A clear overview of care options and why treatment should be individualised.

Endometriosis treatment is not one-size-fits-all. The right care plan depends on your symptoms, suspected or confirmed disease location, age, fertility goals, previous treatments, access to care, other health conditions, side effects, and what matters most to you. Some people need help with pain and bleeding. Some need fertility support. Some need specialist excision surgery. Some need pelvic physiotherapy, pain management, bowel or bladder care, nutritional support, emotional support, or a combination of different approaches. A good treatment plan should look at the whole person, not just one organ, one symptom or one appointment. This guide explains common endometriosis care options, what they may aim to do, and what questions may help you prepare for conversations with healthcare professionals.

There is currently no known cure for endometriosis

There is currently no known cure for endometriosis. This is important to say clearly because people are often offered treatments in a way that can sound as if the disease will be “fixed” permanently. Some treatments may reduce symptoms. Some may help people function better. Some may suppress flares for a period of time. Surgery may remove visible disease when performed by an appropriately skilled surgeon. Fertility treatment may help some people who are trying to conceive. But no treatment should be presented as a guaranteed cure. Symptoms may improve, continue, return or change over time. Some people need ongoing care and review. If a treatment is not helping enough, or the side effects are difficult, it is reasonable to ask for the plan to be reviewed.

What treatment may aim to do

Treatment may have different aims depending on your situation. It may aim to:

  • reduce pain
  • improve daily function
  • manage heavy or difficult bleeding
  • reduce symptom flares
  • support fertility
  • remove visible endometriosis lesions during surgery
  • treat adhesions or scar tissue
  • treat endometriomas
  • reduce inflammation-related symptoms
  • support pelvic floor function
  • support recovery after surgery
  • manage bowel or bladder symptoms
  • support nerve-related pain
  • improve sexual wellbeing
  • improve sleep, energy and quality of life
  • reduce the impact on school, work, relationships or caring responsibilities

Before starting any treatment, it is useful to ask: What is this treatment meant to help with? That one question can make the whole plan clearer.

Treatment should be individualised

Endometriosis affects people differently. The same treatment may help one person and not help another. A treatment plan should consider:

  • your main symptoms
  • whether pain is cyclical, constant or unpredictable
  • whether symptoms affect daily life
  • whether bowel, bladder, chest, diaphragm, scar or nerve symptoms are present
  • whether endometriomas or adhesions are suspected
  • whether fertility matters now or in the future
  • previous medicines tried
  • previous surgery
  • side effects you have experienced
  • other conditions, such as adenomyosis, fibroids, IBS, bladder pain syndrome, pelvic floor dysfunction or chronic pain
  • your age and life stage
  • access to specialist care
  • your priorities and preferences

You should be involved in decisions about your care. It is reasonable to ask for the benefits, risks, limits and alternatives of each option to be explained clearly.

Pain relief

Pain relief may be part of endometriosis symptom management. This may include anti-inflammatory medicines, other pain medicines, heat, rest, pacing, flare planning or referral to pain management services, depending on your symptoms and what is safe for you. Pain relief can help some people manage symptoms, but it does not physically remove endometriosis lesions. You may want to ask:

  • What pain relief options are safe for me?
  • How often can I take this?
  • Should I take it before pain becomes severe?
  • What side effects should I watch for?
  • Is it safe with my other medicines or health conditions?
  • What should I do if this does not control the pain?
  • Should I be referred to a pain specialist?

Pain that is not controlled, or pain that stops you living normally, should be reviewed.

Hormonal treatment

Hormonal treatments may help reduce the severity or frequency of symptoms for some people. They may include:

  • combined hormonal contraception
  • progestogen-only treatments
  • hormonal intrauterine systems
  • injections or implants
  • GnRH medicines
  • other hormonal medicines in selected situations

Hormonal treatment may be used to reduce bleeding, suppress ovulation, reduce cyclical flares or help manage pain symptoms. However, hormonal treatment does not physically remove endometriosis lesions. Some people find hormonal treatment helpful. Others do not get enough relief, cannot tolerate side effects, have medical reasons why certain options are not suitable, or do not want hormonal treatment. You may want to ask:

  • What is this treatment expected to help with?
  • Does it aim to reduce pain, bleeding, flares or all of these?
  • How long should I try it before review?
  • What side effects are common?
  • What side effects need urgent advice?
  • Will it affect fertility while I am taking it?
  • What happens when I stop it?
  • What is the next step if it does not help?
  • Will investigation or referral continue if my symptoms are severe?

Hormonal treatment should not be used as a reason to dismiss ongoing symptoms or delay appropriate specialist assessment where symptoms are severe, complex or affecting daily life.

GnRH medicines

GnRH medicines may be discussed for some people with suspected or confirmed endometriosis symptoms. These medicines work by reducing ovarian hormone activity and creating a temporary low-oestrogen state. Some people describe this as a menopause-like state. They may reduce symptoms for some people, but they do not cure endometriosis and they do not remove lesions. Because they lower oestrogen, they can cause side effects such as:

  • hot flushes
  • night sweats
  • mood changes
  • sleep problems
  • headaches
  • vaginal dryness
  • reduced libido
  • nausea
  • low energy
  • bone density concerns with longer use

Sometimes “add-back” hormone therapy is prescribed to reduce side effects and help protect bone health. GnRH medicines should be discussed carefully before starting. They are not suitable for everyone. You may want to ask:

  • Why is this medicine being suggested?
  • What symptoms is it expected to help?
  • Is this being used to manage symptoms, support diagnosis, or before surgery?
  • How long would I take it for?
  • Will I need add-back therapy?
  • How will bone health be protected?
  • What side effects should I expect?
  • What side effects should make me stop and seek advice?
  • What happens when I stop?
  • What are the alternatives?
  • Will this delay further investigation or specialist referral?

If you are offered a GnRH medicine, you should feel fully informed before deciding.

Surgery

Surgery may be discussed when symptoms are severe, imaging suggests endometriosis, fertility is affected, symptoms continue despite other support, or there is concern about deep or organ-involving disease. Surgery may aim to:

  • diagnose endometriosis
  • treat visible endometriosis
  • remove lesions
  • treat adhesions or scar tissue
  • treat endometriomas
  • assess disease location
  • improve symptoms for some people
  • support fertility for some people

Surgery is not one single thing. The type of surgery, the surgeon’s experience, the disease location and whether a multidisciplinary team is needed all matter.

Excision and ablation

Two words often used in endometriosis surgery are excision and ablation. Excision means cutting out and removing endometriosis tissue. Ablation means destroying tissue on the surface, often using heat or energy. These are different approaches. Many specialist endometriosis surgeons focus on excision because it aims to remove disease rather than only treat the surface. This may be especially important where disease is deep, fibrotic, hidden under scarring, or involving organs or nerves. If surgery is being discussed, it is reasonable to ask:

  • Will endometriosis be excised, ablated or both?
  • Why are you recommending this approach?
  • What areas will be checked during surgery?
  • Do you treat deep endometriosis?
  • Do you treat bowel, bladder, ureter, diaphragm, thoracic or nerve-related disease?
  • What happens if disease is more complex than expected?
  • Will tissue be sent for histology?
  • What follow-up will I have?

You are allowed to ask about the surgeon’s experience. That is part of making an informed decision.

Specialist endometriosis surgery

Not all endometriosis surgery is the same. Some disease is superficial. Some is deep. Some may involve the bowel, bladder, ureters, diaphragm, thoracic area, pelvic sidewall, nerves, abdominal wall, scars or other structures. Complex disease may need advanced planning and specialist input. If complex or extra-pelvic disease is suspected, ask whether the surgeon works with a multidisciplinary team. This may include:

  • gynaecological endometriosis surgeon
  • colorectal surgeon
  • urologist
  • thoracic surgeon
  • fertility specialist
  • pain specialist
  • pelvic physiotherapist
  • radiologist with endometriosis expertise
  • specialist nurse

Not everyone needs every specialist. The team should match the symptoms, imaging findings, suspected disease location and goals of care.

Bowel, bladder, diaphragm, thoracic and nerve involvement

Endometriosis can affect different body systems. If symptoms suggest bowel, bladder, ureter, diaphragm, chest, abdominal wall, scar or nerve involvement, treatment planning may need to be more specialist. Examples include:

  • bowel pain, rectal bleeding, severe constipation or cyclical bowel symptoms
  • bladder pain, blood in urine, repeated UTI-like symptoms or ureter concerns
  • shoulder tip pain, chest pain, shortness of breath or coughing blood around a period
  • sciatic-type pain, numbness, tingling, weakness or foot drop
  • cyclical pain, swelling or bleeding from a scar or belly button

These symptoms should not be treated as “just pelvic pain”. The right care may involve gynaecology alongside colorectal surgery, urology, thoracic surgery, neurology, pain management or other specialist input. Chest pain, shortness of breath, coughing blood, new leg weakness, foot drop, or new bladder or bowel control problems should be assessed urgently.

Fertility care

  • Endometriosis can affect fertility for some people, but not everyone with endometriosis will have difficulty getting pregnant. Fertility care may include:

    • fertility assessment
    • ovarian reserve discussion
    • assessment of endometriomas
    • review of fallopian tubes and pelvic anatomy
    • ovulation induction in selected cases
    • intrauterine insemination in selected cases
    • IVF
    • fertility preservation discussion in some circumstances
    • surgical discussion where appropriate

    If fertility matters to you now or may matter in the future, raise it early. You may want to ask:

    • Could endometriosis affect my fertility?
    • Should I have fertility tests?
    • Could treatment affect ovarian reserve?
    • Should I see a fertility specialist?
    • What are my options if I want to try for pregnancy?
    • How might surgery affect IVF or future pregnancy options?
    • Should fertility advice happen before surgery?

  • Could it affect fertility?

  • Should ovarian reserve be checked?

  • What are the risks of surgery?

  • What happens if we monitor it?

  • Should I see an endometriosis or fertility specialist?

Endometriomas

Endometriomas are ovarian cysts linked with endometriosis. They may be associated with pain, inflammation, ovarian tissue changes and fertility decisions for some people. Treatment decisions should be careful because surgery on the ovary can sometimes affect ovarian reserve. Options may include monitoring, medical symptom management, fertility advice, or surgery in some cases. You may want to ask:

  • How large is the endometrioma?
  • Is one ovary or both ovaries involved?
  • Is it changing over time?
  • Could it affect fertility?
  • Should ovarian reserve be checked?
  • What are the risks of surgery?
  • What happens if we monitor it?
  • Should I see an endometriosis or fertility specialist?

Pelvic physiotherapy

Pelvic physiotherapy may be helpful for some people with endometriosis-related pain, pelvic floor tension, bladder symptoms, bowel symptoms, pain during sex or post-surgery recovery. It does not remove endometriosis lesions, but it may help with muscle tension, movement, pain patterns, bladder or bowel function, sexual pain and rehabilitation. Pelvic floor muscles can tighten in response to pain, inflammation, surgery, fear of pain or long-term guarding. This can become part of the symptom picture. You may want to ask:

  • Could pelvic floor tension be contributing to my symptoms?
  • Would pelvic physiotherapy be appropriate?
  • Should I see someone with pelvic pain or endometriosis experience?
  • Could it help before or after surgery?
  • What should I expect from treatment?

Psychological and emotional support

Endometriosis can affect mental health, relationships, confidence and quality of life. Ongoing pain, dismissal, fertility concerns, painful sex, fatigue, surgery decisions and uncertainty can be emotionally heavy. Psychological support may help with:

  • coping with chronic pain
  • medical trauma or dismissal
  • anxiety around symptoms
  • low mood
  • relationship stress
  • fertility-related distress
  • surgery anxiety
  • pacing and adjustment

This does not mean symptoms are “in your head”. It means living with a chronic condition can affect the whole person.

School, work and daily life support

Treatment is not only about medicines or surgery. It should also consider how symptoms affect daily life. Support may include:

  • school adjustments
  • work adjustments
  • flexible attendance
  • rest plans during flares
  • toilet access
  • heat pack access
  • medication plans
  • support letters
  • reduced physical demands during recovery
  • phased return after surgery

If symptoms affect attendance, performance or daily function, ask what support can be documented.

When treatment is not helping

A treatment plan should be reviewed if:

  • symptoms are not improving
  • pain is still affecting daily life
  • side effects are difficult
  • new symptoms appear
  • bowel, bladder, chest, diaphragm, scar or nerve symptoms are present
  • fertility priorities change
  • symptoms return after stopping treatment
  • surgery did not improve symptoms as expected
  • you feel unclear about the plan

You may want to ask:

  • What was this treatment expected to do?
  • How do we know if it is working?
  • What should happen next?
  • Should another diagnosis be considered?
  • Should I be referred to a specialist service?
  • Should multidisciplinary care be considered?
  • Should my imaging or previous records be reviewed?

You do not have to keep repeating a treatment that is not helping without review.

Finding the right type of care

Endometriosis care may involve different professionals at different stages. Depending on your symptoms, you may need:

  • GP or primary care support
  • gynaecology
  • endometriosis specialist
  • excision surgeon
  • colorectal surgeon
  • urologist
  • thoracic surgeon
  • neurologist
  • fertility specialist
  • pelvic physiotherapist
  • pain specialist
  • dietitian
  • psychologist or counsellor
  • specialist nurse

Use the Endometriosis Care Directory to explore different types of endometriosis-related care providers. The directory is for research and information only. It is not a recommendation, referral service, ranking or medical advice. Always check details directly with the provider and speak with an appropriate healthcare professional before making decisions about your care.

Prepare before you speak with a healthcare professional

Use our Prepare for Appointment Tool to organise your symptoms, questions, concerns, previous treatments and priorities before your appointment. The tool can help you record:

  • your main symptoms
  • how symptoms affect daily life
  • what treatments you have tried
  • what helped
  • what did not help
  • side effects
  • fertility priorities
  • concerns about surgery
  • questions for the appointment
  • what outcome you are hoping for

You do not need a perfect diary. A clear summary of what is happening and how it affects your life can help the conversation feel more focused.

Questions to ask about treatment options

You may want to ask:

  • What are my treatment options?
  • What is each option meant to help with?
  • Does this treatment manage symptoms or remove disease?
  • What are the likely benefits?
  • What are the risks?
  • What side effects should I watch for?
  • How long should I try this before review?
  • What happens if this does not help?
  • Could this affect fertility?
  • Could this affect other health conditions?
  • Should another specialist be involved?
  • Would multidisciplinary care be appropriate?
  • What symptoms should make me seek urgent help?

Final reminder

You deserve clear information and care that takes your symptoms seriously. Informed consent is key. Endometriosis treatment should be individualised. It may involve symptom management, surgery, pelvic physiotherapy, pain care, fertility support, nutrition, emotional support or a combination of approaches. There is currently no known cure, and no treatment should be presented as a guaranteed fix. But the right care can still make a meaningful difference. This resource is here to support your understanding, not replace medical advice from a qualified healthcare professional.