Endometriosis
Endometrial-like tissue outside the uterus, affecting roughly 1 in 9 Australian women.
1. Clinical overview & diagnosis
Endometriosis is the presence of endometrial-like tissue outside the uterus, affecting roughly 1 in 9 Australian women. Definitive diagnosis is via laparoscopy with histological confirmation (RANZCOG), though a clinical diagnosis can and should be made in primary care to begin empirical treatment. Mean diagnostic delay in Australia is 6.5+ years — active case-finding matters.
Red flags for urgent referral
- • Severe dysmenorrhoea unresponsive to first-line therapy
- • Deep dyspareunia
- • Cyclical bowel or bladder symptoms
- • Subfertility
- • Fixed retroverted uterus on examination
2. Patient diagnostic pathway
- 1History — Cyclical pelvic pain, dysmenorrhoea, dyspareunia, subfertility, cyclical bowel/bladder symptoms.
- 2Examination — Abdominal and pelvic exam; look for fixed retroversion, nodularity, tenderness.
- 3Investigations — Transvaginal ultrasound (may be normal in superficial disease; useful for endometrioma/deep disease); consider referral for MRI or diagnostic laparoscopy where diagnosis is unclear or disease is advanced.
3. Treatment & management plan
First-line — Analgesia (NSAIDs), combined oral contraceptive (continuous preferred), or progestogen-only therapy (norethisterone, medroxyprogesterone) or the levonorgestrel IUD (Mirena).
Second-line — GnRH agonists (leuprorelin) with add-back HRT, PBS-listed with prior specialist diagnosis, for 6-month courses. Refer for laparoscopic excision if medical therapy fails.
4. Patient pathway & referral
When & where to refer
- • Suspected deep or advanced disease
- • Failed medical management
- • Subfertility
- • Consider multidisciplinary pain management for chronic cases
Patient education & resources
Clinical decision support only. Not a substitute for independent clinical judgement. HerPath informs, it does not replace the treating practitioner.