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By now, many women have seen the Four Corners episode which exposed poor care, and particularly the overuse of laparoscopic surgery leaving women much worse off with severe, unrelenting pain. Hundreds of women have come forward with complaints about their care, and GPs report being questioned by women with endometriosis about what they should do.

The ABC Four Corners investigation found women had undergone multiple surgeries with major organs removed, usually making them worse in the process.

Endometriosis is when tissue similar to the lining of the uterus implants in the pelvis, bowel or more distant organs.

Here’s what’s important to understand: the symptoms don’t relate closely to the extent of the disease. Widespread endometriosis doesn’t necessarily mean severe pain and, equally, quite localised endometriosis can be associated with debilitating pain. Some women have no symptoms at all and it’s only discovered when investigating infertility.

The diagnosis can generally be made from a woman’s history and combination of symptoms: pain during sex, painful periods, pain with defecation, pelvic pain and/or heavy menstrual bleeding. There’s a common view that ultrasound is necessary, but here’s the problem: ultrasound to detect endometriosis is highly specialised, needs extensive training, and isn’t usually available at your local radiology practice. It can help with the diagnosis and maybe deciding if laparoscopic surgery is advisable, but it’s not essential for diagnosis.

The core treatments are non-surgical – medications and pelvic floor physiotherapy. Laparoscopic surgery is of limited value and far from guarantees pain relief. Sometimes surgery can actually induce chronic pain, so it needs to be chosen carefully, ideally with a second opinion. The ABC Four Corners investigation found that women in this Melbourne practice had undergone multiple surgeries with major organs removed, usually making them worse in the process.

The main message: get diagnosed as quickly as possible so treatment can start early with the least invasive approaches, hopefully controlling the disease before it progresses.

More information: https://endometriosisaustralia.org/