Joint Statement | Best Practice Approaches to the Management of Endometriosis & Pelvic Pain  

Joint Statement | Best Practice Approaches to the Management of Endometriosis & Pelvic Pain  

[Wednesday 12 November 2025]  

In light of the publication of the report of the Victoria’s Government’s Inquiry Into Women’s Pain Bridging the Gender Pain Gap, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG, the College), the Australasian Gynaecological Endoscopy and Surgery Society (AGES), The Faculty of Pain Medicine ANZCA (FPM), the Australian Pain Society (APS) and the New Zealand Pain Society (NZPS) have issued a joint-statement on best-practice approaches to the management of endometriosis and pelvic pain. 

The Inquiry gathered insights from over 13,000 women, girls, carers, healthcare professionals, peak bodies, and researchers to unveil the experiences of girls and women with pain conditions and in accessing pain relief. Recommendations set a clear roadmap for reform and will guide system-wide improvements to bridge the gender pain gap and ensure women's pain is recognised, understood and addressed. This group recognises that women with pain are their own experts in pelvic pain and will endeavour to partner with them to improve their lives. We recognise that they have felt dismissed and we will do better in hearing their needs.

RANZCOG, AGES, FPM, the APS & the NZPS welcome the recommendations laid out in the report and are committed to supporting multidisciplinary clinicians to provide the highest quality care for people affected by persistent pelvic pain. We acknowledge the five key lessons from the inquiry, including recommendations to make women’s healthcare easier to access, grow and train the workforce, strengthen research, and ensure care is free from bias and discrimination, and delivered in a trauma-informed, culturally and linguistically appropriate way.

Our approaches to clinical care should always be guided by the best available clinical evidence and recommendations, which is underpinned by recommendation 1.3 of the report identifying a need to, “improve clinical standards and support best practice.”  

RANZCOG developed and published the Australian Living Evidence Guideline: Endometriosis in May 2025; a national guideline compiling the best available scientific evidence to assist the detection, diagnosis and management of endometriosis, and a related condition, adenomyosis. The living evidence guideline incorporates new research, a broader scope, and wide-ranging multidisciplinary expert input including that of people with lived experience, gynaecologists, primary care providers, physiotherapists and pain specialists. Work is currently underway to adapt this guideline for the Aotearoa New Zealand context.  

“It’s important that we have nationally recognised standards of care and that we as clinicians make sure that across-the-board women receive the same standard of care, wherever they are. The College’s recently released guideline is a great place to start – this is evidence-based, and a ‘living guideline’, meaning it will be updated regularly with the latest research as it emerges,” said Dr Nisha Khot, RANZCOG President. 

A significant change as part of the guideline was the emphasis on non-invasive diagnosis with emerging evidence suggesting that a greater number of cases can be diagnosed with increasing accuracy using techniques such as transvaginal ultrasound and magnetic resonance imaging (MRI). Closely linked, this is backed up by the findings of the Inquiry which suggests that we, “improve non-surgical referral pathways … including access to non-surgical management and treatment options as part of a comprehensive care pathway.”  

While laparoscopy can be an important diagnostic tool or treatment for some people with endometriosis and pelvic pain, the new RANZCOG guideline is clear that it should not be the first-line or only treatment option. Surgery should be performed only when clinically indicated, after careful discussion of benefits and risks by appropriately credentialed surgeons. There is evidence to support laparoscopic surgeries for the management of endometriosis and pelvic pain. In many cases, repeated procedures should be avoided, as they may not improve women’s pain or long-term outcomes and carry risks.  

“Sometimes we focus heavily on the surgical aspects of treatment, but persistent pelvic pain is often far more complex than what surgery alone can address. In fact, we know that multiple surgeries can sometimes worsen this pain. Any surgical intervention should be judicious, evidence-informed, and integrated into a broader interdisciplinary care plan that supports long-term wellbeing,” said Dr Michael Wynn-Williams, President of AGES.  

Endometriosis and persistent pelvic pain are complex conditions that affect each person differently. Both RANZCOG’s guideline and the Inquiry’s Report demonstrate that we must work collaboratively across multiple disciplines - including gynaecology, pain medicine, physiotherapy, psychology, and allied health - to ensure every person receives coordinated and holistic care tailored to their specific needs.

“Research supports the value of an interdisciplinary approach to care for chronic disabling pain – but the reality is that many women struggle to even access a specialist, let alone allied health providers who provide that holistic care. To meaningfully improve access, we need to continue building workforce capability so that clinicians across disciplines feel confident and well-supported in applying contemporary pain science. Strengthening interdisciplinary practice is not only about improving care pathways – it is about ensuring women can receive truly holistic, coordinated, and person-centred care.” said Bernadette Smith, President of the Australian Pain Society.   

Dr Dilip Kapur, Dean of The Faculty of Pain Medicine (ANZCA) emphasises that persistent pelvic pain should be recognised as a persistent pain condition in its own right. As outlined in the FPM’s statement on the clinical approach to persistent pelvic pain including endometriosis-associated pain, best practice care requires timely access to whole-person, multidisciplinary management —incorporating medical, physiotherapy, psychological and pain science-informed interventions. Prioritising early, equitable access to these evidence-based approaches will improve outcomes and reduce harm. 

This group acknowledges that many women across Australia and Aotearoa New Zealand – particularly those in rural and remote areas – have limited access to holistic care. Recommendation 5.6 of the Report sets out that the Victoria Government must “expand access to allied health particularly physiotherapy, in public hospitals, including as part of Women’s Health Clinics, pain clinics and maternity services.” This is crucial if we are to follow the principles of the APS and NZPS and adopt a biopsychosocial model of care that addresses the physical, emotional, and social aspects of living with chronic pain.  

“Pelvic pain is multifactorial and often persists after surgery, requiring a whole person approach. We must recognise and respond to the needs of women living with pain and adopt a broader view in the approach and treatment of pelvic pain, and women’s pain generally. The Victorian Women’s Pain Inquiry report offers a solid foundation for addressing this challenge at the policy level," said Dr Karen Joseph, President of the NZPS.  

RANZCOG, AGES, FPM, APS and NZPS welcome the release of the report and look forward to collaborating with both the Victorian Government and the other jurisdictions across Australia and Aotearoa New Zealand more broadly to deliver better health outcomes for women and girls living with pelvic pain.