If you’ve spent years being told that painful periods are “just part of being a woman” — this article is for you.
Endometriosis affects approximately 1 in 9 Australian women and individuals with a uterus. That is over 830,000 people in this country living with a condition that causes debilitating menstrual pain, pelvic pain, painful sex, bowel and bladder symptoms, and in many cases — infertility. And despite being one of the most common chronic conditions affecting women, the average time from symptom onset to confirmed diagnosis in Australia is 6 to 8 years.
Six to eight years of pain. Of dismissed symptoms. Of being told it’s normal.
It isn’t normal. It’s a diagnosable, treatable condition — and the earlier it’s identified, the better the outcomes.
What Is Endometriosis?
Endometriosis is a chronic inflammatory condition in which tissue similar to the endometrium (the lining of the uterus) grows outside the uterus. This tissue responds to hormonal changes in the same way as the uterine lining — thickening, breaking down, and bleeding with each menstrual cycle. But unlike menstrual blood, which exits the body, this displaced tissue has nowhere to go.
The result is inflammation, scarring, adhesions (bands of scar tissue that bind organs together), and — over time — significant damage to surrounding structures.
The most common sites where endometrial-like tissue grows include:
- The ovaries (where it can form cysts called endometriomas, or “chocolate cysts”)
- The fallopian tubes
- The tissue lining the pelvis (the peritoneum)
- The bowel, bladder, and ureters
In rarer cases, endometriosis has been found in the lungs, diaphragm, and other distant sites.
Endometriosis is classified in stages from 1 (minimal) to 4 (severe) based on the extent and location of the tissue. But staging does not reliably predict symptom severity — some women with Stage 1 endometriosis have agonising pain, while some with Stage 4 have minimal symptoms.
How Common Is Endometriosis in Australia?
Endometriosis affects approximately 11.4% of people with a uterus in Australia — making it more common than type 2 diabetes in women of reproductive age. Around 95% of people with endometriosis will need a surgical procedure at some point in their care. Endometriosis is one of the top five health concerns identified by Australian women, and chronic pelvic pain from endometriosis is an Australian National Women’s Health Priority.
Despite this, awareness remains low, diagnosis remains slow, and many women — particularly in multicultural communities where menstrual pain may be normalised or not discussed openly — wait far longer than average before receiving any diagnosis at all.
Research published in The Lancet highlights that in the Asia-Pacific region, cultural taboos around menstruation contribute to delayed reporting of symptoms. Women may attribute severe pain to disobedience of cultural rules, or feel unable to discuss menstrual symptoms openly — meaning many women in Sunshine’s multicultural community may be living with undiagnosed endometriosis right now.
What Are the Symptoms of Endometriosis?
Endometriosis symptoms vary significantly between individuals and can change over time — one of the main reasons it is so frequently missed or misdiagnosed.
The most common symptoms include:
Dysmenorrhoea (painful periods) — pain that is severe enough to interfere with daily activities, require strong pain relief, or cause absence from work or school. This is the most common and recognisable symptom. The key distinction: ordinary period pain typically responds to standard over-the-counter pain relief and settles within a day or two. Endometriosis-related pain is often more severe, lasts longer, and doesn’t respond adequately to paracetamol or ibuprofen.
Chronic pelvic pain — pain that occurs outside of the menstrual period, including mid-cycle, during bowel movements, or with bladder activity. This pain can be constant or episodic.
Dyspareunia (painful sex) — particularly deep pain during or after penetrative intercourse. This symptom is frequently not volunteered and rarely asked about, contributing to diagnostic delay.
Dyschezia (pain with bowel movements) — particularly during menstruation, this symptom often leads to misdiagnosis with irritable bowel syndrome or inflammatory bowel disease.
Dysuria (pain with urination) — bladder involvement can cause urinary frequency, urgency, or pain, particularly around the time of menstruation.
Menorrhagia (heavy menstrual bleeding) — often coexisting with painful periods.
Bloating — sometimes called “endo belly,” significant abdominal bloating particularly around menstruation is a common complaint.
Fatigue — often profound and poorly understood, likely related to chronic inflammation and the body’s response to persistent pain.
Infertility — endometriosis contributes to infertility in a significant proportion of affected women, either through anatomical disruption (adhesions, damaged fallopian tubes), impaired egg quality, or altered pelvic environment. Many women are only diagnosed with endometriosis when they seek help for difficulty conceiving.
Depression and anxiety — endometriosis contributes to poor mental health not only through the social and functional impact of chronic pain, but through direct inflammatory mechanisms affecting mood. Endometriosis can cause fatigue, depression, and anxious mood as part of the condition itself.
Why Does Endometriosis Take So Long to Diagnose in Australia?
This is the question that frustrates patients, their families, and increasing numbers of clinicians and advocates. There is no single answer — but several interacting factors explain why the diagnostic delay in Australia has historically averaged 6–8 years.
1. Period Pain Is Culturally Normalised
The most important factor is cultural. Severe period pain has long been dismissed as something women simply have to endure. “It’s just bad cramps” is something countless women with endometriosis have been told — by GPs, by specialists, by family members, and by the broader culture.
This normalisation leads women to delay seeking help and leads clinicians to under-investigate when they do. The assumed normalcy of pain contributes to a staggering diagnostic delay of 6–8 years.
2. Endometriosis Has No Pathognomonic Symptom
There is no single symptom or combination of symptoms that definitively identifies endometriosis without further investigation. Many of its symptoms overlap with other conditions — irritable bowel syndrome, bladder pain syndrome, pelvic inflammatory disease, adenomyosis, ovarian cysts — making it genuinely difficult to distinguish on clinical grounds alone.
3. Definitive Diagnosis Has Traditionally Required Surgery
For most of endometriosis’s medical history, the only way to definitively confirm the diagnosis was through laparoscopy — a surgical procedure where a camera is inserted into the pelvis to visualise endometrial deposits. This is invasive, requires anaesthesia, and carries surgical risk.
The reluctance of both clinicians and patients to proceed to surgery — and the long waiting times for gynaecology appointments in Australia — has contributed significantly to diagnostic delay.
However, this is changing. Modern ultrasound technology, performed by sonographers experienced in endometriosis imaging, can now detect many forms of endometriosis — particularly ovarian endometriomas and deep infiltrating endometriosis — without surgery. Specialist MRI is also increasingly used. A GP referral for targeted pelvic ultrasound is now a clinically appropriate and recommended first step in the diagnostic pathway.
4. Underinvestment in Women’s Pain
Research consistently demonstrates that women’s pain is less likely to be believed, investigated, and treated than equivalent pain in men. This is well-documented in emergency medicine, primary care, and specialist settings. Women with endometriosis report waiting longer in emergency departments, being prescribed less pain relief, and being more frequently told their pain is psychological or exaggerated.
5. Limited Awareness Across Specialties
Endometriosis is not only a gynaecological condition. Its bowel, bladder, and systemic symptoms mean it frequently presents first to GPs, gastroenterologists, urologists, and emergency physicians — many of whom may not immediately consider endometriosis. A GP who does not recognise that severe, worsening period pain deserves investigation beyond reassurance is a critical point of delay.
The Australian Government’s Response
In recognition of the crisis-level diagnostic delay and its impact on hundreds of thousands of Australian women, the federal government has committed significant funding to address endometriosis as a national health priority.
This has included $17.4 million to support 22 specialised Endometriosis and Pelvic Pain GP Clinics across Australia — providing multidisciplinary care with a focus on improving diagnostic delay and promoting early access to intervention, care, and treatment options. A further $5.1 million has been committed to developing an Endometriosis Management Plan to support patients in primary care.
These clinics, alongside training programs for GPs and the wider adoption of the Raising Awareness Tool for Endometriosis (RATE) — a clinical tool that helps GPs systematically assess symptoms of endometriosis — are beginning to shift the landscape of diagnosis in Australia.
How Is Endometriosis Diagnosed?
To diagnose endometriosis, your doctor will ask about your symptoms and examine you. They may recommend an ultrasound, MRI scan, or laparoscopy.
Step 1 — GP assessment: Your GP will take a detailed history of your menstrual symptoms, pelvic pain, bowel and bladder symptoms, and their impact on your life. Tools like the RATE questionnaire help GPs systematically capture the full symptom picture. A pelvic examination may be performed.
Step 2 — Pelvic ultrasound: A pelvic ultrasound — ideally transvaginal, performed by a sonographer experienced in endometriosis — can detect ovarian endometriomas and deep infiltrating endometriosis at key sites. It cannot exclude all forms of endometriosis (superficial peritoneal deposits may not be visible on ultrasound), but it is a valuable first-line investigation.
Step 3 — MRI: In cases where ultrasound is inconclusive or bowel/bladder involvement is suspected, specialist MRI provides more detailed imaging of endometriosis deposits.
Step 4 — Laparoscopy: Surgical diagnosis via laparoscopy remains the gold standard for confirming endometriosis, particularly superficial disease not visible on imaging. During laparoscopy, visible deposits can also be removed or destroyed, making it simultaneously diagnostic and therapeutic.
A normal ultrasound does not rule out endometriosis. If your GP has arranged an ultrasound that comes back normal but your symptoms strongly suggest endometriosis, a gynaecology referral is still appropriate.
How Is Endometriosis Treated?
There isn’t a single best treatment for endometriosis that works for everyone. Your medical team should consider your symptoms, preferences, and priorities when recommending treatment options.
Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are first-line for menstrual pain management. They work best when started before pain becomes severe — ideally 1–2 days before the expected start of the period. Paracetamol can be added for additional relief.
Hormonal therapy: Hormonal treatments suppress menstruation and the hormonal fluctuations that drive endometriosis activity. Options include:
- The combined oral contraceptive pill — often prescribed continuously (without a pill-free break) to suppress periods entirely
- Progestogen-only contraception — including the Mirena IUD, implant, or progestogen-only pill
- GnRH analogues — powerful medications that suppress ovarian function entirely; used for more severe disease, often with specialist oversight
Hormonal therapy manages symptoms but does not cure endometriosis — symptoms frequently return when treatment is stopped.
Surgical treatment: Laparoscopic excision or ablation of endometriosis deposits is an effective treatment for symptom relief and fertility improvement. Specialist laparoscopic surgery at an endometriosis centre of expertise offers the best outcomes for complex or recurrent disease.
Multidisciplinary care: Pain psychologists, pelvic physiotherapists, dietitians (as diet can influence inflammatory symptoms), and specialist nurses all play a role in comprehensive endometriosis management. The Australian Endometriosis and Pelvic Pain GP Clinics are designed to facilitate this multidisciplinary approach.
Fertility treatment: Women with endometriosis seeking to conceive should discuss their situation early with a fertility specialist. In vitro fertilisation (IVF) is effective for endometriosis-associated infertility, and the timing and nature of surgical intervention before IVF should be carefully considered.
When Should You See Your GP?
See your GP if you experience:
- Period pain severe enough to interfere with work, school, or daily activities
- Pain that doesn’t respond adequately to standard over-the-counter pain relief
- Pelvic pain outside of your period
- Pain during or after sex
- Pain with bowel movements or urination, particularly around menstruation
- Heavy or irregular periods
- Difficulty becoming pregnant
- Bloating or digestive symptoms that worsen around your period
- Fatigue that is disproportionate to your circumstances
You do not need to minimise your symptoms or apologise for raising them. Severe period pain is not something you simply have to endure. It is a symptom worth investigating — and your GP is the right starting point.
At Central Health Clinic in Sunshine, our GPs take women’s pelvic pain seriously. We can arrange targeted pelvic ultrasound, provide hormonal management options, and refer to specialist gynaecologists and Endometriosis and Pelvic Pain clinics when indicated. You don’t have to wait another 7 years.
Frequently Asked Questions
What does endometriosis pain feel like? Endometriosis pain typically starts as severe period pain — often much worse than what would be considered normal — but can also include chronic pelvic pain between periods, pain during or after sex, pain with bowel movements or urination, and lower back or leg pain during menstruation. Many women describe the pain as stabbing, cramping, or a deep ache. Severity varies widely between individuals and does not reliably correspond to the stage of disease.
Can endometriosis be cured? There is currently no cure for endometriosis. However, it can be effectively managed. Hormonal therapies suppress disease activity and reduce symptoms. Surgical excision of endometriosis deposits provides meaningful relief and in many cases improves fertility. Some women experience remission during pregnancy and after menopause. The goal of management is maximising quality of life and preserving fertility where desired.
Does endometriosis always affect fertility? Not always. Many women with endometriosis conceive naturally. However, endometriosis is associated with reduced fertility, particularly in more advanced stages. It is the cause of infertility in a significant proportion of women who seek fertility treatment. Women with endometriosis who are trying to conceive should discuss their situation with their GP and a fertility specialist early — waiting is not generally recommended.
Can a GP diagnose endometriosis? A GP can clinically suspect endometriosis based on symptoms and examination, arrange first-line investigations including pelvic ultrasound, and provide initial management with pain relief and hormonal therapy. A definitive diagnosis — particularly of superficial peritoneal disease — typically requires laparoscopy. GPs also play a crucial role in timely referral to gynaecologists and Endometriosis and Pelvic Pain clinics.
Is endometriosis the same as adenomyosis? No — they are related but distinct conditions. Adenomyosis is when endometrial-like tissue grows into the muscle wall of the uterus itself (the myometrium), rather than outside it. They often coexist and share many symptoms, including heavy, painful periods. Adenomyosis is typically diagnosed on ultrasound or MRI and managed similarly to endometriosis.
What is the RATE tool? The Raising Awareness Tool for Endometriosis (RATE) is a clinical questionnaire designed to help GPs systematically assess symptoms that may indicate endometriosis. It covers menstrual pain, pelvic pain, painful sex, bowel and bladder symptoms, and the impact of symptoms on quality of life. Using RATE can help women get a diagnosis faster and start treatment sooner.
The Bottom Line
Endometriosis is common, serious, and — in Australia — chronically underdiagnosed. The 6–8 year diagnostic delay is not inevitable. It is a product of cultural normalisation of women’s pain, limited awareness, and system-level barriers that are slowly but meaningfully being addressed.
You do not have to accept that your pain is normal. If your period pain is severe, persistent, and affecting your quality of life — that is enough to seek a proper assessment.
At Central Health Clinic in Sunshine, our GPs provide women’s health consultations including assessment for endometriosis, pelvic ultrasound referrals, hormonal management, and referrals to specialist gynaecologists and Endometriosis and Pelvic Pain clinics. Book an appointment today.
