Endometriosis: Understanding the Symptoms, Diagnosis, and Management
- Laura Gerber
- Mar 25
- 8 min read
Updated: Apr 2
Endometriosis is a common yet often misunderstood condition, affecting approximately 1 in 7 women at some point in their lives. It typically occurs in the teenage years at a person's first menstrual period or during their early twenties and can last until menopause. It can have a profound impact on physical health, emotional well-being, relationships, and even financial stability.
Despite its prevalence, the true number of affected women may be even higher due to underreporting, misdiagnosis, and the lack of non-invasive diagnostic methods. The stigma surrounding women’s health issues further contributes to delayed recognition and treatment.
In this article, we’ll explore what endometriosis is, how it affects daily life, and effective strategies for managing pain flare-ups, exercising safely, and improving long-term well-being.
What is endometriosis?
Endometriosis comes from the word endometrium, which refers to the lining of the uterus (womb). The term itself is derived from ‘endo’ (inside) and ‘metra’ (uterus). Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus.
These growths, known as lesions, are most commonly found on the ovaries, fallopian tubes, bowel, and intestines but have also been detected on the kidneys, diaphragm, and even the brain. Although located outside the uterus, this tissue behaves like the endometrial lining—it thickens, breaks down, and bleeds with each menstrual cycle. However, unlike menstrual blood, this tissue has no way to exit the body, leading to inflammation, scar tissue, and adhesions.
Symptoms of endometriosis
Endometriosis is far more than just lesions in the pelvis. Women with this condition often experience a range of symptoms, including but not limited to:
Pain during sex, ovulation, periods, and defecation
Severe pelvic cramping
Heavy bleeding
Lower back pain
Gastrointestinal issues (constipation and bowel irritation)
Fatigue
Ovarian cysts
Anaemia (low iron)
Stress urinary incontinence
Infertility
How is endometriosis diagnosed?
Transvaginal Ultrasound (TVS) – The first step in diagnosing endometriosis often involves a pelvic ultrasound, specifically a transvaginal ultrasound (TVS), with or without a deep endometriosis ultrasound. This is a common and non-invasive imaging technique used to visualise the pelvic organs, including the uterus, ovaries, and surrounding tissues. This helps assess for ovarian and/or deep endometriosis.
Deep Endometriosis Ultrasound – A deep endometriosis ultrasound is a new technique designed to improve the detection of posterior compartment deep endometriosis. OMNI Ultrasound & Gynaecological Care in Penrith is the first in Australia to offer this advanced imaging technology.
Laparoscopy – A definitive way to diagnose endometriosis is through a laparoscopy—a minimally invasive surgical procedure where a surgeon makes small incisions in the abdomen to examine the internal organs for endometrial-like tissue.
A laparoscopy can determine whether endometriosis is present, where it is located, and how severe it is.
During this procedure, the surgeon may also remove endometrial lesions, which can help improve pain, reproductive health, and gastrointestinal function. However, the severity of pain does not always correlate with the extent of the condition—some women with minimal lesions experience severe pain, while others with extensive endometriosis may have little to no symptoms.
If your laparoscopy results come back normal, it is still a valuable step. It helps rule out endometriosis and allows your healthcare provider to explore other potential causes of your pain.
What about Ultrasound? – A standard ultrasound is generally not a reliable diagnostic tool for endometriosis unless large cysts—such as endometriomas (also known as chocolate cysts)—are present. Smaller lesions are often too thin to be detected on an ultrasound, which is why laparoscopy remains the gold standard for diagnosis.
Purpose of Pelvic Scans
Pre-operative Assessment – Pelvic scans provide valuable information about the pelvic region, which is crucial for planning any potential surgical interventions.
Deep Endometriosis Ultrasound – This can provide additional diagnostic information and assist in determining if a laparoscopy (surgical procedure) and/or hormonal therapies (e.g., birth control pills, hormonal IUD) should be considered as treatment options.
The Future of Endometriosis Diagnosis
There is promising new research into a blood test for detecting endometriosis, and we are excited to see how this evolves in the coming years. This breakthrough could lead to earlier diagnosis and better treatment outcomes.
Is Laparoscopy painful?
Laparoscopy is performed under general anaesthesia, so you’ll be completely unconscious during the procedure and won’t feel any pain at the time of surgery.
After the procedure, it’s normal to experience some discomfort as your body heals. Since laparoscopy involves small incisions, recovery is generally less painful than open surgery.
We recommend seeing our massage therapist once your wounds have healed (from 6 weeks) to break down scar tissue adhesions at the incision site through techniques such as massage, gua sha, cupping, and/or dry needling.
How long does it take to diagnose endometriosis?
In Australia, research shows that the average time from the onset of symptoms to an official diagnosis is around six years. However, this delay has been improving in recent years, likely due to greater awareness among both healthcare professionals and patients. Increased education and advocacy are helping more women recognise the symptoms and seek medical support earlier.
Will surgery eliminate my endometriosis pain?
Endometriosis can lead to peripheral and central sensitisation, meaning the nervous system becomes more sensitive to pain over time. This is why a holistic pain management approach—including Women’s Health Physiotherapy, lifestyle modifications, and medical support—is often necessary for long-term relief.
It’s important to note that Physiotherapy for endometriosis is a specialised field, and not all general physiotherapists have the expertise required to effectively manage this condition. Seeking care from a Women’s Health Physiotherapist with experience in pelvic pain and endometriosis can make a significant difference in treatment outcomes.
For many women, high-quality laparoscopic surgery can successfully remove endometriosis lesions and reduce pain. However, surgery alone may not resolve all symptoms. Pain related to the bladder, pelvic muscles, migraines, sharp nerve pain, or bowel dysfunction may persist and require additional treatment strategies.
A truly comprehensive pain management plan—combining physiotherapy, lifestyle adjustments, and ongoing medical support—is key to achieving long-term symptom relief and improving quality of life.
Is it all in my head? Absolutely NOT. Your pain is real, and support is available.
At Women’s Health Hub, we recommend starting with conservative management to help ease your
symptoms. If this doesn’t provide enough relief, surgery may be an option. However, it’s important to remember that while surgery can remove endometriosis tissue, it may not eliminate all pain as mentioned before due to factors such as peripheral and central sensitisation.
A multidisciplinary approach—incorporating physiotherapy, pain management strategies, exercise physiology, and medical care—is often the most effective way to manage symptoms and improve overall well-being.
Every case of endometriosis is unique, which is why personalised treatment is key to finding what works best for you.
How to manage endometriosis?
Effective endometriosis management requires a personalised, multi-faceted approach that addresses both physical symptoms and overall well-being.
Comprehensive Diagnosis and Treatment Plan
A thorough assessment to identify each woman’s unique symptoms.
A tailored treatment plan to address individual concerns.
Holistic Management Sessions
Lifestyle adjustments, including diet, exercise, and stress management.
Psychological support to help improve mental and emotional well-being.
A combination of high-quality surgery (if needed), medications, physiotherapy, and ongoing care.
Empowering Women Through Education & Support
Providing women with the tools and knowledge to take an active role in their care.
Supporting their emotional, social, and professional well-being, ensuring they can continue to thrive.
At Women’s Health Hub, we recognise that no two experiences of endometriosis are the same. That’s why our approach is centred around personalised care that puts your health first.
Exercise as a treatment for endometriosis
The top self-reported management tools for endometriosis symptoms are:
Heat
Rest
Meditation/breathing
Dietary changes
Exercise
Stretching
Yoga/Pilates
Massage
Exercise is not one size fits all.
Exercise is one of the most effective long-term strategies for managing endometriosis, as it supports pain relief, hormonal balance, inflammation control, and musculoskeletal health. Physical activity stimulates the production of endorphins—your body’s natural pain relievers—and helps regulate inflammation, a key factor in endometriosis-related pain.
Recent research highlights the importance of personalised exercise programs and regular supervision in empowering women to use movement as a self-management tool. Ensuring that exercise feels safe and non-threatening is crucial, while group training can foster a sense of belonging, enhance social support, and promote active coping strategies that are essential for managing endometriosis
effectively.
However, not all forms of exercise are equally beneficial. In some cases, unsuitable movements can exacerbate pelvic pain, trigger flare-ups, or increase fatigue. That’s why it’s essential to consult an expert in this area, such as a women's health physiotherapist or an exercise physiologist, to develop a tailored, evidence-based exercise plan that supports symptom management and overall well-being.
How Our Exercise Physiologist Can Help
Our Accredited Exercise Physiologist understands the complexities of endometriosis, pelvic pain, and fatigue. We create individualised exercise programs tailored to:
Your body – taking into account pelvic floor tone and musculoskeletal imbalances
Your menstrual cycle – adjusting intensity to match your energy levels
Your specific health needs – ensuring exercises relieve, rather than worsen, symptoms
“Move smarter, not harder.” It's not just about core strength! Women with endometriosis often have a high-tone pelvic floor, meaning excessive core activation (like crunches, certain Pilates moves, or even downward dogs) can increase intra-abdominal pressure, leading to pain during sex, urination, or bowel movements.
Reducing tension is just as important as building strength! We focus on exercises that lengthen and release tight muscles before introducing strength work.
Exercise doesn’t always have to mean burpees or star jumps! Movement can be gentle yet effective—think breathwork, mobility drills, resistance training, and functional movement patterns.
Who should be in your endometriosis care team?
Endometriosis is a chronic condition with no known cure, requiring a multidisciplinary approach for the best possible outcomes. A well-rounded care team may include:
Women’s Health Physiotherapist – Assesses pelvic floor tone, activation, and relaxation patterns, providing hands-on treatment and guided exercise to improve function and reduce pain.
Accredited Exercise Physiologist – Develops an exercise program customised to your body and menstrual cycle. Each phase—menstruation, follicular, ovulation, and luteal—may respond best to different types of movement, such as HIIT or yoga, to support pain management.
Massage Therapist – Helps release muscle tension, particularly in areas that may contribute to pelvic floor tightness, such as the inner thighs.
Pilates Instructor – Designs strength and flexibility programmes similar to an exercise physiologist, focusing on safe movement strategies. For optimal results, exercise should be tailored to individual needs, focusing on reducing tension rather than increasing muscle activation.
We recommend Rehab Pilates in a studio setting rather than a large group reformer class.
Osteopath – Assists in breaking up scar tissue, relieving trigger points, and promoting relaxation in the pelvic floor and surrounding muscles.
Clinical Nutritionist/Dietitian – Provides tailored nutrition advice to help manage gastrointestinal symptoms commonly associated with endometriosis.
Pain Specialist or Pelvic Pain Clinic – Supports pain management through medical interventions, lifestyle modifications, and other therapies.
Gynaecologist – Oversees diagnosis, treatment, and surgical interventions such as laparoscopy if required.
A collaborative approach ensures women with endometriosis receive comprehensive and individualised care, addressing both physical symptoms and overall quality of life.
Endometriosis is REAL
Endometriosis is real, not rare, and your pain should never be ignored. While living with endometriosis can feel overwhelming, there are many resources and services available to support you on your journey.
At Women’s Health Hub, we have a team of highly experienced and passionate professionals who understand endometriosis and are dedicated to helping women live their best, most fulfilled lives—free from unnecessary pain and discomfort.
How to prepare for your appointment?
Before seeing a health professional, it helps to write down all your current and past symptoms so your concerns are fully addressed.
At Women’s Health Hub, we take a comprehensive, evidence-based approach to your care. Our multidisciplinary team includes:
Women’s Health Physiotherapists
Accredited Exercise Physiologists
Massage Therapists
Pilates Instructors
All under one roof, ensuring seamless, collaborative care tailored to your needs.
If you're struggling with symptoms, book an initial consultation and take the first step towards personalised, evidence-based treatment. Let’s break the stigma, raise awareness, and ensure every woman gets the support she deserves.
You may be eligible for a Chronic Disease Management Plan (formerly known as an Enhanced Primary Care Plan) under Medicare for Exercise Physiology and/or Women’s Health Physiotherapy. This plan provides access to subsidised allied health services for individuals with a chronic medical condition that has been present for six months or longer.
To determine your eligibility, speak with your GP, as they are responsible for preparing and prescribing these care plans. If you qualify, Medicare may cover a portion of up to five allied health sessions per calendar year.
We can discuss how this applies to your care during your consultation. Feel free to ask us any questions!
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