March is Endometriosis Awareness Month, highlighting a condition that can have a significant impact on daily life, wellbeing and fertility. Here’s what to know about the signs of endometriosis, and when to start a conversation with your doctor.

Endometriosis is a common, often misunderstood condition that can have a real impact on daily life. It’s also frequently under-recognised, partly because many people are taught to “push through” painful periods, and partly because symptoms can look like other conditions1.

In simple terms, endometriosis happens when tissue similar to the lining of the uterus (endometrium) grows outside the uterus. This tissue can respond to hormones across the menstrual cycle, which may lead to inflammation, pain and scarring. Endometriosis can affect anyone who menstruates, and symptoms can start in the teens or later. Some people have severe symptoms; others have mild symptoms – and some have endometriosis with no obvious symptoms at all.

In Aotearoa New Zealand, endometriosis is estimated to affect around 120,000 people across all communities and backgrounds2. It can also be harder to recognise and diagnose when access to consistent healthcare is limited, or when pain is normalised in families and social circles. If you’ve been living with symptoms for a long time, it’s worth knowing: it’s not “all in your head”, and you’re not overreacting by seeking support.

Signs and symptoms to look out for

Endometriosis doesn’t look the same for everyone. Symptoms can fluctuate over time and may worsen gradually.

Common signs include:

• Pelvic pain, especially during periods (and sometimes outside of periods). This may be a deep ache, sharp pain, or cramping that feels different from typical period discomfort.
• Pain during or after sex, particularly deep pelvic pain.
• Bowel or bladder symptoms, such as pain when opening your bowels, pain when urinating, or symptoms that flare around your period.
• Heavy or irregular bleeding, including very heavy periods or bleeding between periods.
• Back pain or pain radiating into the legs, especially cyclic pain linked to your period.
• Difficulty getting pregnant, which can be one way endometriosis comes to attention.

A useful rule of thumb: if your period pain or pelvic symptoms regularly disrupt school, work, sleep, exercise, or social life – or if you need to plan your life around your cycle – it’s worth discussing with a clinician.

When to talk to your doctor

Consider making an appointment if:

• Pain is affecting your quality of life,
• Symptoms are recurring and cyclical (often worse around your period),
• You’re missing work/school, avoiding activities, or relying heavily on pain relief,
• You have pain during sex or with bowel/bladder function,
• You’re trying to conceive and haven’t had success,
• Or you’re simply worried and want clarity3.

If making the appointment feels daunting, remember: you’re not asking for a diagnosis on the spot. You’re starting a conversation and building a plan.

If you don’t have a GP, or you’d rather not talk to your own GP just yet, consider booking a free-of-charge online GP appointment with CareHQ* through the MySouthernCross app. You can still return to your normal GP for ongoing care.

Southern Cross Health Insurance products don’t cover any costs related to infertility or assisted reproduction. Other selected healthcare services unrelated to infertility or assisted reproduction may be covered. We encourage you to check with us to confirm what is included in your cover.

How endometriosis is assessed and diagnosed

A diagnosis often begins with a thorough history (your symptom story) and a pelvic exam if appropriate. Your doctor may also discuss other possible explanations for your symptoms.

Some people will have an ultrasound, which can sometimes detect ovarian endometriomas (cysts linked with endometriosis) or other signs – but it may not detect all endometriosis. That’s important to know, because a “normal” scan doesn’t necessarily rule it out.

In some cases, diagnosis may involve referral to a gynaecologist. For most, a careful clinical assessment and a trial of treatment is a reasonable first step, depending on symptoms and life stage4. Occasionally for some people, a laparoscopy (keyhole surgery) is needed if treatment fails or no other diagnosis is possible.

Treatment options: what support can look like

There’s no single “best” treatment for everyone. A good plan usually considers your symptoms, your preferences, your response to previous treatments, and whether fertility is a current goal.

Common approaches include:

• Pain management: Anti-inflammatory medicines may help some people, especially if started early in the pain cycle. Heat packs, gentle movement, and specific pain strategies can also be useful.
• Hormonal treatments: Options like the combined oral contraceptive pill or other hormonal therapies may reduce symptoms by limiting cycle-related inflammation and bleeding.
• Pelvic physiotherapy: Pelvic floor tension can develop alongside chronic pelvic pain. Working with a pelvic health physiotherapist can help reduce pain and improve function.
• Lifestyle support: Sleep, stress support, gentle exercise, and nutrition strategies tailored to the individual can support symptom management.
• Surgery: For some people – especially those with severe symptoms or specific complications – surgery may be recommended as a final step. Outcomes vary, and decisions are best made with a specialist you trust5.

It’s also worth acknowledging the emotional load. Living with persistent pain, uncertainty, or fertility stress can be draining. Support can include counselling, peer support, or simply naming what’s going on with trusted people.

How to prepare for your appointment

A little preparation can make the appointment more productive6:

• Track your symptoms for 1–2 cycles if you can: pain severity, timing, bleeding, bowel/bladder symptoms, fatigue, and anything that triggers or relieves symptoms.
• Note what you’ve tried (pain relief, contraception, lifestyle changes) and whether it helped.
• Bring a clear “impact statement”: e.g., “I’m missing work two days a month,” or “I avoid sex because of pain,” or “I’m struggling to function during my period.”
• Ask direct questions, such as:
  • “What could be causing these symptoms?”
  • “Could this be endometriosis?”
  • “What tests make sense next?”
  • “What are my treatment options, and what are the pros/cons?”
  • “When should I consider a referral to a gynaecologist?”

A final note

Endometriosis can be complex and it’s valid to ask for further investigation. The first step is often just being heard and building a plan that helps you feel more in control of your health.

1. ‘Below the Belt’ Exposes the Silent Crisis of Endometriosis Care – Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School, 21 June 2023. Retrieved from https://petrieflom.law.harvard.edu/2023/06/21/below-the-belt-exposes-the-silent-crisis-of-endometriosis-care/
2. (n.d.) Endo information – Endometriosis New Zealand. Retrieved from https://nzendo.org.nz/endo-information/
3. (n.d.) Dysmenorrhoea – Healthify He Puna Waiora. Retrieved from https://healthify.nz/health-a-z/d/dysmenorrhoea
4. (n.d.) How is endometriosis diagnosed? – Endometriosis New Zealand. Retrieved from https://nzendo.org.nz/endo-information/
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5. (n.d.) Managing endo – – Endometriosis New Zealand. Retrieved from https://nzendo.org.nz/managing-endo/
6. (n.d.) Seeing your doctor about persistent pelvic pain – Jean Hailes for Women’s Health. Retrieved from https://www.jeanhailes.org.au/resources/seeing-your-doctor-about-persistent-pelvic-pain