Endometriosis treatment and management: what are your options?

This page is a continuation of endometriosis symptoms and diagnosis. If you've recently been diagnosed — or you've been living with endometriosis for years — you're probably wondering what can actually be done. Treatment almost always works best when it's tailored and maintained over time.

Endometriosis is a chronic condition

One of the most important things to understand is that endometriosis behaves like a chronic disease — not a problem that's "fixed" by a single intervention. Without ongoing management, pain and disease recur at approximately 10% per year after surgery and recurrence rates of 40–50% have been reported at five years without post-operative treatment. This is why treatment plans need to be maintained, not just initiated. Both the 2025 RANZCOG Australian Living Evidence Guideline and the 2022 ESHRE international guideline recommend that treatment be individualised and revisited over time.

Hormonal treatments

Hormonal therapies reduce the oestrogen stimulation that drives endometriosis. They don't cure the disease but for many women they provide excellent, sustained symptom relief.

The combined oral contraceptive pill (COCP) is one of the most common first-line options. Continuous use (no pill-free or "sugar pill" week) is generally preferred for severe period pain, as it removes the withdrawal bleed that often triggers the worst symptoms.

Progestogens work by causing endometriosis tissue to thin and become inactive. Options include:

• The Mirena IUD — a long-acting device providing localised hormonal effect; evidence shows it performs as well as dienogest for quality-of-life improvement in deep endometriosis
• Dienogest (Visanne) — a daily tablet specifically licensed for endometriosis, with good evidence for reducing pain and preventing recurrence
• Slinda (drospirenone-only pill) and norethisterone — further options depending on individual circumstances

GnRH agonists and antagonists are second-line treatments that temporarily switch off ovarian hormone production. GnRH agonists (such as Zoladex) are well-established injectable options, used with add-back hormonal therapy to protect bone density. Newer oral GnRH antagonists — including relugolix combination therapy (Ryeqo) — offer rapid onset, no initial hormonal flare and good long-term tolerability. The SPIRIT trials (Lancet 2022) found 75% of women on relugolix combination therapy had a meaningful reduction in period pain at 24 weeks.

Surgical treatment

Surgery is appropriate when medical treatment has failed, when deep infiltrating endometriosis is suspected on imaging, when an ovarian endometrioma requires intervention or when fertility is a concern.

Laparoscopic excision vs ablation

When surgery is performed, the technique matters. A 2024 Cochrane systematic review (nine trials, 578 women) found that excision — removing the endometriosis ("cutting it out") — was substantially more effective than ablation (burning the surface):

• Pain recurrence: 49% with ablation vs 10–34% with excision
• Reoperation rates: 32% vs 3–16%

Excision is the preferred technique where technically feasible.

Endometrioma surgery and ovarian reserve

Surgery on ovarian endometriomas (cysts) can reduce ovarian reserve. A 2025 meta-analysis confirmed a significant decline in AMH (a marker of egg supply) after cystectomy (removal of an ovarian cyst or endometrioma). This doesn't mean surgery should be avoided — but for women with fertility goals, this conversation needs to happen before any decision is made. For women planning IVF, routine surgery for small asymptomatic endometriomas isn't recommended, as it may reduce ovarian reserve without improving IVF outcomes. In some cases we might discuss egg freezing before proceeding with surgery. You can read more about ovarian cysts.

The multidisciplinary team

Hormones and surgery alone are often not enough — particularly for women with long-standing pain, gut symptoms or significant psychological burden. Current Australian (RANZCOG 2025) and international (ESHRE 2022) guidelines now specifically recommend multidisciplinary care as part of standard endometriosis management.

Pelvic floor physiotherapy

Chronic pelvic pain frequently leads to secondary pelvic floor dysfunction — muscle guarding, altered movement patterns and nerve sensitisation that persist even when endometriosis is treated. A 2025 systematic review of 17 trials found significant improvements in both pain and quality of life with physical rehabilitation and a 2025 RCT found supervised pelvic floor training reduced pelvic pain at four months, sustained at 12 months.

Pain psychology

Endometriosis is associated with central sensitisation, where the pain-processing system becomes amplified over time. A 2024 meta-analysis found that pain catastrophising and a sense of low control significantly worsened outcomes — and both are modifiable with therapy. Cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) have the strongest evidence for chronic pelvic pain.

Dietitian support

Many women with endometriosis experience gut symptoms that overlap with irritable bowel syndrome (IBS) — bloating, altered bowel habits and abdominal pain. A 2025 prospective cohort study found a low-FODMAP diet significantly improved pelvic pain scores and quality of life, with 65% reporting reduced pain. A Mediterranean-style diet is also supported for its anti-inflammatory effect. These three disciplines work best when involved from the start — not as a last resort.

Fertility and endometriosis

Endometriosis affects fertility in some women, but it is not a diagnosis of infertility. Many women conceive naturally, and outcomes can often be improved with the right management. If having children is a priority, this should be discussed explicitly at your first consultation — it shapes every aspect of the treatment plan.

A note on shared decision-making

There's no universal protocol for endometriosis. Your symptoms, your fertility goals, your tolerance for side effects and your values all matter. The role of your specialist is to explain the evidence clearly and help you make decisions you feel confident in — not to hand you a prescription and send you on your way. If you feel your pain has been dismissed or your concerns overlooked, it's worth seeking a specialist assessment. An eight-year average diagnostic delay in Australia is too long and every woman deserves a clear management plan.

Endometriosis treatment on Sydney's North Shore

Dr David Krones is an advanced laparoscopic surgeon consulting from North Shore Private Hospital, Level 3, Suite 3A/3 Westbourne St, St Leonards, and operating at North Shore Private and The Mater Hospital — within easy reach of Crows Nest, Chatswood, Lane Cove, Willoughby, North Sydney, the wider North Shore and Northern Beaches. A referral from your GP is the first step to discussing your endometriosis and exploring your treatment options. It may also help to understand how endometriosis differs from related conditions — see adenomyosis vs endometriosis.

Frequently asked questions

More questions? See our gynaecology FAQ.

Written by Dr David Krones, FRANZCOG · Last updated 1 July 2026. This article is general educational information only and does not replace individual medical advice. It does not establish a doctor–patient relationship.