Endometriosis, affecting approximately one in seven Australian women, remains under-recognised, under-funded and misunderstood.
Despite the profound impact endometriosis has on health and wellbeing, its diagnosis and management is complex – with an average of 6–8 years between the onset of symptoms and diagnosis.
‘This delay is where pharmacists have a crucial role in recognising the symptoms of endometriosis and referring women promptly for diagnosis and treatment,’ said Grace Wong, Medication Safety Pharmacist at The Royal Women’s Hospital – who will be leading a session on Championing change for endometriosis care at PSA25 next month.
Why does endometriosis take so long to diagnose?
There are several interrelated factors at play. Historically, a definitive diagnosis of endometriosis required laparoscopic surgery with histopathological confirmation.
But the limited availability of trained gynaecologists to perform these procedures has created a bottleneck in timely diagnosis.
Additionally, the variable and often non-specific nature of endometriosis symptoms – such as chronic pelvic pain, fatigue, dysmenorrhea, cyclical hematuria, dysuria and gastrointestinal disturbances – can lead to misdiagnosis of other conditions such as irritable bowel syndrome.
Patients experiencing chronic pelvic or abdominal pain may present repeatedly for symptom relief, with opioids or high-dose non-steroidal anti-inflammatory drugs (NSAIDs) often supplied without further investigation into the underlying cause. This pattern not only delays appropriate diagnosis but also increases the risk of adverse effects and medicine overuse.
Societal stigmas surrounding menstruation can lead many to normalise menstrual pain, delaying medical attention.
‘Removing stigma and making women feel confident and comfortable to speak to their pharmacist for advice is something pharmacists and pharmacy support staff can continue to improve,’ Wong said.
When should endometriosis be suspected?
Endometriosis should be considered in anyone of reproductive age presenting with persistent pelvic pain – especially when it’s acyclical, unresponsive to first-line treatments, or associated with other gynaecological symptoms such as dyspareunia (painful intercourse) or dysmenorrhoea.
Atypical symptoms of endometriosis include:
- cyclical gastrointestinal symptoms (such as painful bowel movements)
- dyschesia (difficult defecation)
- chronic fatigue
- urinary urgency
- pain in the lower back, legs, upper abdomen or chest.
‘Once diagnosed, pharmacists can help women manage their symptoms through providing evidence-based advice, appropriate counselling for any prescribed medicines, and support women in their journey to managing their condition and leading high quality and productive lives,’ Wong said.
What’s the role of pharmacists?
Pharmacists are often the first health professionals that people with endometriosis speak to about menstrual pain or gastrointestinal discomfort. So understanding the pathophysiology, risk factors, and wide-ranging symptoms of endometriosis is essential.
Pharmacists can play a critical role by recognising these red flags, challenging the stigma of normalising menstrual pain and shifting symptomatic management with:
- over-the-counter pain relief
- investigating the presentation and symptoms
- seeking appropriate medical assessment aids in the timely diagnosis of endometriosis
- inquiring about patients who present prescriptions for menstrual-related analgesia, who may have underlying red flags that went unrecognised by prescribers.
Validating patient experiences means avoiding the following terminology:
- ‘It’s just period pain’ or ‘That’s normal for women’: these phrases are dismissive and contribute to delayed diagnosis and stigma
- ‘Everyone goes through this’: minimises the patient’s pain and experience
- ‘Are you sure it’s not just stress?’: while stress can exacerbate symptoms, it should not be suggested as the sole cause
- ‘You don’t look sick’: many chronic illnesses, including endometriosis, are invisible.
Instead, pharmacists could ask:
- ‘Could you describe if you’ve experienced painful intercourse or pain during bowel movements, particularly around your menstrual cycle?’
- ‘Do you have any urinary symptoms, such as pain or blood in your urine, and do these seem to relate to your period?’
- ‘Would you be willing to track your symptoms daily to help us identify any patterns?’
Pharmacists should also inquire about the impact of symptoms on quality of life and well-being to help break through the ‘suck it up’ mentality that’s often dismissed as normal menstrual pain or hormonal fluctuations.
‘As trusted health professionals, pharmacists have an important role in raising awareness about this condition and supporting efforts to improve services for women with endometriosis,’ Wong said.
What are the treatment options?
Treatment of endometriosis is often medical, with a patient-centred approach based on symptoms and reproductive goals.
When pharmacological treatment is appropriate, pharmacists hold a critical role in supporting medicine adherence and counselling.
Common pharmacological treatments include:
- hormonal therapies such as combined oral contraceptive pill (COCP), progestogen-only pills, or levonorgestrel-releasing intrauterine devices (IUDs)
- non-hormonal options including NSAIDs for pain control
- emerging therapies including GnRH antagonists (e.g. elagolix, relugolix) and selective progesterone receptor modulators, particularly for refractory cases.
As medicines experts, pharmacists play a critical role in counselling patients on endometriosis treatments, and managing adverse effects such as reduced bone density associated with GnRH therapy.
What does the future hold?
Until recently, endometriosis had been largely overlooked in national funding and research priorities. However, there has been a recent welcome shift in public health policy towards acknowledging endometriosis as a serious chronic condition requiring coordinated care.
The federal government’s National Action Plan for Endometriosis, launched in 2018, marked the first significant step toward national recognition. Since then, investment in awareness campaigns have helped improve visibility and care pathways. Building on this, the 2025–26 federal budget introduced pivotal investments in women’s health, including the establishment of 11 specialist endometriosis and pelvic pain clinics and the addition of a new Medicare Benefits Schedule item for advanced diagnostic ultrasound techniques.
‘Pharmacists are an integral part of the healthcare system, and I envisage there is potential for pharmacists to be more involved directly and indirectly in care of women with endometriosis, to help support the National Action Plan’s vision,’ Wong said. ‘To prepare for further involvement, I would encourage pharmacists to find ways to upskill now to be ready and confident to step up when the time comes.’
Hear more from Grace Wong about the role of pharmacists in endometriosis by attending the ‘Championing change for endometriosis care’ session at PSA25, held in Sydney from 1–3 August. Register here to attend.
