A £2.4 million trial has begun across the UK to establish whether a specialist pain management programme, delivered remotely, can improve quality of life for premenopausal women with persistent endometriosis pain. The five-year study is funded by the National Institute for Health and Care Research (NIHR) through its Health Technology Assessment Programme. It responds to the frequent return of symptoms after surgery or hormonal therapy.

Endometriosis affects about one in ten women. The condition causes chronic pelvic pain and severe fatigue, and it disrupts work, relationships and fertility. Standard clinical options often fail to deliver lasting relief. Pain returns in up to half of patients within five years of surgery, which leaves many women facing repeated operations or long courses of medication with limited effect.

The trial is led by researchers at the University of Aberdeen. Dr Lucky Saraswat, a consultant gynaecologist and honorary senior lecturer, is the lead researcher. Participants will be premenopausal women whose pelvic pain remains poorly controlled despite standard care. Recruitment will take place through specialist clinical services.

The intervention is known as the e-PMP, an endometriosis-specific pain management programme that runs for 12 weeks and is delivered online. Its content draws on psychotherapy informed by cognitive behavioural therapy and on specialist physiotherapy. Participants also receive guidance on relationships, intimacy and communication, along with training in self-compassion. A further element covers the optimisation of medication and the management of side effects, which can themselves reduce quality of life.

Delivering the programme remotely removes the need to travel to specialist centres. Access to endometriosis services varies considerably between regions, and women with severe pain or fatigue can find regular attendance difficult. An online format may also allow the programme to reach people who would otherwise wait months for a specialist appointment.

The study will compare two groups, with one receiving the e-PMP alongside standard care and the other receiving standard care alone. Researchers will assess clinical effectiveness, measuring whether the programme changes pain and quality of life, and will also examine cost-effectiveness. That economic analysis is intended to inform future commissioning decisions by the National Health Service (NHS) and to shape clinical guidelines. A programme that works but costs too much to deliver at scale would be unlikely to reach routine practice, so the cost data carries weight alongside the clinical results.

The potential clinical value lies in offering an approach that involves neither surgery nor hormones. Women who wish to avoid further operations may find that appealing. So may those who are planning a pregnancy, since many hormonal treatments suppress ovulation and are unsuitable for anyone trying to conceive. Repeat surgery carries its own risks, including damage to surrounding tissue and a gradual build-up of scarring, which gives additional reason to look for alternatives.

Endometriosis UK, the national charity, has welcomed the trial. It has stressed the need for greater investment in the condition and for evidence-based options to manage chronic pain. Many women report waiting years for a diagnosis, and the charity has argued that treatment options after diagnosis remain too narrow for those whose symptoms do not respond to first-line care.

The NIHR Health Technology Assessment Programme funds research that examines whether treatments and services are effective and affordable for the NHS. Its backing signals that the question of non-invasive pain management for endometriosis has been judged important enough to warrant a large national study. Results are not expected for several years, and the programme will not be offered through the NHS until the findings have been reviewed.

If the e-PMP proves effective and affordable, it could give clinicians a structured option to offer women whose pain persists after surgery or medication. If it does not, the trial will still provide firm evidence on the limits of this form of support, which would help direct future research and spending.

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