Endometriosis Treatment and Management: What Are Your Options?
This article is a continuation of What Is Endometriosis? — if you haven't read that yet, it covers the condition, its symptoms, and how it is diagnosed.
If you've recently been diagnosed with endometriosis — or you've been living with it for years — you're probably wondering: what can actually be done?
There is no single cure for endometriosis. But there are highly effective treatments that can significantly reduce pain, assist your fertility and improve quality of life. The key is finding the right combination for you — because treatment almost always works best when it's tailored and maintained over time.
This page outlines the three main pathways: hormonal therapies, surgery and multidisciplinary care.
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 is "fixed" by a single intervention.
Without ongoing management, pain and disease recur at approximately 10% per year after surgery. At five years without post-operative treatment, recurrence rates of 40–50% have been reported. 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 reflect this — treatment should 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 / ‘sugar pill’ periods) is generally preferred for severe period pain, as it eliminates the withdrawal bleed that often triggers the worst symptoms.
Progestogens work by causing ectopic endometriosis tissue to thin and become inactive. Options include:
The Mirena IUD — a long-acting device that provides 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 are further options depending on individual circumstances
GnRH agonists and antagonists are second-line treatments that work by temporarily switching 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.
Post-operative hormonal therapy matters. The PRE-EMPT trial (BMJ 2024, 405 women, 3 years) found that starting either a long-acting progestogen or the COCP after surgery produced around a 40% improvement in pain. Women on long-acting progestogens had a 33% reduction in the risk of needing further surgery — making post-operative hormonal therapy the recommended approach for most women after conservative surgery.
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 (‘cut 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/reserve) after cystectomy (removal of ovarian cyst/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 is not recommended, as it may reduce ovarian reserve without improving IVF outcomes. Or at times we might discuss egg freezing prior to proceeding with surgery.
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. A 2025 RCT found supervised pelvic floor training reduced pelvic pain at four months which was 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 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 IBS (Irritable Bowel Syndrome) — 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 in women with endometriosis, 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 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 is 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 is worth seeking a specialist assessment. An 8-year average diagnostic delay in Australia is too long and every woman deserves a clear management plan.
To discuss your endometriosis and explore your treatment options, contact our rooms for an appointment.
📞 02 9053 1245 ✉️ admin@drdavidkrones.com.au 📍 Suite 3A, North Shore Private Hospital, St Leonards NSW 2065
This articles was written by Dr David Krones FRANZCOG, last updated 4th June 2026
References
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RANZCOG Australian Living Evidence Guideline: Endometriosis (Farquhar C et al., May 2025)
Cooper KG et al. PRE-EMPT trial. BMJ 2024;385:e079006. [PMID 38749550]
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Muzii L et al. Dienogest meta-analysis. Reproductive Sciences 2023. [PMID 37217824]
Giudice LC et al. SPIRIT 1 and 2 trials. Lancet 2022;399:2267–2279.
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Australian Institute of Health and Welfare. Endometriosis in Australia 2023.
This article is intended as general educational information and does not replace individual medical advice.