If you’re looking into endometriosis treatment options, you’ve probably already been living with symptoms for some time. For many people, getting a diagnosis comes after years of uncertainty. Once you finally have some answers, another question often follows: should you consider endometriosis surgery, or are there non-surgical treatments that may be right for you?
Recent discussion about endometriosis surgery has left many people feeling unsure. Some worry about having surgery they may not need. Others worry about waiting too long for treatment that could improve their symptoms or support their fertility. It’s understandable to have questions, especially when there is so much information and opinion to navigate.
Before making any decisions, it’s important to understand what your endometriosis looks like and how it’s affecting you. We look at your symptoms, your imaging, your fertility plans and what matters most to you before talking about treatment. From there, we can explain your options, including when non-surgical management may be appropriate and when surgery may become part of the conversation. You should have the time, information and support to make a decision that feels informed and right for your situation.
What the Current Guidelines Recommend
When fertility isn’t an immediate priority, treatment focuses on improving your quality of life and helping you manage symptoms. The stage of endometriosis doesn’t always reflect how it affects you. Some people with Stage IV endometriosis have few or no symptoms, while others experience significant pain despite having only superficial disease. This is why your treatment plan is guided by both your symptoms and what we find during your assessment. Current Australian guidelines developed through RANZCOG recommend starting with the least invasive treatment that is likely to improve your symptoms. For many people, that means hormonal therapy and symptom management before surgery is considered. If symptoms continue despite medical treatment, imaging shows more advanced disease such as an endometrioma or deep endometriosis, fertility is part of your plans, or the diagnosis is still unclear, your specialist may recommend a laparoscopy (keyhole surgery).
Endometriosis surgery can reduce pain, improve quality of life and support fertility for some people. It isn’t the right option for everyone, and it isn’t a guaranteed cure. Before recommending surgery, your specialist will consider your symptoms, your imaging, your fertility goals and your overall health. Understanding the potential benefits, the limitations and the possible risks can help you decide on the approach that feels right for your situation.
Non-Surgical Treatment Options for Endometriosis
For many people, non-surgical treatment is the best place to start. This is often the case if your symptoms are mild to moderate, you’re managing them reasonably well, or you’d prefer to explore medical treatment before considering surgery. These treatments focus on managing symptoms rather than removing endometriosis. For some people, that’s enough to improve day-to-day life. If you have more extensive disease, structural changes such as endometriomas or fertility concerns, surgery may become part of the conversation.
Pain relief
Anti-inflammatory medications such as ibuprofen, mefanamic acid or naproxen, and simple analgesics such as paracetamol, are often the first step for period pain and pelvic discomfort. They are most useful to provide background pain relief but do not treat underlying disease.
Combined oral contraceptive pill
The pill is one of the most commonly prescribed hormonal treatments. By suppressing or regulating ovulation, and therefore the menstrual cycle, it can reduce period pain and slow the growth of endometrial tissue and is often the first hormonal option offered after diagnosis.
Progestin therapy
Progestins, delivered as a pill, injection, or implant, suppress endometrial tissue and reduce bleeding. They are a well-established option for people who cannot take oestrogen-containing contraceptives.
Hormonal IUD (Mirena)
The Mirena releases a low-dose progestin locally to ease period pain and heavy bleeding and is a useful option for long-term symptom management without a daily tablet.
GnRH agonists
GnRH agonists induce a temporary, reversible medical menopause that reduces endometrial activity. They are effective for pain but are generally used short-term, because of their effect on bone density, and are often used to prepare for surgery rather than as a standalone long-term treatment. Because of the side effects of menopausal symptoms and the impact on bone density, this is sometimes used in conjunction with a physiological dose of oestrogen.
When Surgery Is Considered, and What It Involves?
If non-surgical treatment hasn’t provided enough relief, imaging shows more extensive disease or fertility is an important part of your planning, your specialist may recommend surgery. In most cases, this is performed using a laparoscopy, also known as keyhole surgery.
A normal pelvic ultrasound does not rule out endometriosis. In this instance, a laparoscopy allows your surgeon to confirm the presence or absence of endometriosis. Where disease is confirmed on ultrasound or examination findings, a laparoscopy also allows your surgeon to treat endometriosis. It is performed through small incisions.
Excision and ablation
There are two main techniques used to treat endometriosis during a laparoscopy: excision and ablation. Excision removes the endometriosis lesions from the surrounding tissue, while ablation uses heat to destroy the lesions on the surface.
Current evidence shows that neither technique is consistently better for everyone. The most appropriate approach depends on the location and extent of the disease, your symptoms and your surgeon’s experience. In some cases, both techniques may be used during the same procedure.
One advantage of excision is that the removed tissue can be examined under a microscope. This confirms the diagnosis through histopathology, which is one reason excision is often preferred when either technique would be suitable. However, in another example of superficial endometriosis on the ovary, ablation is preferred to minimise injury to the ovary and its potential impact on future fertility. If you have deep or complex endometriosis, excision can be technically demanding and is best performed by a surgeon with specific expertise in endometriosis surgery.
Cystectomy for endometriomas
If an endometrioma (an ovarian cyst caused by endometriosis) is causing symptoms or affecting fertility, your specialist may recommend a cystectomy to remove the cyst wall. The aim is to treat the endometrioma while preserving as much healthy ovarian tissue as possible, which is particularly important if you’re thinking about having children. Small endometriomas that aren’t causing symptoms may not need surgery and can often be monitored with regular ultrasound.
Hysterectomy
For a small number of people with severe symptoms that haven’t improved with other treatments, a hysterectomy may become one of the options to consider. This is usually only recommended if you’ve completed your family and other treatments haven’t provided enough relief. It’s also important to understand that a hysterectomy isn’t a guaranteed cure for endometriosis. If endometriosis outside the uterus isn’t also treated, symptoms can continue after surgery.
Deciding Whether Surgery Is Right for You
There isn’t one treatment approach that’s right for everyone. The decision depends on your symptoms, the extent of your endometriosis, your fertility plans and what you’re hoping to achieve. Before recommending surgery, your specialist will take the time to understand your individual situation and talk through the options with you.
As a general guide, non-surgical treatment is often the right place to start if your symptoms are mild to moderate, hormonal therapy is helping to manage them, you’ve recently been diagnosed, you’re not planning to conceive in the near future or you’d like time to explore your options before considering surgery.
Surgery plays an important role in both diagnosing and treating endometriosis. Your specialist may recommend it if non-surgical treatment hasn’t provided enough relief, imaging shows more extensive disease such as an endometrioma or deep infiltrating endometriosis, fertility is an important consideration or your symptoms are significantly affecting your quality of life.
The decision to have surgery should never feel rushed. Equally, if surgery is likely to benefit you, it’s important to understand when and why it may be recommended. Taking the time to understand your symptoms, your imaging, your fertility goals and your personal preferences helps ensure the treatment plan is tailored to your needs. At Create Health, that’s how we approach every consultation. We start by understanding your situation, explain what we’ve found and talk through every option with you. The goal is to help you make a decision that feels informed and right for you.
Endometriosis Surgery and Your Fertility
If you’re hoping to have children, planning surgery involves another layer of consideration. We look at whether surgery is likely to help, when it should happen and how to protect your ovarian reserve throughout the process.
For example, removing an endometrioma may improve access to eggs during IVF egg collection. At the same time, surgery can affect ovarian reserve, so it’s important to balance the potential benefits with the possible impact on future fertility. Understanding your ovarian reserve, your fertility goals and your treatment timeline helps guide the right approach for your situation.
At Create Health, our gynaecology and endometriosis specialists work closely with the fertility team at Create Fertility. This means your surgical care and fertility planning are considered together, giving you a coordinated treatment plan that reflects your individual goals.
Frequently Asked Questions: Endometriosis Surgery in Melbourne
Is it possible to treat endometriosis without surgery?
Yes, for many people, non-surgical management is the recommended first-line approach and can control symptoms for years. Surgery is generally considered when medical treatment hasn’t worked, when significant structural disease is present, or when fertility is a priority. Your specialist will guide this based on your individual assessment.
Is excision better than ablation?
Current guidelines do not establish that one technique gives clearly better outcomes than the other. Excision does allow the removed tissue to be examined under the microscope to confirm the diagnosis, which is one reason it is often preferred when either would be suitable. The best technique depends on the nature and location of your disease and your surgeon’s experience.
Will endometriosis come back after surgery?
Endometriosis can recur after surgery. Ongoing hormonal management afterwards is often recommended to reduce the chance of recurrence, and your specialist will discuss this with you as part of your longer-term plan.
How long is recovery after laparoscopic surgery?
Most people return to light activity within one to two weeks and to normal activities within two to four weeks, depending on the complexity of the procedure. Your specialist will give you a personalised recovery plan based on what was performed.
Endometriosis Care at Create Health Melbourne
Choosing between surgical and non-surgical treatment for endometriosis isn’t always straightforward. It starts with understanding your symptoms, your fertility goals and what matters most to you. From there, we can explain your options and recommend a treatment plan that’s tailored to your individual needs.
Our endometriosis specialists in Melbourne provide thorough, evidence-based assessments and take the time to answer your questions before making any recommendations. Whether you’re considering surgery for the first time or looking for a second opinion, we’re here to help you understand your options with confidence.
With clinics in Mount Waverley, East Melbourne and Berwick, our experienced endometriosis surgeons work alongside specialists in fertility, physiotherapy and psychological care. By bringing these services together, we can provide coordinated care that supports your health, your wellbeing and your future fertility goals.
