Health Insights
How is endometriosis assessed? What to expect when you seek help
Endometriosis can take time to diagnose. Learn how to describe your symptoms, what a GP consultation may involve, the role and limits of examinations and scans, and what to bring.
Severe period pain, pain during sex and persistent pelvic pain are often minimised or put up with for years. If you are wondering whether endometriosis could be part of the picture, it helps to know what an assessment may involve.
Endometriosis is a long-term inflammatory condition in which tissue similar to the lining of the uterus is found outside the uterus. (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) This article explains how to describe your symptoms, what a GP consultation may involve, and what examinations and scans can and cannot show. It is not a tool for self-diagnosis.
For possible causes of pelvic pain more broadly, see what can cause persistent pelvic pain?.
Why diagnosis can take time
Diagnosis can be delayed. Symptoms vary widely between people, many of them are also found in other conditions, and endometriosis is often under-recognised. (Royal Australian and New Zealand College of Obstetricians and Gynaecologists; RANZCOG quick reference guide) Endometriosis Australia reports an average diagnostic delay of 6.5 years. (Endometriosis Australia)
Severe period pain that interferes with daily life is one of the common symptoms of endometriosis, and it is worth discussing with a doctor. (Endometriosis Australia)
Describing your symptoms and their effect on your life
Symptoms differ from person to person, and the level of pain does not reliably reflect how much endometriosis is present. Common symptoms include severe period pain, pain during or after sex, pelvic pain, heavy periods and infertility. Less common symptoms include bowel or urinary symptoms, severe tiredness, back pain, sleep difficulty and headache. (RANZCOG quick reference guide)
Having one or more of these symptoms does not mean you have endometriosis. Similar symptoms can have other causes, which is why assessment matters.
A doctor may ask about your symptoms and how they affect your life, whether you are trying to become pregnant, any history of autoimmune disease, and whether close relatives have had endometriosis. (RANZCOG quick reference guide) It can help to think about:
- 01
where the pain is, when in your cycle it happens and how long it lasts
- 02
how much it stops you from working, studying, exercising or sleeping
- 03
pain during or after sex, or when you go to the toilet
- 04
how heavy your periods are and whether they are regular
- 05
bowel or bladder symptoms, back or leg pain, or tiredness
- 06
what you have already tried for the pain and whether it helped
- 07
whether you are trying, or planning, to become pregnant
Keeping a short-term symptom diary may help the discussion with your doctor. (RANZCOG quick reference guide)
What a GP consultation may involve
A doctor will usually ask about your symptoms and medical history. They may offer an abdominal or pelvic examination, which can help look for signs of endometriosis and for other possible causes of your symptoms. A pelvic examination is not always needed, and a normal examination does not rule out endometriosis. (RANZCOG quick reference guide)
An examination is your choice. You can ask what it involves and why it is suggested before deciding.
The RANZCOG guideline notes that endometriosis can be diagnosed and managed in primary care, and that for some people referral to a specialist may be beneficial. (Royal Australian and New Zealand College of Obstetricians and Gynaecologists)
What examinations and scans can and cannot show
For people with symptoms that suggest endometriosis, an internal (transvaginal) ultrasound is the preferred first investigation. If that is not appropriate, for example because of age or sexual history, a pelvic MRI may be offered, and an ultrasound over the abdomen can be used if neither is possible. (RANZCOG quick reference guide)
Scans reported by specialists trained in endometriosis can identify it with high accuracy, but a normal ultrasound does not rule it out. If there is clinical concern, a specialist ultrasound or an MRI may be suggested. (RANZCOG quick reference guide)
Endometriosis has previously required surgery to confirm the diagnosis. RANZCOG notes emerging evidence that more cases can be diagnosed accurately using non-invasive imaging, such as transvaginal ultrasound and MRI. (Royal Australian and New Zealand College of Obstetricians and Gynaecologists)
A laparoscopy is keyhole surgery under general anaesthetic. Tissue that looks like endometriosis can be removed during the operation and checked under a microscope. Whether to have one depends on your symptoms, your preferences and whether you are planning a pregnancy, and it is worth discussing the possible benefits and risks with your doctor. (Endometriosis Australia; RANZCOG quick reference guide)
A normal result is information, not a dismissal of your symptoms. It is reasonable to ask what a result does and does not rule out.
When referral may be considered
Depending on your symptoms and scan results, a doctor may suggest a specialist ultrasound, an MRI or a referral to a gynaecologist, for example if symptoms do not improve with initial management or deep endometriosis is suspected. If fertility is a current priority, referral to a fertility specialist may be suggested. (RANZCOG quick reference guide)
People with suspected or confirmed endometriosis may benefit from coordinated care from a team, which can include GPs, nurses, physiotherapists, psychological support services, gynaecologists with expertise in endometriosis and pain management services. (RANZCOG quick reference guide)
Whether and when referral is appropriate depends on your symptoms, findings, preferences and priorities, including any plans for pregnancy. Decisions about care should be shared between you and your doctor. (Royal Australian and New Zealand College of Obstetricians and Gynaecologists)
Records and questions to bring
If you have them, it can help to bring:
- 01
a symptom diary covering your cycle, pain and other symptoms
- 02
previous ultrasound, MRI, pathology or operation reports
- 03
letters from other doctors you have seen about these symptoms
- 04
a list of medicines and supplements, including hormonal contraception, and what you have tried for pain
Questions you might ask include:
- 01
What could be causing my symptoms, and what else should be considered?
- 02
Which examinations or scans would be useful for me, and why?
- 03
What would a normal result mean?
- 04
Should I be referred, and to whom?
- 05
What should I do if my symptoms change before my next appointment?
For broader preparation tips, see your first women's health appointment: what to discuss and how to prepare.
When to seek help sooner
If your symptoms severely affect your daily life, it is worth seeing your doctor rather than putting up with them. Endometriosis can have psychological and social effects as well as physical ones. (Royal Australian and New Zealand College of Obstetricians and Gynaecologists; RANZCOG quick reference guide)
Ongoing symptoms are usually assessed through a routine appointment. If you have sudden, severe pain or other warning signs, seek urgent medical care or call Triple Zero on 000. What can cause persistent pelvic pain? lists warning signs that need urgent care.
Taking the next step
References
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (n.d.). Australian Living Evidence Guideline: Endometriosis. https://ranzcog.edu.au/resources/endometriosis-clinical-practice-guideline/ Checked 14 October 2026.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (n.d.). Australian Living Evidence Guideline: Endometriosis. Quick reference guide for primary care. https://ranzcog.edu.au/wp-content/uploads/Endometriosis-Guideline-Quick-Reference-Guide.pdf Checked 14 October 2026.
Endometriosis Australia (n.d.). Understanding endometriosis. https://www.endometriosisaustralia.org/about-endometriosis Checked 14 October 2026.
Endometriosis Australia (n.d.). Symptoms of endometriosis. https://www.endometriosisaustralia.org/symptoms Checked 14 October 2026.
Endometriosis Australia (n.d.). Diagnosis of endometriosis. https://www.endometriosisaustralia.org/diagnosis Checked 14 October 2026.
Your symptoms are worth describing in full
A consultation can help you talk through your symptoms and how they affect you, and discuss what assessment may be appropriate.