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‘Australian Living Evidence Guideline: Endometriosis’ Will Improve Consistency of Care for People Living with Endometriosis

Saturday 10 May 2025

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG, the College) has today proudly published the ‘Australian Living Evidence Guideline: Endometriosis.’ RANZCOG has led the development of this pivotal resource, which provides the best available scientific evidence to assist the detection, diagnosis and management of endometriosis, and a related condition, adenomyosis. A quick reference guide and flowchart have been designed specifically to support primary care providers, and there are also new resources available for the public too.

Endometriosis is a chronic, inflammatory, gynaecologic disease marked by the presence of endometrial-like tissue outside the uterus. In 2023 the Australian Institute of Health and Welfare (AIHW) reported that 1 in 7 (14%) people assigned female at birth in Australia and aged 50-55 are diagnosed with endometriosis by age 44–49, and for women aged 29-34, 8.8% were estimated to have been diagnosed with endometriosis by age 26–31. Endometriosis is often under-recognised, and diagnostic delay and affordability of ongoing care can have a substantial impact on quality of life on individuals, their family, partner, and carers.

A living evidence approach

The updated living-evidence guideline replaces the first ‘Australian Clinical Practice Guideline for the Diagnosis and Management of Endometriosis’ developed by RANZCOG in 2021 with funding support from the Australian Government. This was part of the Government’s overarching National Action Plan for Endometriosis (2018) which comprises of three priority areas to address endometriosis: awareness and education, clinical management and care, and research.

In 2022, the Australian Government invited RANZCOG to update the original guideline and transition it into a living evidence format. The living evidence guideline builds on the evidence from the foundation guideline and incorporates new research, a broader scope, and wide-ranging multidisciplinary expert input including that of gynaecologists, primary care providers, physiotherapists, pain specialists, and people with lived experience.

Using living evidence ensures the clinical guideline can respond to emerging evidence relevant to the Australian context and highlight areas where there is either low certainty or absent evidence to signal where further research is needed. The College encourages the Albanese government to extend funding beyond 2025 to enable the guideline to continue to be updated over time to find and maintain the most recent scientific evidence.

Who was involved?

The Australian Living-Evidence Guideline: Endometriosis, and its associated resources have been produced by a dedicated team of experts led by Professor Cindy Farquhar, RANZCOG Dean of Research and Policy, using a rigorous, evidence-based development process underpinned by the internationally recognised the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. Materials have been reviewed by multiple expert groups including the Department of Health and Aged Care, the Australian Living Evidence Collaboration (ALEC), the University of Auckland, and other prominent consumer advocacy groups.

“The living evidence guideline represents a major step forward in providing consistent, high-quality care for Australians living with confirmed and suspected endometriosis and adenomyosis. Considering up-to-date scientific evidence, expanded diagnostic options beyond surgery, and a truly interdisciplinary approach, we’re better positioned to deliver more timely, personalised, and effective care.”

– Professor Cindy Farquhar, Chair of the RANZCOG Endometriosis Guideline Development Group.

Highlights from the updated guideline

Emphasis on non-invasive diagnosis with emerging evidence suggesting that a greater number of cases can be diagnosed with increasing accuracy using techniques such as transvaginal ultrasound and magnetic resonance imaging (MRI). Endometriosis has previously required a surgical procedure for diagnosis to be confirmed and so this could help reduce diagnostic delay.
New recommendations to support early treatment in primary care, supporting GPs to begin first-line hormonal treatment while diagnostic investigations are under way. Primary care specific resources (the quick reference guide with summary flowchart), have been developed to improve access to key evidence-based recommendations for the diagnosis and management of endometriosis
New recommendations specific to adolescents.
New recommendations have been included for physiotherapy and psychological interventions.
A free eLearning module for multidisciplinary care providers to support delivery of consistent, high-quality care across Australia will be available at the end of May.

A focus on primary care

“We have been particularly focused on ensuring that guideline recommendations are implementable and focused on the concerns of primary care practitioners when diagnosing and managing patients presenting with symptoms of endometriosis. Having clear, evidence-based tools like the quick reference guide and flowchart will be a game-changer for primary care. It will help primary care practitioners feel more confident starting treatment early and ensure we’re on the same page with specialists when it comes to managing what is often a complex, variable, and long-term condition.”

– Professor Danielle Mazza AM, Head of the Department of General Practice at Monash University and member of the guideline development group.

Support for people living with Endometriosis

Whilst the living evidence guideline is a clinical document for use by healthcare professionals, new patient-facing resources have also been developed to help individuals understand the conditions and navigate their care journey.

“My own experience with endometriosis was difficult to navigate. Like so many others, I felt frustrated by my symptoms and alone in what I was experiencing. These resources will empower people living with endometriosis by providing clear, reliable information to help them start meaningful conversations, advocate for themselves, and participate more confidently in shared decision-making with their care providers.”

– Alexis Wolfe, Consumer Liaison on the guideline development group.

The Australian Living Evidence Guideline: Endometriosis was launched by Professor Farquhar during RANZCOG’s Education and Engagement Day in Melbourne on 10 May 2025. The guideline, quick reference guide, and patient information resources are now available.