Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrium) grows outside the uterus. It is most often found on the ovaries, the fallopian tubes and the tissue lining the pelvis, and less often on the bladder or bowel.

This tissue still responds to the hormones of the menstrual cycle, so it thickens and bleeds each month. Over time this can lead to inflammation and pain. It can also cause scar tissue (adhesions) and fluid-filled cysts on the ovaries, known as endometriomas.

Endometriosis is a long-term condition. It cannot be cured, but for most women the symptoms can be managed well. Symptoms often ease around menopause, though this is not the case for everyone.

Endometriosis affects about 1 in 7 women and people assigned female at birth in Australia. Despite being common, it is often diagnosed late — many people wait years between their first symptoms and a diagnosis. Knowing what to look for, and acting on symptoms early, can help.

Adenomyosis is a related condition where tissue similar to the uterine lining grows into the muscle wall of the uterus. It can cause heavy, painful periods and a feeling of pressure or bloating in the lower abdomen. Endometriosis and adenomyosis can occur together, and they are assessed in a similar way. The management options overlap, and the right plan depends on your symptoms and whether you are planning a pregnancy.

Dr Mahadik helps women work towards a diagnosis of endometriosis and looks after them through that process. She provides surgery for early-stage endometriosis.

If more advanced endometriosis is found, Dr Mahadik will refer you to an advanced endometriosis specialist for further care, so you get the right treatment for your situation.

Endometriosis affects everyone differently. Some women have severe symptoms, while others have very few — and the amount of pain does not always match the amount of endometriosis found. Common symptoms include the following.

• Painful periods (period pain that stops you doing your usual activities)
• Pelvic pain at other times of the month, not just during your period
• Pain during or after sex
• Lower back pain

• Heavy periods
• Bleeding between periods

Persistent heavy or painful periods are worth reviewing, as they can point to endometriosis, adenomyosis, fibroids or other causes.

• Pain when opening your bowels or passing urine, often worse around your period
• Bloating, constipation, diarrhoea or nausea, particularly during your period
• Tiredness or low energy
• Trouble falling pregnant

Chronic pelvic pain is pain in the lower abdomen and pelvis that lasts longer than six months. Endometriosis is one of the more common causes, but it is not the only one. Sometimes there is a single clear cause, and sometimes more than one thing is contributing at once.

Because the causes overlap, part of the assessment is working out what is driving the pain. Treating the underlying cause can ease the pain; where no single cause is found, the focus shifts to reducing pain and improving quality of life.

Aside from endometriosis, pelvic pain can be linked to:

• Adenomyosis
• Fibroids
• Ovarian cysts
• Irritable bowel syndrome
• Interstitial cystitis (painful bladder syndrome)
• Pelvic inflammatory disease
• Scar tissue (adhesions) from previous surgery or infection
• Pelvic floor muscle problems

The way endometriosis is diagnosed in Australia has changed. In the past, keyhole surgery (laparoscopy) was considered the only way to confirm it. Current Australian guidelines no longer require surgery to make a diagnosis — assessment can begin with your symptoms and an ultrasound, and treatment can often start at your first appointment.

Dr Mahadik will start by talking through your symptoms and medical history and, where appropriate, examining you. Recognising the pattern of symptoms is a key part of the picture.

A transvaginal pelvic ultrasound is usually the first scan for women with symptoms that suggest endometriosis. If this scan is not suitable, an abdominal ultrasound may be used instead. The scan works best when it is done and read by someone with particular experience in gynaecological imaging.

If the ultrasound is not clear, or if deeper endometriosis is suspected, a pelvic MRI may be recommended. Laparoscopy is still useful in some situations — for example, when imaging is normal but symptoms continue, or when surgery is being considered as treatment — but it is no longer needed simply to make the diagnosis.

A normal ultrasound does not rule out endometriosis. Some types, particularly small or superficial deposits, do not always show up on a scan. If your symptoms continue despite a normal result, it is important to keep the conversation going rather than assume nothing is wrong. Further specialist imaging, a treatment trial, or a laparoscopy may be discussed.

Many people experience symptoms for years before endometriosis is identified. Symptoms can be mistaken for "normal" period pain, they overlap with other conditions, and milder disease does not always appear on imaging. This is why taking persistent symptoms seriously, and reviewing them early, matters.

Endometriosis does not always need treatment — if symptoms are mild and you are not troubled by them, watchful waiting is reasonable. When treatment is needed, the aim is to control pain, manage symptoms and protect your quality of life. There is no single right approach; the plan is built around your symptoms, your stage of life and whether you are planning a pregnancy. Treatment can begin while further assessment is still underway.

Simple pain-relief medicines, such as anti-inflammatories, can help with period and pelvic pain and are often used alongside other treatments. Dr Mahadik can talk through which options suit you and how to use them safely.

Hormonal treatment aims to reduce or stop the monthly bleeding that drives symptoms. First-line options include the combined contraceptive pill and progestogens, which come as tablets, an injection, an implant or a hormonal intrauterine device (IUD). These are often used continuously to reduce or skip periods.

If the first option does not suit you or has not helped after about three months, a different first-line treatment or an alternative can be considered. Some second-line hormonal treatments are available for symptoms that are harder to control, and these are discussed on an individual basis.

Hormonal treatment does not cure endometriosis, and symptoms can return once it is stopped. It is important not to stop or change a prescribed medicine without medical advice.

Surgery may be considered when symptoms are severe, when they have not responded to medical treatment, or to remove endometriomas or scar tissue. It is usually done by laparoscopy (keyhole surgery), with the endometriosis tissue removed (excised) where possible.

Surgery can improve pain for many women, though symptoms can return over time, and some women need more than one procedure. Dr Mahadik will explain what surgery can and cannot achieve in your situation, including the benefits and the risks, so you can make an informed decision.

Because endometriosis is a long-term condition, managing it often works best as a combination of approaches rather than a single treatment. Alongside medical and surgical options, this can include pelvic floor physiotherapy, support for bladder and bowel symptoms, and help with the emotional impact of living with ongoing pain. Where helpful, Dr Mahadik can coordinate care with other health professionals, and your GP can arrange a mental health plan through Medicare if you would like added support.

Endometriosis can affect fertility for some women, though many with the condition conceive without difficulty. It can make falling pregnant harder by affecting the ovaries, the fallopian tubes or the pelvic environment.

One important point is that hormonal treatment for endometriosis is not a fertility treatment — it does not improve your chances of falling pregnant naturally, and it is not used while you are trying to conceive. If you are planning a pregnancy now or in the future, it is worth discussing this early so your management can take that into account.

If falling pregnant is proving difficult, Dr Mahadik can talk through your options and, where appropriate, refer you to a fertility specialist. Some fertility treatments take place at a specialist fertility clinic rather than in the consulting rooms.