometriosis can be used to treat both endometriosis pain and infertility that’s sometimes associated with the condition.

Laparoscopic surgery has been shown to improve pregnancy rates in those with mild endometriosis. A small clinical trial study evaluated the effect of laparoscopic surgery on pregnancy in infertile women with minimal or mild endometriosis. After nine months, almost half of the women in the trial had become pregnant.

In some cases of endometriosis with high levels of pain, if symptoms aren’t relieved by medical treatment or laparoscopic surgery, a doctor may recommend a hysterectomy.

During a hysterectomy, the uterus is removed. This causes a surgical menopause and some women may need to take menopausal hormone therapy. This is rare and usually a last resort, only suitable if you don't want to get pregnant and where your quality of life is being severely affected.

Less common still is bowel surgery. This may be recommended if the endometriosis is affecting the walls of the bowel and is causing significant symptoms. In this instance, a specialist may want to remove a piece of the bowel.

Physiotherapy to treat endometriosis

Physiotherapy may ease endometriosis symptoms and improve your ability to move and function. It’s often recommended as part of best practice according to the international guidelines for endometriosis, says Alexandra Diggles, a women’s health physiotherapist.

“Physiotherapists work to alleviate pain conditions caused by poor biomechanics, neural irritation or altered muscle patterns,” she says.

Women’s health physiotherapist Ruth Schubert agrees. “A pelvic physiotherapist can be an important member of an endometriosis management team … [and] can help manage the symptoms of painful intercourse, bladder and bowel pain, period pain, constipation, deconditioning and fatigue.

“A key focus of treatment will be learning to relax the pelvic floor, which is commonly overactive in endometriosis. A physio can also help implement exercise programs for pain management and for improving physical conditioning.”

The link between endometriosis and nutrition

Although there’s currently no firm scientific link between diet and endometriosis, it helps to eat well, says nutritionist Tracey Gaibisso.

“Further research is needed in order to fully understand the full influence of diet on the risk of developing endometriosis,” she says. “But current guidelines suggest women may benefit from reducing processed foods, reducing trans fats, increasing consumption of fruit (especially citrus) and vegetables, reducing red meat intake, and increasing fish and seafood.”

One Australian study found that women with endometriosis are frequently diagnosed with irritable bowel syndrome – often before their endometriosis is discovered.

“Maintaining a healthy diet is always important and especially so for anyone dealing with a chronic, debilitating condition,” says Elisabeth Gasparini, Head of Nutrition and Dietetics at Melbourne’s Royal Women’s Hospital. “There’s also no harm in being proactive and attempting dietary changes that may be beneficial.”

Choosing not to treat endometriosis

There’s no rule that says a person living with endometriosis must treat the condition. Some women may decide they can live comfortably with their symptoms, or that the possible risks or side effects of medical treatment such as surgery are too great.

As much as endometriosis is experienced uniquely by every individual, so too will the condition progress uniquely.

“For some women, lesions will grow in size over time and may cause distortion of the anatomy of the uterus, tubes and ovaries as these organs stick to each other,” says obstetrician gynaecologist Dr Erin Nesbitt-Hawes.

Many women’s symptoms will improve after menopause, but that doesn’t mean they’re guaranteed to go away.

“The choice of what endometriosis treatment is best should ultimately be the patient’s, in consultation with her specialist,” says Prof Rombauts.

Talk with your doctor to decide what’s best for you and don’t be afraid to reassess as your life or symptoms change.

Looking for a convenient online GP service?

If you’re finding it difficult to manage the symptoms of endometriosis or want to discuss treatment options, our partnership with GP2U, an online video GP service, makes it easier for you to access telehealth services. All HCF members with health cover can access a standard GP consultation (up to 10 minutes) for a fee of $50.