Treatment & management of endometriosis
Page highlights:
- There were 44,200 endometriosis-related hospitalisations in 2022–23, a 54% increase since 2012–13 (28,700 hospitalisations). This represents 335 hospitalisations per 100,000 females (up from 250 in 2012–13).
- The rate of endometriosis hospitalisations doubled among females aged 20–24 in the past decade, from 325 hospitalisations per 100,000 females in 2012–13 to 650 per 100,000 in 2022–23.
- There were 1,300 endometriosis-related hospitalisations for First Nations people, representing 2.9% of endometriosis-related hospitalisations.
- The age standardised-rate for endometriosis-related hospitalisation in Major cities was 1.5 times the rate in Remote and very remote areas.
- Around two-thirds (65%) of endometriosis-related hospitalisations took place in a private hospital.
Emergency department presentations
- There were more than 4,800 endometriosis-related emergency department (ED) presentations in 2023–24. This represents around 35 presentations per 100,000 females.
- Around three-quarters (76%) of endometriosis-related ED presentations were triaged as needing to be seen within 30 minutes or less.
There is no known cure for endometriosis. Treatments are available to manage the symptoms associated with endometriosis and improve quality of life, including:
- pain relievers
- hormonal treatments, including hormonal contraceptives, which suppress ovulation and periods
- surgery for the removal of lesions via laparoscopy (key-hole surgery) or laparotomy (abdominal surgery).
In severe cases, surgery may be performed to remove the uterus (hysterectomy) or remove parts of the bowel affected by endometriosis (The Royal Women’s Hospital 2023). In most cases, hysterectomy is performed to treat other causes of uterus pain (for example, adenomyosis), and to prevent possible future regrowth of endometriosis around these organs. Where endometriosis has contributed to reduced fertility, surgery to remove lesions may be used to improve fertility.
Individuals may also seek treatment from allied health or complementary therapies, such as physiotherapy, acupuncture, traditional Chinese medicine, exercise, and diet modifications (RANZCOG 2021).
General practitioners are often the first point of contact for those with suspected endometriosis and are therefore instrumental in identifying symptoms, prescribing medication or providing referrals to specialists for further testing and/or treatment. The management of endometriosis in primary care presents a substantial data gap. See Data gaps and opportunities for further information.
Hospitalisations
According to the AIHW National Hospital Morbidity Database (NHMD), there were 44,200 endometriosis-related hospitalisations in 2022–23. This represents 335 hospitalisations per 100,000 females. Around half (51%) of endometriosis-related hospitalisations in 2022–23 had endometriosis as the principal diagnosis (the main reason for hospitalisation).
Age
Most endometriosis-related hospitalisations (82% in 2022–23) are among females aged 15–44 (Figure 3), which are generally regarded as a woman’s reproductive years. This represents 19 out of every 1,000 hospitalisations among females in this age group.
Figure 3: Age profile of endometriosis-related hospitalisations, 2012–13 to 2022–23
Line chart shows that in 2022–23 the overall number of hospitalisations, rate of hospitalisation and total bed days were highest among females aged 35–39.
Notes:
- Rates were calculated using the December estimated resident population for females.
- To preserve confidentiality, data by hospital sector (public/private) have been suppressed for age groups 0–14, 60–64 and 65+.
Source: AIHW National Hospital Morbidity Database (NHMD).
Trends over time
Rates of endometriosis-related hospitalisation increased among females aged 15–44 over the past decade. The greatest increase was among those aged 20–24, where the rate of endometriosis hospitalisations doubled, from 325 hospitalisations per 100,000 females in 2012–13 to 650 per 100,000 in 2022–23 (Figure 4). This was particularly driven by the increase in the rate of hospitalisations in private hospitals among this age group, which more than doubled from 170 to 410 hospitalisations per 100,000 females.
Figure 4: Endometriosis-related hospitalisations, 2012–13 to 2022–23
Line chart shows that the number and rate of hospitalisations were higher in private hospitals than public hospitals for all years. The median age was younger in public hospitals across all years.
Note: Rates were calculated using the December estimated resident population for females.
Source: AIHW National Hospital Morbidity Database (NHMD).
Variation between population groups
In 2022–23, endometriosis-related hospitalisations varied between population groups (Figure 5). These differences could reflect potential variations in access to health services, including different barriers to access, or differences in health-seeking behaviour between population groups, rather than a difference in disease prevalence.
First Nations people
There were 1,300 endometriosis-related hospitalisations for Aboriginal and Torres Strait Islander (First Nations) women in 2022–23, representing 255 hospitalisations per 100,000 females. In 2022–23, about 2.9% of endometriosis-related hospitalisations were First Nations women, lower than the proportion of all female hospitalisations who were First Nations women (6.0%).
The age-standardised rate for endometriosis-related hospitalisations among non-Indigenous Australians was 1.2 times the rate for First Nations women.
Socioeconomic area
The age-standardised rate for endometriosis-related hospitalisation in the highest 20% of socioeconomic areas (the areas of least disadvantage) was 1.3 times the rate in the lowest 20% (the areas of most disadvantage).
Remoteness area
The age standardised-rate for endometriosis-related hospitalisation in Major cities was 1.5 times the rate in Remote and very remote areas. This contrasts with the pattern seen for all female hospitalisations, for which the age-standardised rate in Remote and very remote areas is twice the rate in Major cities.
Country of birth
In 2022–23, 25% of endometriosis-related hospitalisations were among females born outside of Australia. This is similar to the proportion for all female hospitalisations (27%), and likely reflects the pattern seen in the general population, with 31% of females born outside of Australia according to the Census of Population and Housing (ABS 2024).
The rate of endometriosis-related hospitalisation varied by the region of birth. Rates were highest among patients born in the Americas, and lowest among patients born in Southern and Eastern Europe.
Median age also varied with country of birth. The median age of Australian-born endometriosis patients was lower than all other regions.
Figure 5: Endometriosis-related hospitalisations, by population group, 2022–23
Bar chart shows that the crude rate of endometriosis hospitalisations was highest in the second most advantaged socioeconomic group, in Major cities and in the Americas country of birth group.
Funding source
Most endometriosis-related hospitalisations were partly or fully funded by private health insurance (57%). A further 31% were for public patients, while 8.1% were for self-funded patients. Almost two-thirds (65%) of endometriosis-related hospitalisations took place in a private hospital.
Compared with all female hospitalisations in 2022–23, endometriosis-related hospitalisations were more likely to be partly or fully funded by private health insurance, self-funded, and/or occur in a private hospital (Table 1).
Funding source | Endometriosis hospitalisations, ages 15–44 (%) | Endometriosis hospitalisations, all ages (%) | All female hospitalisations, ages 15–44 (%) | All female hospitalisations, all ages (%) |
|---|---|---|---|---|
Private health insurance (partly or fully funded) | 56.2 | 56.7 | 32.5 | 41.0 |
Medicare(a) | 30.4 | 30.6 | 55.4 | 49.1 |
Self-funded | 9.0 | 8.1 | 7.2 | 4.2 |
Other | 4.5 | 4.6 | 4.9 | 5.7 |
Total | 100.0 | 100.0 | 100.0 | 100.0 |
(a) Also includes a small number of overseas visitors covered by Reciprocal Health Care Agreements and those ineligible for Medicare who’s services were free of charge at the discretion of the hospital.
Source: AIHW National Hospital Morbidity Database (NHMD).
Hospital sector | Endometriosis hospitalisations, ages 15–44 (%) | Endometriosis hospitalisations, all ages (%) | All female hospitalisations, ages 15–44 (%) | All female hospitalisations, all ages (%) |
|---|---|---|---|---|
Public hospital | 34.6 | 34.6 | 62.4 | 57.4 |
Private hospital | 65.4 | 65.4 | 37.6 | 42.6 |
Total | 100.0 | 100.0 | 100.0 | 100.0 |
Source: AIHW National Hospital Morbidity Database (NHMD).
Length of stay
Most endometriosis-related hospitalisations lasted 2 days or less, with 44% being same-day hospitalisations. The average length of stay was slightly shorter for hospitalisations with endometriosis as a principal diagnosis, compared with that for all endometriosis-related hospitalisations.
The average length of stay for endometriosis-related hospitalisations was shorter than that for all female hospitalisations:
- 1.5 days compared with 2.7 days for all female hospitalisations
- 2.0 days compared with 5.5 days for all female hospitalisations excluding same-day hospitalisations.
Procedures
In 2022–23, 95% of endometriosis-related hospitalisations involved at least 1 procedure (Table 2). Laparoscopic excision of lesion of pelvic cavity was the most common procedure, occurring in 45% of endometriosis-related hospitalisations.
Rank | Procedure code | Procedure name | Description | Per cent of hospitalisations |
|---|---|---|---|---|
1 | 35637-10 | Laparoscopic excision of lesion of pelvic cavity | Removal of lesions by cutting | 44.5 |
2 | 35630-00 | Diagnostic hysteroscopy | Examination of the inside of the uterus | 40.9 |
3 | 35640-00 | Dilation and curettage of uterus [D&C] | In which the lining of the uterus is scraped away | 37.9 |
4 | 30393-00 | Laparoscopic division of abdominal adhesions | In which adhesions are cut and divided | 24.4 |
5 | 35703-00 | Test for tubal patency | Assessment of whether fallopian tubes are blocked, used in investigating infertility | 17.5 |
6 | 35637-02 | Laparoscopic diathermy of lesion of pelvic cavity | Removal of lesions by burning | 16.1 |
7 | 35503-00 | Insertion of intrauterine device [IUD] | Insertion of a contraceptive device, which is also used in the treatment of endometriosis | 15.4 |
8 | 36812-00 | Cystoscopy | Examination of the inside of the bladder | 15.2 |
9 | 35638-10 | Laparoscopic salpingectomy, bilateral | Removal of both fallopian tubes | 13.1 |
10 | 35653-07 | Laparoscopic total abdominal hysterectomy | Removal of the uterus | 13.0 |
Notes:
- Procedures were counted only once if the same procedure was conducted more than once in a hospitalisation.
- Procedures for cerebral anaesthesia (ACHI block code 1910) were not included in this analysis – these are companion procedures for many other procedures.
- ‘Diagnostic hysteroscopy’ is the name of a procedure in the ACHI and does not imply that this procedure is being used to diagnose endometriosis.
Source: AIHW National Hospital Morbidity Database (NHMD).
Emergency department presentations
According to the AIHW National Non-admitted Patient Emergency Department Care Database (NNAPEDCD), there were 4,800 endometriosis-related emergency department (ED) presentations in 2023–24. This represents around 35 presentations per 100,000 females. Almost all (90%) presentations had endometriosis listed as the principal diagnosis.
Most endometriosis-related ED presentations were among females aged 15–44 (Figure 6). The rate of endometriosis-related ED presentations was highest in the 25–29 age group.
Around 71% of endometriosis-related ED presentations in 2023–24 ended with the patient leaving the hospital without being admitted or referred to another hospital. For 26% of the endometriosis-related presentations the patient was admitted to the same hospital for further care.
Figure 6: Number and rate of endometriosis-related emergency department presentations, by age group, 2023–24
| Age group (years) | ED presentations |
|---|---|
| 10 – 14 years | 15 |
| 15 – 19 years | 352 |
| 20 – 24 years | 1026 |
| 25 – 29 years | 1190 |
| 30 – 34 years | 938 |
| 35 – 39 years | 607 |
| 40 – 44 years | 393 |
| 45 – 49 years | 190 |
| 50 – 54 years | 40 |
| 55+ years | 18 |
| Age group (years) | ED presentations per 100,000 population |
|---|---|
| 10 – 14 years | 1.9 |
| 15 – 19 years | 44.4 |
| 20 – 24 years | 120.8 |
| 25 – 29 years | 122.6 |
| 30 – 34 years | 92.4 |
| 35 – 39 years | 61.3 |
| 40 – 44 years | 42.9 |
| 45 – 49 years | 23.1 |
| 50 – 54 years | 4.7 |
| 55+ years | 0.4 |
Notes:
- Includes presentations with a principal and/ or additional diagnosis of endometriosis.
- Rates were calculated using the December estimated resident population for females.
Source:
National Non-admitted Patient Emergency Department Care Database (NNAPEDCD).
Triage category
Triage category is used to indicate the level of urgency of a patient’s need for care. Of all endometriosis-related ED presentations in 2023–24:
- 11% were categorised as ‘requiring immediate or emergency care’ (within 10 minutes)
- 65% as ‘urgent’ (within 30 minutes)
- 23% as ‘semi-urgent’ (within 60 minutes) and
- 1.4% as ‘non-urgent’ (within 120 minutes).
Trends over time
Where endometriosis was the main reason for attending the ED (the principal diagnosis), the rate of ED presentations is trending upwards after fluctuating in the years surrounding the COVID-19 pandemic. Overall, between 2018–19 and 2023–24, ED presentations have slightly increased from 29 per 100,000 females to 32 per 100,000 (Figure 7). This is similar to the pattern seen among all female ED presentations during this period, which also fluctuated during the COVID-19 pandemic.
An individual may present to the ED with symptoms of endometriosis before they have received a diagnosis. In these cases, diagnoses related to pain, abnormal bleeding or menstrual issues are likely to be recorded. Figure 7 displays ED presentations for several diagnoses which may be related to endometriosis.
Figure 7: Emergency Department presentations for endometriosis and other selected diagnoses (principal diagnosis), 2018–19 to 2023–24
Chart shows the number of presentations for possible related diagnoses, including abnormal vaginal/uterine bleeding, acute pain in abdomen, pain in upper and lower abdomen and other pain in abdomen.
Note: Rates were calculated using the December estimated resident population for females.
Source: National Non-admitted Patient Emergency Department Care (NNAPEDC) Database.
ABS (Australian Bureau of Statistics) (2024), Australia's Population by Country of Birth, ABS Website, accessed 13 March 2025.
RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) (2021) Endometriosis clinical practice guideline, RANZCOG, accessed 25 October 2022.
The Royal Women’s Hospital (2023) Treating endometriosis, The Royal Women’s Hospital Website, accessed 6 February 2023.