Endometriosis

On average it takes years, often six or seven, between the first symptoms of endometriosis and a diagnosis. Years of being told period pain is normal, of quietly building life around a calendar, of wondering whether you're imagining it.

You're not imagining it. Endometriosis is a common inflammatory condition affecting roughly one in seven women and people assigned female at birth in Australia.

There is no cure. There is a great deal that can be done, and we would like to start.

More than a bad period

Endometriosis occurs when tissue similar to the lining of the uterus grows outside it: on the ovaries, the ligaments that hold the uterus, the bowel or bladder surfaces, the lining of the pelvis. That tissue responds to hormonal signals, becomes inflamed, and over time can form scarring and adhesions that stick organs together.

The pain is real, and it is often not confined to your period. People describe:

• Period pain that isn't controlled by simple pain relief
• Pain with sex, often deep, and sometimes lasting hours afterwards
• Bowel symptoms: pain opening the bowels, bloating, constipation or diarrhoea that follows the cycle
• Bladder symptoms, including pain or urgency that worsens around the period
• Pain that turns up elsewhere on a cycle, in the lower back, hips or legs
• Fatigue that doesn't lift with rest
• Difficulty conceiving

None of this makes you dramatic, or unlucky, or bad at coping. It makes you someone with an under-recognised medical condition that deserves proper attention.

How it's investigated

We start with your history, in detail, because it is still the strongest signal we have. Where you feel it, when, what makes it worse, what you've already tried, what it has cost you.

From there, investigation may include a specialist gynaecological pelvic ultrasound performed by someone experienced in looking for endometriosis, and MRI where deeper disease is suspected. Imaging is useful, but it has limits: a normal scan does not rule endometriosis out. Laparoscopy remains the only way to see and confirm disease definitively, and to treat it in the same operation, which is exactly why we don't rush to it, and why we don't withhold it when it's warranted.

What management looks like

Endometriosis is a long condition, and one treatment rarely does the whole job. Most people do best with a combination that changes over time.

Hormonal management aims to quieten the cycle and reduce inflammation, and there are several categories to choose between. Surgical management means excision, removing disease rather than simply burning the surface, which can meaningfully reduce pain for many people, though symptoms can return.

Alongside that, pelvic floor physiotherapy addresses the muscle guarding that builds up over years of pain. Pain science helps explain why a nervous system that has been on alert for a decade keeps sounding the alarm, and what can be done about it. Psychology has a place too, not because the pain is in your head, but because living with chronic pain is genuinely hard and support helps. Laura Scott and Catherine Corcoran both work with people managing endometriosis.

Endometriosis and fertility

Many people with endometriosis conceive without help. Some don't, and the relationship between the two is not simple: the severity of pain doesn't predict the effect on fertility.

If you are trying, or thinking about trying, tell us early. It shapes the timing of surgery, the choice of hormonal treatment, and whether fertility investigation should happen alongside pain management rather than after it. Dr Joseph Sgroi and Dr Marcus Davenport can hold both conversations at once, which spares you having to start again with someone new.