The New RANZCOG Endometriosis Guideline: What Patients Need to Know

RANZCOG has released its updated Endometriosis Clinical Practice Guideline, providing clearer, evidence-based recommendations for the diagnosis and management of endometriosis in Australia and New Zealand. This guideline reflects the latest research and aims to improve access to timely diagnosis, reduce delays in treatment, and ensure women receive consistent, high-quality care.

Here’s what the update means for patients and clinicians across Aotearoa New Zealand.

A Stronger Focus on Early Recognition and Reducing Diagnostic Delay

The updated guideline emphasises that severe period pain is not normal, and early recognition is essential. Key recommendations include:

• Clinicians should consider endometriosis in anyone with chronic pelvic pain, dysmenorrhoea, dyspareunia, abnormal bleeding, or infertility.

• Diagnosis should not be delayed by waiting for symptoms to “settle” or trialling multiple treatments first.

• A clinical diagnosis can be made based on symptoms and examination; laparoscopy is no longer required for diagnosis in all cases.

This shift aims to reduce the long-standing delays many patients experience - often 6–10 years.

Updated Guidance on Imaging and Diagnosis

Ultrasound first

Pelvic ultrasound (preferably performed by an experienced provider) is recommended as the first-line imaging test, especially when deep infiltrating endometriosis or ovarian cysts are suspected.

Deep infiltrating endometriosis can be diagnosed on imaging

Experienced sonographers or MRI can identify bowel, bladder, rectovaginal, and uterosacral disease.

Laparoscopy remains important

Surgery is still the gold standard when:

• Diagnosis is uncertain

• Symptoms are severe

• Imaging is inconclusive

• Fertility planning requires it

• Surgical management is expected to improve quality of life

Treatment Recommendations: A More Individualised Approach

Medical management as first-line for pain

The guideline supports:

• NSAIDs

• Combined oral contraceptive pill

• Progestin-based therapies (including Mirena IUS)

• GnRH antagonists/agonists in selected cases

Medication aims to reduce inflammation, suppress ovulation, and improve quality of life.

Surgical excision for selected patients

Surgery is recommended when:

• Pain persists despite medical therapy

• Deep endometriosis affects organs such as bowel, bladder, or ureters

• Fertility is a priority

• Severe symptoms significantly impact day-to-day life

The guideline strongly supports referral to specialised laparoscopic surgeons for complex disease.

Endometriosis and Fertility: Updated Recommendations

The guideline reinforces:

• Endometriosis can affect fertility, but many women conceive naturally.

• Surgical excision of endometriosis can improve fertility in some cases.

• Ovulation induction, IUI, or IVF may be appropriate depending on age, ovarian reserve, disease severity, and partner factors.

Importantly, the guideline encourages shared decision-making, ensuring women understand all options, benefits, and limitations.

Holistic, Multidisciplinary Care

The new guideline recognises that endometriosis is not only a gynaecological condition - it affects mental health, work, relationships, sexual function, and overall wellbeing.

Recommended support includes:

• Pelvic physiotherapy

• Clinical psychology

• Dietetic support

• Pain specialists

• Sexual therapy

• Exercise and lifestyle strategies

This reinforces the need for personalised, whole-person care rather than a one-size-fits-all model.

What This Means for Patients in New Zealand

The updated guideline aims to:

• Reduce diagnostic delays

• Improve access to expert care

• Support evidence-based medical and surgical treatments

• Encourage multidisciplinary support

• Promote shared decision-making

• Improve long-term outcomes and quality of life

For many patients, it validates what they have long known: their pain is real, and they deserve timely, expert care.

Endometriosis Care in My Practice

I offer comprehensive endometriosis assessment and management, including:

• Specialist pelvic ultrasound interpretation

• Medical treatment options

• Laparoscopic excision surgery for endometriosis

• Fertility assessment and planning

• Multidisciplinary referrals

• Telehealth consultations for patients across NZ

If you have symptoms suggestive of endometriosis or would like to discuss your treatment options, you are welcome to book an appointment.