InsideHer Learning | Endometriosis Course

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Course Overview

From symptom pattern to confident next step.

This course covers diagnosis, red flags, management pathways, GI symptom overlap, low FODMAP evidence, and dietetic assessment considerations.

Practical guidance

An easy-to-navigate learning experience built from the attached source pack.

Evidence led

Clinically grounded and conservative with claims, using symptom patterns to guide referral, not self-diagnosis.

GI and nutrition focused

Support quality of life as well as symptom reduction, keeping dietary restriction proportionate to the evidence.

Referral aware

Self-paced HTML course across 6 learning modules, built from the attached PDF and DOCX source pack. Primary lens: clinical recognition, GI symptoms, and dietetic practice.

01

Module 1

Foundations

What endometriosis is, where it can occur, and why disease stage does not map neatly to symptom burden.

By the end of this module

Recognise the broad clinical footprint of endometriosis, including extra-pelvic and GI-adjacent presentations.

Remember this

Classification systems describe disease; they do not reliably predict pain, fatigue, or quality-of-life impact.

InsideHer stance

Keep language clinically grounded, avoid minimising symptoms, and avoid overexplaining the condition through a single mechanism.

Clinical frame

Think in patterns: cycle-linked pain, bowel symptoms, fatigue, fertility concerns, and function loss often travel together.

Definition and distribution

Endometriosis is a common inflammatory gynaecological condition in which tissue similar to endometrium grows outside the uterus. It commonly affects the peritoneum, ovaries, and fallopian tubes, but it can also affect the bladder, bowel, lungs, and more distant sites. A practical takeaway for clinicians is that pelvic symptoms are common, but pelvic location alone should not narrow thinking too early when cyclical extra-pelvic symptoms are present.

Prevalence and burden

The attached course material notes that prevalence estimates vary internationally, while Australian estimates suggest endometriosis may affect around 1 in 7 females up to ages 44 to 49 when clinically suspected and surgically confirmed cases are combined. The burden extends well beyond pain. Work, study, social life, relationships, fertility, mental health, and finances are all commonly affected.

Clinical Insight

Severity score is not a pain score

The source material is explicit that commonly used classification systems correlate poorly with symptoms, quality of life, and outcomes. More disease on paper does not reliably mean more pain in the room.

Classification systems

Common systems include rASRM, Endofound, ENZIAN, and the Endometriosis Fertility Index.

Most used in Australia

The course source identifies rASRM as the most commonly used staging system in Australia.

Disease trajectory

Untreated disease is not inevitably progressive. Some cases progress, some remain stable, and some regress.

Central sensitisation

Pain can become amplified over time, which helps explain persistent symptoms despite treatment.

Risk markers worth noticing

First-degree relative with endometriosis. Heavy periods, early menarche, or short cycles. Fertility concerns or nulliparity in the wider clinical picture. Low BMI or a history suggesting gynaecological structural differences.

What this condition is not

Not just “bad period pain.” Not always confined to the pelvis. Not reliably captured by one scan, one test, or one symptom score. Not best managed by a single-discipline response when symptoms are complex.

02

Module 2

Recognition and Diagnosis

How to recognise red flags, understand diagnostic delay, and interpret investigations without overcalling normal results.

Key Point

A normal exam or ultrasound does not rule out endometriosis

The source material emphasises that clinical examination has low diagnostic accuracy, and even high-quality ultrasound may miss superficial peritoneal disease.

Referral clues

Severe period pain affecting daily activities. Deep pelvic pain during sexual intercourse. Painful bowel motions, especially during menstruation. Heavy bleeding, infertility concerns, and cyclical bladder or bowel symptoms. Family history in a first-degree relative.

Diagnostic delay

The attached material highlights long diagnostic delays, with Australian averages around 8 years. Barriers include symptom normalisation, lack of awareness, limited access to specialist imaging or surgery, stigma, cost, and misdiagnosis as IBS or other chronic pain conditions.

First-line imaging

Transvaginal ultrasound is the preferred first-line investigation when appropriate and available.

MRI

MRI may help when ultrasound is inconclusive or deep disease is suspected, but it cannot exclude endometriosis.

Biomarkers

No biomarker, including CA-125, is accurate enough to diagnose endometriosis on its own.

Laparoscopy

Still relevant, especially when suspicion remains high despite negative imaging, but not required for every initial clinical diagnosis.

03

Module 2 · Diagnostic approach

A four-step way to interpret investigations.

Start with the pattern, investigate appropriately, avoid over-reassuring too early, and treat while pursuing clarity.

01

Listen for the pattern

Start with symptoms, timing, impact on function, and whether the pattern is cyclical, progressive, or infertility-linked.

02

Investigate appropriately

Use examination and ultrasound thoughtfully, recognising both their value and their limitations.

03

Do not over-reassure too early

If imaging is negative but clinical suspicion remains high, further specialist review is still appropriate.

04

Treat while pursuing clarity

Guideline-based treatment can begin in suspected cases, especially when symptoms are significant and pregnancy is not being pursued.

04

Module 2 · Deeper context

Why delay persists, and the clues not to miss.

Diagnostic delay and extra-pelvic presentations both push clinicians toward — or away from — the right referral.

Why diagnostic delay persists

Lack of reliable non-invasive tests and symptom-based screening tools. Symptoms dismissed as “normal period pain.” Overlap with IBS, fibromyalgia, chronic fatigue, and other pain presentations. Limited time in general practice to unpack complex chronic symptoms. Poor access to specialist ultrasound, gynaecology, and surgery. Financial barriers and long public wait times.

Extra-pelvic clues clinicians should not miss

Shoulder tip pain or cyclical chest symptoms. Catamenial pneumothorax or cyclical cough and haemoptysis. Cyclical urinary symptoms such as dysuria or haematuria. Cyclical scar pain or swelling after prior abdominal surgery.

When a “GI referral” is actually an endometriosis referral in disguise

If a patient presents for bloating or bowel symptoms but also reports worsening period pain, pain opening bowels during menstruation, or difficulty conceiving, treat that as a referral trigger back to a GP or gynaecologist rather than a signal to stay only inside nutrition management.

05

Module 3

Management Pathways

Medical, surgical, physiotherapy, psychological, and self-management options, with emphasis on multidisciplinary care.

01

Analgesia

Paracetamol and NSAIDs may be trialled, but evidence is limited. Opioids are not a good long-term strategy because of dependence risk, constipation, hyperalgesia, and limited benefit in chronic pelvic pain.

02

Hormonal treatments

First-line hormonal options include combined hormonal contraceptives and progestogens. They suppress ovulation and menstruation and are not appropriate for people actively trying to conceive.

03

Surgery

Laparoscopic surgery can diagnose disease, remove lesions, and address anatomical distortion. It can improve quality of life, but it is not curative and recurrence is common.

04

Pelvic physio and psychology

Pelvic floor dysfunction, pacing, CBT, ACT, and mindfulness may all have a role, particularly when pain is persistent or function is significantly affected.

06

Module 3 · Practice lens

Care is multidisciplinary, and pain is not the whole story.

Fragmentation of care drives dissatisfaction. Do not reduce the problem to pain alone.

Why multidisciplinary care matters

The source pack repeatedly points to fragmentation of care as a problem. Patients often want support from doctors, physiotherapists, psychologists, dietitians, and other practitioners, but access is inconsistent and expensive.

Treatment dissatisfaction is common

Dissatisfaction is driven by delayed diagnosis, persistent pain, side effects, cost, poor access, symptom recurrence, and a narrow treatment focus that may overlook fatigue, psychological distress, or GI symptoms.

Medical support

Use short trials and regular review. Limited efficacy data should not be mistaken for long-term benefit.

Fertility considerations

Hormonal suppression is often useful, but it is not appropriate when the patient is actively trying to conceive.

Function matters

Track work, exercise, sleep, mood, intimacy, and daily participation, not just pain intensity.

Recurrence matters too

Even after surgery, recurrence and repeat procedures are common, so longitudinal care planning matters.

Practice Lens

Do not reduce the problem to pain alone

Patients may be equally burdened by fatigue, bloating, bowel symptoms, fertility concerns, identity disruption, and the feeling of not being believed.

07

Module 4

Nutrition and EndoFOD

How to talk about dietary approaches carefully, and where the low FODMAP evidence is strongest.

Nutritional challenges

Pain, fatigue, and low energy can reduce motivation to prepare balanced meals. GI symptoms can drive restrictive eating, food fear, or inconsistent intake. Body image changes, stress, and anxiety can alter eating behaviour. NSAIDs and opioids may worsen GI tolerance and appetite.

What patients commonly try

The source material describes widespread use of anti-inflammatory eating patterns, gluten restriction, dairy restriction, reduced red meat intake, low nickel diets, and low FODMAP strategies. Most approaches are popular before they are well proven. That means the dietitian's role is partly therapeutic and partly protective: helping patients avoid unnecessary restriction while still taking symptoms seriously.

InsideHer Guidance

Restriction should earn its place

The course source is clear that many diets lack strong efficacy evidence and can increase nutritional risk, food anxiety, cost, and social burden. The objective is symptom relief with the least unnecessary restriction.

EndoFOD Snapshot

Low FODMAP has the strongest GI-specific evidence in this pack. FODMAP restriction is intended to reduce luminal distension, gas, and water shifts. It targets GI symptoms, not endometriosis lesions themselves. The source pack cites observational, cohort, and randomised evidence. The attached RCT summary reports meaningful GI improvement in a substantial subset of participants.

What the source pack reports

In the randomised crossover study referenced in the course material, 60% of participants responded to the low FODMAP diet, with improvements in GI symptoms, abdominal pain, bloating, stool form, and quality of life over 28 days.

Where to stay careful

The evidence is stronger for GI symptom management than for endometriosis-specific pain. It is not yet proof that low FODMAP changes dysmenorrhoea, dyspareunia, or disease progression.

How to position low FODMAP correctly

Use it for selected patients with poorly controlled GI symptoms. Explain that it is a symptom-management tool, not a disease cure. Teach reintroduction early so patients know restriction is temporary. Review whether constipation, bloating, stool form, and quality of life are improving.

How to avoid overpromising with food

Do not imply a perfect diet can “fix” endometriosis. Separate prevention hypotheses from treatment evidence. Watch for disordered eating risk, financial strain, and food fear. Prefer the least restrictive plan that improves symptoms meaningfully.

08

Module 4 · Applying the evidence

Using diet and supplements well.

Low FODMAP, other dietary approaches, and supplement messaging from the source pack.

Using a low FODMAP diet well

Use it as a short-term tool, not a lifelong elimination diet. Follow elimination with structured reintroduction to identify personal triggers. Individualise intensity according to symptom pattern and cycle timing. Return to a stricter pattern temporarily during flares if needed, then liberalise again.

Other dietary approaches from the source pack

Gluten-free diets are popular, but confounding with FODMAP reduction is a major issue. Dairy restriction is not supported as a routine strategy for endometriosis. Anti-inflammatory and Mediterranean-style patterns may be sensible from a general health perspective, but direct treatment evidence remains limited. Vitamin C and E had some evidence for pain reduction in the cited meta-analysis, while omega-3 and vitamin D evidence was mixed or insufficient.

Supplement messaging from the source pack

Vitamin C plus vitamin E may justify a limited monitored trial in selected pain presentations. Routine vitamin D or omega-3 supplementation is not strongly supported for endometriosis symptom control. Any supplement plan should be time-limited, reviewed, and stopped if there is no meaningful benefit.

09

Module 5

GI Symptoms and Overlap

Understanding why bowel symptoms are common in endometriosis and why IBS overlap matters.

GI symptoms are common

The source pack reports GI symptoms may affect 75% to 98% of people with endometriosis.

They often worsen during menstruation

Cycle timing matters. Symptoms can intensify around menses and overlap closely with IBS patterns.

Bowel lesions are not required

GI symptoms frequently occur without direct bowel infiltration of disease.

Several mechanisms may be involved

Inflammation, visceral hypersensitivity, microbiota shifts, opioid use, and gut-brain interactions may all contribute.

Overlap Matters

IBS-like symptoms should not end the diagnostic conversation

The source pack describes substantial overlap between endometriosis and IBS, including a pooled IBS prevalence of 23.4% among individuals with endometriosis and high rates of endometriosis later confirmed in women previously labelled with IBS.

Gut-brain axis relevance

The attached material explicitly links psychological distress and GI symptom burden. This matters clinically because stress management, pain coping, and GI symptom work often need to sit alongside dietary strategies.

Why IBS overlap matters

Shared symptom patterns can delay diagnosis, complicate treatment decisions, and tempt over-restriction. Thoughtful history taking helps separate cyclical symptom flares, functional gut features, and medical red flags requiring referral.

Cycle-aware interpretation

Ask whether loose stools, urgency, bloating, or pain worsen premenstrually or during menstruation. Remember that prostaglandins may contribute to looser stools during menses. Use menstrual timing to enrich the history rather than to dismiss symptoms as “normal.”

Three screening prompts for IBS-like presentations

Do bowel symptoms worsen around periods? Is there deep dyspareunia, heavy bleeding, or infertility in the same history? Has pain been normalised or previously labelled without endometriosis assessment?

10

Module 6

Dietetic Assessment and Next Steps

What to gather in an initial consult, when to refer onward, and how to keep management proportionate.

Confirm diagnosis status

Document whether diagnosis is based on symptoms, imaging, laparoscopy, or remains suspected but unconfirmed.

Characterise GI symptoms

Note type, severity, duration, pattern, relation to meals, and relation to the menstrual cycle.

Review medical history

Ask about surgeries, hormone treatments, analgesics, neuromodulators, supplements, and comorbidities.

Assess nutrition risk

Screen for restrictive eating, weight change, food fear, low energy intake, low iron, and unintended nutritional compromise.

Map family history

Include endometriosis, IBS, inflammatory bowel disease, coeliac disease, reflux, and colon cancer where relevant.

Know the red flags

Unexplained weight loss, possible coeliac disease, inflammatory features, or other alarm symptoms should prompt medical review before dietary restriction.

11

Module 6 · Assessment flow

Four assessment steps, then a clear next decision.

Pause restrictive diet changes if red flags have not been medically addressed.

01

Assessment step 1

Clarify diagnosis, disease location if known, prior surgery, and current medical management.

02

Assessment step 2

Characterise GI symptoms carefully using stool pattern, timing, severity, duration, and quality-of-life impact.

03

Assessment step 3

Assess menstrual cycle characteristics, iron risk, family history, medications, supplements, and current restrictions.

04

Assessment step 4

Decide whether the next best step is diet therapy, further medical investigation, or both in parallel.

12

Module 6 · Before you restrict

Referral rule, baseline markers, and a practice checklist.

The source material recommends referral back to a GP or gastroenterologist before commencing dietary changes when important alarm features are present.

What to check before restricting diet

Has coeliac disease been screened appropriately with adequate gluten intake beforehand? Is there unexplained weight loss, suspected inflammation, or concern for another GI disorder? Could the patient tolerate a restrictive intervention nutritionally, psychologically, and practically? Are medications or supplements driving symptoms or nutrition risk?

Useful baseline markers

Iron studies and complete blood count, especially when bleeding burden is high. Vitamin D and B12 where clinically relevant. Weight, recent change, appetite pattern, and fatigue severity. Food-related quality of life, meal skipping, and social eating avoidance.

InsideHer practice checklist

Confirm what has already been investigated and what has not. Assess whether symptoms are cyclical, meal-related, or both. Screen for pain burden, fatigue, mood, and quality-of-life disruption. Choose the least restrictive intervention likely to help. Review response, liberalise where possible, and escalate referral when required. Document clearly enough that the next clinician can see the pattern quickly.

13

Check

Knowledge Checks

Use these quick checks to reinforce the core clinical decisions from the source material.

Which investigation is preferred first line when appropriate?

Transvaginal ultrasound, performed by an experienced sonographer where possible.

Does a normal ultrasound exclude all endometriosis?

No. Superficial disease can be missed, and persistent symptoms still matter.

What has the strongest GI-focused dietary evidence in this source pack?

A low FODMAP diet for selected patients with poorly controlled GI symptoms.

Should dietetic management start with maximal restriction?

No. Restriction should be proportionate, evidence-aware, and followed by liberalisation where possible.

When should IBS-like symptoms trigger endometriosis thinking?

When bowel symptoms are cyclical, linked to periods, combined with dyspareunia, heavy bleeding, or infertility, or have delayed appropriate diagnosis.

What should you do when alarm features are present?

Refer for medical review and investigation before pushing ahead with restrictive dietary changes.

Endometriosis Foundations and GI Care