Welcome to the Spring Edition of O&G Magazine, which focuses on endometriosis. Endometriosis or simply ‘endo’ as its commonly referred to by us as clinicians and our patients, is a complex, heterogenous disease with a wide spectrum of symptomatology. It is extremely common, with 1 in 10 women being diagnosed at some point in their lifetime. Given its prevalence, endometriosis often forms the cornerstone of daily practice in gynaecology clinics. In some respects, a lot has changed in this field and in others, very little. This is in part the reason why we commissioned endometriosis as the theme for the current edition of the magazine. Allow me to expand on this.

In Australia, the progressive increase in media and government coverage of the disease since the mid-2010s has brought improved awareness across public and professional domains. As a result of this, in addition to tireless advocacy from the Australian Coalition for Endometriosis (Pelvic Pain Foundation, Endometriosis Australia, EndoActive, QENDO and Endometriosis Western Australia) and other organisations such as RANZCOG and Pelvic Pain Victoria amongst others, we have seen a gamut of government funding including, most recently, new MBS rebates for complex gynaecology consultations.

For the first time in 20 years, women’s health medications such as Visanne (dienogest), Slinda (drosperidone), Ryeqo (relugolix/ estradiol/norethisterone), Prometrium (micronized progesterone), Yasmin/ Yaz (estradiol/ drosperidone) are subsidised on the PBS, making them more affordable. We now have cheaper MR scans and better rebates for sub-specialised endometriosis ultrasound imaging.

New incentivised funding is available at a primary healthcare level for multi-disciplinary endometriosis and pelvic pain clinics. Across Australia, state government health departments are launching inquiries into the current status of disease treatment and giving voice to patients’ stories. In fact, since the release of the federal National Action Plan for Endometriosis in 2018, over $87 million dollars has been committed to various clinical, educational and research initiatives related to the disease.

We’ve seen developments in clinical guidance. RANZCOG’s ‘Australian Living Evidence Guideline: Endometriosis’ published in May 2025 presents a cohesive summary of current evidence for assessment and treatment with the aim of ensuring consistency of care (read more on this in this edition). ANZCA’s Pain Faculty chapter also released a complementary statement (ANZCA, 2025) on the current approach to persistent pelvic pain, at the same time identifying the existing deficiency in our understanding of some of its aetiologies.

Whilst we proudly celebrate these wins for endometriosis care, we recognise that progress on the ground is still very slow. The chronic underfunding of GPs has resulted in deficiencies in primary care, such as poor access and the perception that women’s health care is difficult, too complex and under rewarded.

Existing generalised healthcare inequities in rural and remote areas are compounded for endometriosis. Access to quality imaging, physiotherapy, mental health services and pain specialists can be difficult and costly. Availability of multidisciplinary endometriosis care is rare in public healthcare settings, let alone outside major metropolitan centres.

In healthcare settings, improved awareness has resulted in increased rates of diagnosis and treatment but has also caused over attribution of female abdominal and pelvic symptoms to endometriosis. Emergency departments struggle with presentations of acute-on-chronic pain flares in patients with poorly managed disease and, upon admission to hospital, persistent pelvic pain patients experience the same roadblocks to care as any other chronic pain patients.

Patient expectations around care are higher on account of increased availability of education and information about the disease – expectations that are sometimes insurmountable due to resource limitations. Like most chronic conditions, good endometriosis care involves self-care including engagement in multidisciplinary therapy. With all these demands and the concurrent increase in diagnoses of other systemic conditions such as ADHD, POTS, ASD, MCAS amongst others, both patients and clinicians can find it hard to navigate the multitudes of therapies and recommendations.

Increased awareness and patient health literacy has reinforced the need to address the fundamental questions about endometriosis which we still don’t have answers to, such as:

• Better understanding of the pathophysiology
• Factors affecting susceptibility to persistent disease
• Immune aspects of disease onset and progression
• Optimal treatment for fertility, etc

Presenters at the recent World Endometriosis Congress in Sydney stressed the importance of collaboration and multi centre data gathering to advancing research in this field. In clinical settings, we are finding gaps in data collection which result in inaccurate or outdated epidemiological statistics. This, in turn, affects resource allocation; if you cannot prove how many patients present to your public clinic with endometriosis symptoms, pursuing funding for better treatment is difficult.

The Minister for Health & Ageing, the Hon. Mark Butler, has committed funding through the Medical Research Future Fund and National Health and Medical Research Council (NHMRC), and in May 2025 a $50 million-dollar philanthropic donation was made to the University of Sydney for endometriosis dedicated research. Hot off the press, the Victorian Premier, the Hon. Jacinta Allen, has pledged $1.5 million in the Women’s Health Research Catalyst Grants program (Victorian State Govt., 2025) to support research projects in women’s health across the board. Since the inception of the National Action Plan for Endometriosis, we have seen an increase in research output as documented by a spike in publications (Abbott, 2024). We eagerly await the results of their work as we grapple with this complex disease spectrum. We would also like to acknowledge and support the research already undertaken and currently taking place in this field.

This edition of O&G Magazine explores endometriosis care and advocacy, featuring case studies, patient perspectives, and clinical updates from across Aotearoa New Zealand and Australia. We examine the lived experience of endometriosis through powerful contributions, including a Q&A with Bindi Irwin, the account of a physician navigating their own endo journey, and the transformative journey “Over It to Empowered”, highlighting the impact of a multidisciplinary care approach. Clinical insights include an in-depth look at the medical management of invasive rectal endometriosis and a case study on ethnic disparities in diagnosis and treatment.

We also spotlight advances in ultrasound, dietary interventions and emerging nutrition research, and the roles of physiotherapy and psychology in holistic care. Endometriosis in children and adolescents is explored alongside a review of Dr Susan Evans’ book Endometriosis & Pelvic Pain for Teens tailored to this patient population. We revisit Stage 4 disease and its management with a focus on fertility, and in our regular ‘Leaders in Focus’ section, we speak with a rural practitioner about delivering care in their corner of this vast country. To round out the issue, Dr Marilla Druitt reviews Peta Wright’s book Healing Pelvic Pain, reinforcing the importance of holistic care.

As we celebrate Endometriosis Awareness Month with its yellow theme every March, we are reminded of just how far we have come and, by the same token, of the long road ahead. We hope to revisit this theme in the near future to update you on more incredible milestones and discoveries, which result in improved understanding and better management of the disease. For now, we invite you to enjoy this edition and, as always, look forward to your feedback.