Australian Living Evidence Guideline: Endometriosis

This guideline provides evidence-based guidance to support the diagnosis and treatment of endometriosis and adenomyosis.

Living Evidence Guideline Patient Resources

Endometriosis Guideline Article Featured Image

190 million

People are affected by endometriosis

1 in 7

Australians assigned as female at birth are diagnosed with endometriosis by age 44-49

8.8%

Australians assigned female at birth are estimated to have been diagnosed with endometriosis by age 26–31.

$9.6 billion

Cost to the Australian economy per year (or $30,000 per person with endometriosis)

Australian Living Evidence Guideline: Endometriosis

RANZCOG has developed the Australian Living Evidence Guideline: Endometriosis; a clinical resource which provides the best available scientific evidence to assist the diagnosis and management of endometriosis.

In the guideline, you’ll find more info on:

Signs and symptoms associated with endometriosis
Diagnosis of endometriosis
Treatment options for endometriosis
Surgical options for endometriosis
Specific information for adolescents

While the guideline has been developed to support clinical guidance for healthcare professionals, it is accessible for everybody and can be discussed with your doctor.

This guideline is now endorsed by the RACGP.

Learn more about the guideline’s development.

Endometriosis

Endometriosis is a chronic, inflammatory, gynaecologic disease marked by the presence of endometrial-like tissue outside the uterus. The causes of endometriosis are not fully understood.

There is currently no ‘cure’ for endometriosis, but various treatments and management strategies are available including hormone therapy, medications, and surgery. The choice of treatment should be a shared decision made by you and your doctor.

Endometriosis can be diagnosed and managed by your primary care practitioner, but for some people, referral to a specialist may be beneficial.

Adenomyosis

Adenomyosis is a condition where tissue that normally lines the inside of the uterus grows into the muscle wall of the uterus. It is affected by oestrogen and can occur with or without endometriosis.

Endometriosis and adenomyosis are very similar, but adenomyosis remains challenging to identify.

Hormonal therapy may be offered as a first-line treatment for adenomyosis, depending on patient preference and clinical judgement.

Patient resources

Raising Awareness Tool for Endometriosis (RATE)

RATE is a quick-to-use online tool for patients and health professionals to assess possible endometriosis.

Access RATE→

Endometriosis

Endometriosis is a chronic inflammatory condition that can affect women of reproductive age.

Learn more→

Videos

Endometriosis: You Are Not Alone

Read video transcript

How do I know if my heavy bleeding with periods and period pain is normal?

Sex is painful for me. I really want a baby but am having problems getting pregnant.

I have heard of endometriosis but I’m not sure if I have it. I google and do my own research. How do I know if I have it? Do I need paracetamol or the pill? Physio? An ultrasound? Surgery?

Everyone’s story is different.

You may be experiencing pelvic pain or a wide variety of symptoms for many reasons.

It might be endometriosis.

Endometriosis occurs when tissue like the lining of the uterus grows outside of the uterus causing pain and other symptoms.

That’s just the definition.

We understand the experience of endometriosis.

Endometriosis affects the lives of over one million Australians.

We need clear, substantiated facts based on data and science. Real, information about what works.

It’s available!

RANZCOG have brought together healthcare experts from a range of medical professions, and people with lived experience to create one clear source of relevant, trusted, up-to-date information.

This team of experts have searched the available research on endometriosis, and screened for the most reliable papers with the highest certainty of evidence to present The Australian Living Evidence Guideline: Endometriosis

The purpose of the guideline is to promote high-quality and consistent care by providing evidence-based recommendations to health care practitioners.

Endometriosis is a complex condition that there is no perfect cure for yet, but we do have a wide choice of effective management strategies.

It is important to discuss this with your doctor and choose an option that suits you. ‘And me’. ‘And me’. ‘And me’.

Please see the RANZCOG website for more information.

The Australian Living Evidence Guideline: Endometriosis is supported by funding from the Australian Government.

Endometriosis: How Was The Guideline Developed?

Read video transcript

In 2021, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) developed the first Australian clinical practice guideline for the diagnosis and management of endometriosis.
This was important for the Australian Government’s National Action Plan for Endometriosis.

The guideline provides evidence-based recommendations to health care practitioners who diagnose and manage people of all ages with suspected or confirmed endometriosis.

It also supports high-quality and consistent care throughout Australia.

In 2022, the Australian Government invited RANZCOG to update the Guideline to create a Living Evidence Guideline to find and maintain the most up to date scientific evidence.

A group of experts looked at the feedback from the original guideline, developed research questions and then worked to identify the best available evidence to answer each question.

Reliable evidence must have an appropriate study design, use high-quality methodology, include relevant treatment options and be statistically precise.

Clinical guideline recommendations are then developed based on a balance of benefits and risks, certainty of the evidence, values and preferences, resource use, equity, acceptability and feasibility.

Recommendations are based on the highest level of certainty that the evidence can provide and have been contextualised to the Australian healthcare setting. That’s why you may not see some treatments or management strategies which you’ve heard about included in this guideline.

Clinical Resources

Quick Reference Guide for Primary Care

Providing evidence-based information to healthcare practitioners who diagnose and manage people of all ages with suspected or confirmed endometriosis.

Read the guide →

Australian Living Evidence Guideline: Endometriosis

RANZCOG has developed the Australian Living Evidence Guideline: Endometriosis; a clinical resource which provides the best available scientific evidence to assist the diagnosis and management of endometriosis.

Read the guide →

Endometriosis eLearning module

The Endometriosis eLearning module is designed to support clinicians in understanding and implementing the recommendations and good practice points from the Australian Living Evidence Guideline for Endometriosis.

It will cover topics including diagnosis, management, and interdisciplinary care, and features videos and case studies to support practical application, clinical decision-making, and communication with patients.

Log in to Acquire and start the Endometriosis eLearning module today.

Latest news

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

May 10, 2025

The new guideline provides up-to-date, evidence-based recommendations to improve diagnosis, treatment, and care consistency for people living with endometriosis and adenomyosis.

About the Guideline

This comprehensive living evidence guideline was developed by a dedicated team led by Professor Cindy Farquhar, RANZCOG Dean of Research and Policy.

Thank you to all those involved including the guideline development group, the consumers who have shared their own lived experiences of endometriosis, as well as the advocacy groups who ensure that this important women’s health issue receives the exposure and resources it deserves.

RANZCOG acknowledges the funding received from the Australian Government to develop this living guideline and, in addition, it’s ongoing financial commitment to improve diagnosis and treatment options for better patient outcomes through the landmark National Action Plan for Endometriosis and Medical Research Future Fund.

What has changed?
Recommendations are evidence based using the internationally recognised GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology.

The 2021 guideline has been completely updated with new evidence searches.

The evidence was searched for 23 clinical questions and appraised for the highest certainty.

All recommendations were updated to include:

9 strong recommendations
29 conditional recommendations
40 good practice statements

What is new?
Key highlights of the guideline include:

A summary flowchart for the diagnosis and management of endometriosis
Quick reference guide for primary care
Signs and symptoms associated with endometriosis
Diagnosis of endometriosis with transvaginal ultrasound
First-line hormonal treatment options for endometriosis
Surgical options for endometriosis
Cancer risk
Consideration of adolescents

Background information

In 2021 the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) developed the first “Australian clinical practice guideline for the diagnosis and management of endometriosis” (known as the Foundation Guideline) with funding support received from the Australian Government.

The Foundation Guideline adapted the National Institute for Health and Care Excellence’s (NICE) Endometriosis: diagnosis and management (NG73), September 2017 guideline for the Australian healthcare setting. This was part of the Australian Government’s overarching National Action Plan for Endometriosis (2018) that comprises 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 Foundation Guideline and transition it into a living evidence format (Living Guideline). The Living Guideline builds on the evidence from the Foundation Guideline and incorporates new research.

Using living evidence will ensure the clinical guidelines are able to 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. In this project (2022-25), the College is also tasked with developing a dissemination and implementation plan for both primary and secondary care.

Foundation Guideline (2021)

Foundation Guideline Technical Report (2021)

https://ranzcog.edu.au/wp-content/uploads/Endometriosis-Clinical-Practice-Guideline-Technical-Report.pdf

Endometriosis

Endometriosis is a chronic, inflammatory, gynaecologic disease marked by the presence of endometrial-like tissue outside the uterus.

Symptoms associated with endometriosis vary widely. Some people experience very little or no pain, while others may have significant pain, or reoccurring symptoms that severely impact daily life. In many people, endometriosis has been associated with debilitating painful symptoms, a long diagnostic delay after symptom onset, and persistence and recurrence of symptoms despite optimal medical and surgical treatments.

Endometriosis is often under-recognised, and delays in diagnosis may have a substantial impact on quality of life on the individual, their family, partner, and carers. The annual cost of the condition in Australia in 2017 calculated using the WERF EndoCost tool was AUD $9.6 billion or ($30,000 per person with endometriosis) due to productivity losses, reduced income, part-time work, use of sick leave, or missed opportunities. Additional expenses are often due to costs of pharmaceutical medications, investigations, surgery, carer support, fertility treatment and allied health and complementary therapies.

Endometriosis has previously required a surgical procedure for the diagnosis to be confirmed. Emerging evidence suggests that a greater number of cases can be diagnosed with increasing accuracy using non-invasive techniques such as transvaginal ultrasound and magnetic resonance imaging (MRI).

Frequently asked questions

What are clinical guidelines?

Clinical guidelines are a set of evidence-based recommendations to support healthcare professionals to:

Make clinical decisions
Standardise treatment
Reduce variations
Enhance patient outcomes

How are clinical guidelines developed?

RANZCOG has an evidence-based process to develop clinical guidelines which includes:

Defining the purpose of the guideline based on current information.
Setting up a Guideline Development Group (a team of experts, including consumers and representatives from key stakeholder groups).
Clinical questions (which direct the searches for evidence and identify research gaps).
Evidence reviews using a standardised method called GRADE (Grading of Recommendations Assessment, Development, and Evaluation).
Rating the certainty of evidence and strength of recommendations.
Writing a draft the guideline and then consult with multiple expert groups and consumer advocacy groups to gather their feedback.
Finalisation and publishing of the guideline

Why isn’t all available evidence included in clinical guidelines?

The Australian Living Evidence Guideline: Endometriosis includes the best available research. Not all evidence will meet the necessary quality standards and may be excluded if it has methodological flaws. Factors include study design (e.g., randomized controlled trials), risk of bias, relevance to the guideline topic, and consistency of findings.

What is “living evidence”?
Traditional guidelines may be updated every few years whereas living evidence refers to continuously updated research that is regularly reviewed and incorporated into clinical guidelines.

How is new evidence identified?
New studies can be identified if they have a significant impact on clinical care (eg. if a new treatment is found), or new research can be screened with evidence surveillance.

How will I know if a recommendation has changed?
The Australian Living Evidence Guideline: Endometriosis will include version tracking of any changes.

Can guidelines differ between countries?
Yes, due to differences in healthcare systems, populations, and available resources.

Do clinical guidelines consider patient preferences?
The Australian Living Evidence Guideline: Endometriosis incorporates patient values, preferences, and shared decision-making principles.

What if my case is different from what’s described in the guideline?
Guidelines provide general recommendations. Your healthcare provider should tailor care to your specific symptoms, medical history, and personal circumstances

Can I have a treatment if it is not included in the guideline?
Yes, you can choose to have treatment or not according to your individual needs and preferences and in discussion with your healthcare provider.

I live in regional Australia, how can I access the right care?
The guideline has been developed to support care for people throughout Australia. The recommendations suggest preferred options for the diagnosis and management of endometriosis, but these can be discussed with your healthcare provider according to your needs.