Living with Endometriosis in Rural Australia

8 June

Endometriosis is a condition that affects one in seven females across Australia. For women living in rural and remote regions, navigating the healthcare system can be particularly confusing and challenging, especially when dealing with persistent pelvic pain. The complexities of accessing suitable care in these areas often add another layer of difficulty to an already burdensome condition.

Raising awareness and improving the general population’s understanding of endometriosis and pelvic pain play a crucial role in addressing the isolation that many women in rural communities experience. By fostering greater knowledge and open conversations about these issues, it becomes possible to reduce the sense of loneliness and misunderstanding that often accompanies persistent pain conditions.

At the heart of managing endometriosis is the question of how women can maintain a great quality of life and continue participating in activities that are meaningful to them, despite living with ongoing pain. Equipping individuals with practical tools and reliable information to effectively self-manage their condition is an important step towards supporting rural women who are facing the daily challenges of persistent pelvic pain. Through access to these resources, women are empowered to take an active role in their own health and wellbeing, building resilience and fostering a sense of hope and empowerment within rural communities.

For the one in five females in Australia living with pelvic pain, receiving a diagnosis of endometriosis takes an average of seven to twelve years. For females experiencing with pelvic pain living in regional areas, this diagnosis can take much longer. Pelvic pain and endometriosis are complex conditions that can affect the individual’s life on many levels; economic, social, emotional and physical. It can affect their quality of life and sense of wellbeing. Women often report feeling helpless, unsupported, and can be vulnerable to the perpetual cycle of persistent pain often followed by nervous system dysregulation. The topic of endometriosis and pelvic pain is often accompanied by misinformation, as recent research has challenged many previous therapeutic approaches and understandings of the condition. Endometriosis has many faces and research has found that presence, amount and location endometrial cells within the pelvis does not correlate with corresponding pain levels. This means that you can have endometriosis and no pain, or experience significant pain and have no presence of endometriosis. Helping understand what pain is and the complex relationship between pain and tissue damage is important. It is therefore a multifaceted condition that commonly causes pain and has been found to be influenced by variables such as inflammation, nervous system dysregulation, gut microbiome dysbiosis, pelvic floor muscle tension and therefore pain sensitivity.

‍Informing readers of the recent evidence can help to allay fears and empower individuals to take small steps in self-management. Long wait times and limited access to services and pain management options are obstacles women in the west face when managing their pelvic health. This can further lead to feelings of isolation and not being understood. Sometimes women living in regional and remote areas can wait years for a specialist appointment. It is also imperative to recognise that there is no one size fits all approach to managing pelvic pain. Pain is complex and multifactorial and is influenced by many factors. Senior Lecturer in Pain Sciences and pelvic pain researcher, Dr Jane Chalmers explains that “Good management has to start with good understanding. You won’t change behaviour until you understand why it matters.” The time delay between the onset of symptoms and diagnosis of the condition is on average seven years and in this time, some people are able to find relief, however for many others, they suffer in silence. Providing evidence-based information to educate and empower people experiencing longstanding pelvic pain can play a role in facilitating a sense of safety, autonomy and empowerment within the nervous system by gaining further understanding of their condition.

Diagnosis

‍The multifaceted nature of endometriosis means that no two cases are the same which can therefore delay diagnosis and effective treatment. Some individuals experience no symptoms, while others can experience severe pain, heavy menstrual bleeding, irregular periods, bleeding between periods, abdominal bloating, anxiety and depression, bladder pain, fertility problems and fatigue, among other symptoms.

There is a growing need to improve diagnostic pathways for earlier and more accurate management of the condition, ideally before symptoms become chronic. Recent evidence has also brought to light the emergence of non-invasive diagnostic techniques such as transvaginal ultrasound and magnetic resonance imaging (MRI) which are gaining further accuracy in the diagnosis of endometriosis. Again, a barrier here being gaining access to specialised radiographic and sonographic modalities that do not exist in rural areas.

Previously the main line of treatment was laparoscopic surgery in the form of ablation or excision. However, recent guidelines also highlight growing importance of non-surgical management as the first line of treatment now, with surgery being only performed if clinically indicated. It is important for females to be aware that laparoscopic procedures do not guarantee a reduction in pain.

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A Holistic Approach

Previously, endometriosis and pelvic pain were treated from an entirely medical perspective with hormonal therapy pharmaceuticals and laparoscopic surgery as the first line in treatment. However, current best practice promotes a collaborative care approach from various health practitioners. There is a call for a multi-disciplinary treatment options and clear care management pathways as outlined in the National Action Plan for Endometriosis (NAPE). Evidence guidelines outline the importance of a multidisciplinary team approach to the management of endometriosis, particularly from a biopsychosocial perspective where physical, emotional and social aspects are addressed. As highlighted in the Faculty of Pain Medicine ANZCA (FPM), statement on the clinical approach to persistent pelvic pain, best practice care encompasses timely access to whole-person, multidisciplinary management where equitable access to evidence based holistic treatment is prioritised. Multidisciplinary care usually involves advice and guidance from a nutritionist or dietician, pelvic health physiotherapist or osteopath, psychologist or counsellor, along with a specialist gynaecologist. Interprofessional collaboration is recognised as an essential aspect of providing quality and effective pain management. Coordinated care across various specialties is essential. However, guidelines are only as good as the practical application and it is widely recognised that many women living in rural and remote areas have limited access to a team of holistic care providers.

‍Pain management

Current medical practice to manage pelvic pain associated with endometriosis includes medication such as paracetamol and anti-inflammatories, hormonal therapies that reduce or eliminate menstruation. Specialists that manage this condition for their patients are more readily referring to other practitioners to be included in the healthcare picture and collaborative shared care. It is recognised that chronic pelvic pain can be complex and multifactorial and therefore a multidimensional approach is essential.

A holistic approach to pelvic pain is essential in long term management of endometriosis. In her book, Healing Pelvic Pain, Dr Peta Wright; a holistic gynaecologist, advocates for an integrative, multidisciplinary approach to managing pelvic pain and endometriosis. Drawing on her clinical experience treating females suffering chronic pelvic pain and endometriosis, Dr Wright supports a whole-body approach, considering nervous system regulation and inflammation paramount in successful and comprehensive management.

Dr Wright advocates for informing and empowering women to help give them tools and support to manage their pain conditions. Dr Wright considers nervous system, diet, gut health, inflammation, stress, lifestyle, pelvic floor muscle tension, even whether we will live in a stressful environment or not, can all influence our experience of pain. As remedies, practices such as journalling, being in nature, deep breathing and meditation can all help as tools to help regulate our nervous system. You can read more about her and purchase her book here. Whilst pharmaceuticals, hormone therapy and laparoscopic surgery were previously the preferred method of treatment, research now supports alternate modalities such as hands on manual therapy, anti-inflammatory diets, supplements, stretching, breath work,

Chronic pain dials up the nervous system, leading to central sensitisation and current research demonstrates the complexity of psychological, behavioural and social factors that can perpetuate pain. The Bridging the Gender Pain Gap Inquiry into Women’s Pain Report 2025 report conducted in Victoria found that 89% of respondents said that pain affected their mental health. Persistent pelvic pain can affect the individual’s emotional relationships, hobbies and interests and has been linked with increased levels of anxiety and depression. Therefore, for suffers of longstanding pelvic pain affecting their mental wellbeing, it is important to seek professional help with a registered psychologist. A consultation with a therapist help break down and give you understanding of how pain is created in the brain, what things can influence it, and most importantly, helpful strategies to manage it long term. When patients are informed about their condition, it helps to allay fears which can help break the pain cycle.

Our nervous system can become upregulated or heightened, which is the body’s innate protection mechanism in response to pain. However, if the nervous system is ‘dialled up’ long term, it can consequently result in the body becoming more sensitive to pain. Factors such as lifestyle, stress, nutrition, previous history and even understanding how pain works can all influence one’s experience. Fear has in fact been shown to amplify the perception of pain, with research indicating that anxiety concerning pain can intensify the overall experience. Sometimes if left unchecked, these protection mechanisms can lead to long term pain cycles which is why it can be extremely helpful to receive professional guidance.

Accessibility

The 2018 National Action Plan for Endometriosis (NAPE) has called for improved accessibility for people in rural and regional areas, along with a stronger appreciation and understanding of endometriosis as a complex chronic condition and the psychological and social implications on sufferers. It recognises the important of improving awareness, education, diagnosis, treatment and research in Australia and in addition, calls for health practitioners’ treatment approach to:

Provide a working diagnosis and explanation of your symptoms
Prioritise access, education and empowerment of patients
Ensure care is holistic, individualised and person-centered
Improve quality of life for those living with endometriosis or pelvic pain
Utilise evidence-based treatments and a collaborative approach within a multidisciplinary team

Whilst this plan is evidence of growing advocacy for supporting women’s health concerns in regional and rural areas, plans are only as good as the implementation to real life cases. Whilst evidence continues to demonstrate the importance of multidisciplinary care in managing persistent pain, the evidence must be translated into practice in order to be implemented effectively.

‍Best practice in the treatment of complex pelvic pain requires a shift from viewing pain as pathology alone to understanding it as a meaningful, multidimensional experience. Symptoms are not simply problems to be eliminated, but signals that invite deeper awareness, safety, and therapeutic engagement. This approach calls for clinicians to adopt a patient-centred, agency-focused lens—one that honours the complexity of each individual’s experience and the layered nature of persistent pelvic pain.‍ ‍

Effective care is grounded in presence, partnership, and attentive witnessing, moving beyond hierarchical models toward collaborative relationships that empower patients. By gently challenging disempowering narratives relating to geographical isolation, along with fostering a more respectful and holistic framework of care, practitioners can support the restoration of agency and dignity for women.

‍Endometriosis is a prevalent and often debilitating condition that can be particularly challenging to manage in rural and remote settings, where access to specialised care may be limited. Enhancing health literacy and improving community awareness of endometriosis and persistent pelvic pain are critical steps in reducing diagnostic delays, social isolation, feelings of disempowerment and barriers to care. Empowering individuals through education, evidence-based resources and self-management strategies is central to optimising long-term outcomes. By supporting patients to better understand their condition and ways that people living in rural areas may engage proactively with healthcare resources, they are more able to participate in self-management strategies and maintain quality of life.

A patient-centred approach that prioritises education, accessibility and self-efficacy can foster resilience, improve functional outcomes and support rural individuals living with endometriosis to manage their condition more effectively. Ultimately, best practice lies in integrating clinical expertise with compassion, curiosity and respect for the whole person, therefore creating a therapeutic environment where healing is not only pursued, but meaningfully supported, regardless of location.

Key takeaways

‍ ‍- If you believe you have symptoms of endometriosis, or are experiencing pelvic pain, keep a symptom diary for a month to record pain levels, food triggers and emotional stress levels. You can find a template here and take the completed diary to your GP or specialist appointment to save time. The Quendo APP also includes a symptom diary for daily tracking. It can be helpful to recognise what activities make pain worse and also things that improve pain and overall wellbeing.
‍ ‍- Get started; check out the below resources and do your best to become informed on what you can do to take charge. It is amazing how becoming informed of what is going on in your body can in fact change your everyday experience; education has been shown to lead to empowerment through self-management and therefore, improved health outcomes.
‍ ‍- Support networks and connection are underestimated and often underutilised when it comes to women’s health concerns; so talk to you girl gang, grab your buddies and don’t be afraid to spread the word!
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Did you know that we offer online Telehealth Consultations for women experiencing pelvic pain? From the comfort of your own home, you can connect with our pelvic health physiotherapist to discuss your specific concerns. We work with you to create effective and long-lasting solutions for pelvic floor concerns and pelvic pain conditions for those living in regional Queensland.

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